Charge Capture and Coding Flashcards

Which coding system is primarily used for reporting inpatient hospital diagnoses in the United States?

Answer: ICD-10-CM

ICD-10-CM (International Classification of Diseases, 10th Revision, Clinical Modification) is used to code diagnoses for inpatient and outpatient encounters in the US.

A patient is admitted for a hip fracture and also has diabetes mellitus type 2 that is monitored during the stay. How should the diabetes be coded?

Answer: Code it as an additional diagnosis (comorbidity)

Conditions that coexist at admission and affect patient care or length of stay are coded as additional diagnoses per UHDDS guidelines.

What is the purpose of a charge description master (CDM)?

Answer: To serve as the facility's database linking services to charges and billing codes

The CDM (chargemaster) is a comprehensive list of all services, supplies, and procedures with associated charges, revenue codes, and HCPCS/CPT codes.

Which entity publishes and maintains CPT codes?

Answer: American Medical Association (AMA)

The AMA owns and annually updates the Current Procedural Terminology (CPT) code set used for reporting medical procedures and services.

A coder assigns a code for a service that was documented but not ordered by the physician. This is an example of:

Answer: Phantom billing

Phantom billing (billing for services not rendered or not ordered) is a form of healthcare fraud.

What does the modifier -59 indicate when appended to a CPT code?

Answer: The procedure is distinct and separate from other services on the same date

Modifier -59 indicates a distinct procedural service, showing that a procedure or service was independent from other services performed on the same day.

Revenue code 0450 on a UB-04 claim form typically represents which type of service?

Answer: Emergency room services

Revenue code 0450 (and its subcategories 0451-0459) represents emergency room services on the UB-04 institutional claim form.