CCC flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

ICD-10-PCS character count

ICD-10-PCS procedure codes contain exactly seven alphanumeric characters, each representing a defined axis such as section, body system, root operation, body part, approach, device, or qualifier.

Excludes1 note

An Excludes1 note under a code means the excluded condition cannot be coded together with the code it appears under, because the two conditions are mutually exclusive.

Excludes2 note

An Excludes2 note indicates the excluded condition is not part of the condition represented by the code, so both codes may be reported together when documented.

CPT Category II codes

CPT Category II codes are four digits followed by the letter F and are used for performance measurement and tracking, not for reimbursement purposes.

HCPCS Level II

HCPCS Level II codes begin with a letter A through V and describe drugs, supplies, durable medical equipment, and services not represented in CPT.

Seventh character requirement

ICD-10-CM codes for injuries, external causes, and most obstetric conditions require a seventh character specifying encounter type, such as initial, subsequent, or sequela.

Anatomical position

Anatomical position is the reference posture with the body erect, face forward, and palms facing forward; all directional terms such as medial and proximal are based on it.

Sagittal plane

The sagittal plane divides the body into left and right portions; a midsagittal plane divides the body into equal left and right halves.

Proximal versus distal

Proximal means closer to the point of attachment or trunk, while distal means farther from it; both terms describe positions along the limbs.

Suffix -ectomy

The suffix -ectomy means surgical removal or excision of a structure, as in appendectomy, which is removal of the appendix.

Abdominal quadrants

The abdomen is divided into four quadrants: right upper, left upper, right lower, and left lower; the appendix lies in the right lower quadrant.

Arteries versus veins

Arteries carry blood away from the heart, while veins carry blood toward the heart; most arteries carry oxygenated blood and most veins carry deoxygenated blood.

Coronal plane

The coronal, or frontal, plane divides the body into anterior and posterior portions; it runs vertically from side to side.

Principal diagnosis definition

The principal diagnosis is the condition chiefly responsible for the patient's admission after study, established to be the primary reason for inpatient care.

Signs and symptoms coding

Signs and symptoms that are routinely associated with a confirmed diagnosis are not coded separately; when no definitive diagnosis is documented, code the signs and symptoms.

Sequela coding sequence

For a sequela, code the residual condition or nature of the late effect first, followed by the code for the cause of the sequela.

Principal procedure definition

The principal procedure is the procedure most closely related to the principal diagnosis, or the most significant procedure performed for definitive treatment of that diagnosis.

Provider query purpose

A provider query is used when documentation is ambiguous, incomplete, or conflicting, so the coder can assign the most accurate code without assuming clinical facts.

Combination code rule

When a single combination code fully identifies a condition and its manifestations, that code is reported instead of multiple separate codes describing the same condition.

External cause codes

External cause codes from categories V, W, X, and Y identify how and where an injury or poisoning occurred and are never assigned as a principal diagnosis.

MS-DRG payment formula

MS-DRG payment equals the DRG relative weight multiplied by the hospital's adjusted base rate, with adjustments for wage index, teaching, and disproportionate share.

NCCI edits

National Correct Coding Initiative edits define code pairs that cannot be reported together unless a clinically appropriate modifier supports separate and distinct services.

Medical necessity

Medical necessity means services are reasonable and necessary for the diagnosis or treatment of illness or injury and meet accepted standards of care.

Anti-Kickback Statute

The federal Anti-Kickback Statute prohibits knowingly offering or receiving remuneration to induce referrals for items or services payable by federal healthcare programs.

Physician fee schedule formula

Medicare physician payment equals the sum of work, practice expense, and malpractice relative value units, multiplied by the conversion factor and adjusted by geographic indices.

Data quality dimensions

Data quality dimensions include accuracy, completeness, consistency, timeliness, validity, and granularity; each is assessed to ensure the record supports reliable coding and reporting.

Quantitative record analysis

Quantitative analysis verifies that required documentation components, signatures, and dates are present and complete in the health record.

Qualitative record analysis

Qualitative analysis reviews the clinical content of the record for accuracy, consistency, and adequacy to support diagnoses, procedures, and quality of care.

Master patient index

The master patient index is the facility's database of patient identifiers used to link all encounters; duplicate entries threaten data integrity and patient safety.

HIPAA breach notification timing

Affected individuals must be notified of a breach of unsecured PHI within 60 days of discovery; HHS must be notified within 60 days for breaches affecting 500 or more individuals.

Minimum necessary standard

The HIPAA minimum necessary standard requires limiting uses and disclosures of PHI to the least amount needed, except for treatment and certain authorized disclosures.

Stark Law

The Stark Law prohibits physician self-referral of designated health services payable by Medicare or Medicaid unless a specific regulatory exception applies.