TERMS E/M Neoplasms ICD-9ICD-10

Put codes on claim forms that insurance will pay for-is considered fraudulent

CODING FOR COVERAGE

Using a code that reports a higher level of service than what was actually performed and is fraudulent

UPCODING

Two-character codes that add clarification, additional details to the original code description, and provides necessary information to insurance companies

MODIFIERS

International Classification of Disease developed by the World Health Organization

ICD

A code listed next to a main term in the Alphabetic Index

DEFAULT CODE

Determination that provider acted according to standard practice in providing a particular treatment or procedure

MEDICAL NECESSITY

Codes used to report and reimburse physicians for their expertise and thought processes involved in diagnosing and treating patients

EVALUATION AND MANAGEMENT

Levels of History, Physical Examination and Medical Decision Making

KEY COMPONENTS

One doctor transfers a patient to another for treatment

REFERRAL

A group of services included in the code for the operation and not reported separately

GLOBAL SURIGCAL PACKAGE

Malignant tumor that has spread beyond its borders

METASTASIS

The code for primary, malignant carcinoma of the prostate

185

The primary location of this carcinoma is in the pyloric area

STOMACH

Excised malignancies should be reported with this code

PERSONAL HISTORY OF V CODES

Carcinoma in situ of the cervix should be coded

233.1

Codes for an adverse effect, rash from Amobarbital

782.1, E937.0

Sunburn, first degree

692.71

If doctor does not indicate if a fracture is open or closed it is coded

AS CLOSED

Code for human immunodeficiency virus [HIV] [AIDS] disease

042

Type II, controlled diabetes mellitus with ophthalmic manifestations

250.50

The ICD-10 code for evaluation of a pilonidal cyst

L05.91

Inflammation of the stomach lining or gastritis in ICD-10

K29.70

Hodgkin’s sarcoma disease

C81.31

Non ruptured cerebral aneurysm

I67.1

Patient went into cardiac arrest at home, caused by an accidental overdose of digoxin

T46.0x1A, I46.8