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Understanding Health Insurance Key Terms Chapter 6B Questions and Answers
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Understanding Health Insurance Key Terms Chapter 6B Questions and Answers Cooperating Parties for ICD-10-CM/PCS AHA, AMA, CMS, and NCHS organizations and agencies that approve official guidelines for coding and reporting ICD-10-CM and ICD-10-PCS. Essential Modifier Qualifies the main term...

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  • November 24, 2024
  • 5
  • 2024/2025
  • Exam (elaborations)
  • Questions & answers

Subjects

  • understanding health insurance key terms chapter 6
  • cooperating parties for icd 10 cmpcs aha ama cm
  • essential modifier qualifies the main term by list

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Understanding Health Insurance Key
Terms Chapter 6B Questions and
Answers
Cooperating Parties for ICD-10-CM/PCS - answer AHA, AMA, CMS, and NCHS
organizations and agencies that approve official guidelines for coding and reporting
ICD-10-CM and ICD-10-PCS.

Essential Modifier - answer Qualifies the main term by listing alternative sites,
etiology, or clinical status; it is indented two spaces under the main term.

Etiology and Manifestation Codes - answer Include the following notes in the ICD-10-
CM Tabular List of Diseases and Injuries: code first underlying disease; code, if
applicable, any casual condition first; use additional code; and code diseases classified
elsewhere.

General Equivalency Mapping (GEM) - answer Translation dictionaries or crosswalks
of codes that can be used to roughly identify ICD-10-CM/PCS codes for their ICD-9-CM
equivalent codes (and vice versa).

ICD-10-Coding Conventions - answer (See terms below)

And - answer When two disorders are separated by the word "and," it is interpreted
as "and/or" and indicates that either of the two disorders is associated with the code
number.

Code First Underlying Disease - answer Appears when the code referenced is to be
sequenced as a secondary code; the code, title, and instructions are italicized.

Code, If Applicable, Any Casual Condition First - answer Requires casual condition
to be sequenced first if present; a casual condition is a disease that manifests (or
results in) another condition.

Colon - answer used after an incomplete term and is followed by one or more
modifiers (additional terms).

Due To - answer Located in the index in alphabetical order to indicate the presence
of a cause-and-effect (or casual) relationship between two conditions.

Eponym - answer Disease or syndrome named for a person; listed in appropriate
alphabetical sequences as main terms in the index.

, Excludes1 Note - answer A "pure" excludes, which means "not coded here' and
indicates mutually exclusive codes; in other words, two conditions that cannot be coded
together.

Excluses2 Note - answer Means "not included here" and indicated that although the
excluded condition is not classified as part of the condition it is excluded from, a patient
may be diagnosed with all conditions at the same time; therefore, it may be acceptable
to assign both the code and the excluded code(s) together if supported by medical
documentation.

In - answer Located in alphabetical order below the main term; to assign a code from
the list of qualifiers below the word "in," the physician must document both conditions in
the patient's record.

In Diseases Classified Elsewhere - answer Indicates that the manifestation codes
are a component of the etiology/manifestation coding convention.

Includes Note - answer Appear below certain tabular list categories to further define,
clarify, or provide examples.

Manifestation - answer Condition that occurs as a result of another condition;
manifestation codes are always reported as secondary codes.

Not Elsewhere Classifiable (NEC) - answer Means "other" or "other specified" and
identifies codes that are assigned when information needed to assign a more specific
code cannot be located.

Not Otherwise Specified (NOS) - answer Indicates that the code is unspecified;
codes should ask the provider for a more specific diagnosis before assigning the code.

Other and Other Specified Code - answer Assigned when patient record
documentation provides detail for which a specific code does not exist in ICD-10-CM.

Parentheses - answer Enclose supplementary words that may be present or absent
in the diagnostic statement, without affecting assignment of the code number.

See - answer Directs the coder to refer to another term in the index to locate the
code.

See Also - answer Located after a main term or subterm in the index and directs that
coder to another main term (or subterm) that may provide additional useful index
entries.

See Category - answer Instruction directs the coder to the ICD-10-CM tabular list,
where a code can be selected from the options provided there.

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