Free Quiz Answer Key |Rules for Ethical and Legal Coding - Chapter 1

The nervous system includes the brain and spinal cord.

Necrosis: The death of the tissue.

Unbundling is coding the individual parts of a specific diagnosis or procedure rather than a combination or bundle that includes all of those components and is illegal.

Unbundling: Coding the individual parts of a specific diagnosis or procedure rather than one combination or bundle that includes all of those components.

The Physicians' Desk Reference (PDR) will help you find alternative or generic names for drugs or other chemicals used in the patient's treatment that may have been prescribed by the physician, been taken incorrectly or accidentally, caused an allergic reaction, or had a toxic effect.

Physician’s Desk Reference (PDR): A series of reference books identifying all aspects of prescription and over-the-counter medications, as well as herbal remedies.

For every dollar that is spent to pay for health care fraud investigations and prosecutions by the government, $4 is returned.

Dyslipidemia: Abnormal lipoprotein metabolism.

A medical dictionary can help a coder find an alternate term that might be easier to find in the ICD-10-CM manual.

ICD-10-CM: The acronym for International Classification of Diseases, Tenth Revision, Clinical Modification.

Double billing is sending a claim for the second time to the same insurance company for the same procedure or service, provided to the same patient on the same date of service.

Double Billing: Sending a claim for the second time to the same insurance company, for the same procedure or service, provided to the same patient on the same date of service.

You must code all conditions or complications that are relevant to the current encounter. Failure to do so can be considered unethical.

Condition: A health-related situation.

Upcoding is using a code on a claim form that indicates a higher level of service or a more severe aspect of disease or injury than is actual and true.

Upcoding: Using a code on a claim form that indicates a higher level of service, or a more severe aspect of disease or injury, than that which was actual and true.

Coding for coverage is choosing a code on the basis of what the insurance company will cover (pay for) rather than accurately reflecting the truth.

Coding For Coverage: Choosing a code on the basis of what the insurance company will cover (pay for) rather than accurately reflecting the truth.

It is very important that the codes indicated on the health claim form represent the services actually performed and the reasons why they are provided as supported by the documentation in the patient's health record. Don't use a code on a claim form without ensuring the supporting documentation is there in the file.

Site: The location on or in the human body; the anatomical part.

HIPAA created the Health Care Fraud and Abuse Control Program.

Para: An alphanumeric that identifies the number of times a woman has given birth, designated on the chart as P1, P2, etc.; had a fetus reach viability.

In the prone position, a patient is lying on his or her stomach facing downward.

Anatomical Site: A specific location or part of the human body.

Code the diagnosis but no signs/symptoms associated with that diagnosis because they are integral to the condition. The chest pain is integral to the diagnosis of acute anterior wall myocardial infarction, and only the acute anterior myocardial infarction is coded.

Myocardial Infarction (MI): Malfunction of the heart due to necrosis or deterioration of a portion of the heart muscle; also known as a heart attack.

This is an important reminder that if individuals try to get you to participate in illegal or unethical behaviors, the question is not "Will you be caught?" but "When will you be caught?" It is not worth breaking the law and being charged with any of these penalties just to hang onto a job.

Complication: An unexpected illness or other condition that develops as a result of a procedure, service, or treatment provided during the patient’s hospital stay.

All of these abbreviations are on the "Do Not Use" list created by the Joint Commission.

Other Specified: Additional information that the physician specified and isn’t included in any other code description.

Inferior means toward the bottom (the feet) of the body.

Infarction: Tissue or muscle that has deteriorated or died (necrotic).

The abbreviation AP stands for anteroposterior.

Anatomical Site: A specific location or part of the human body.

Read the Official ICD-10-CM Guidelines for Coding and Reporting.

Upcoding: Using a code on a claim form that indicates a higher level of service, or a more severe aspect of disease or injury, than that which was actual and true.

In the Fowler's position, a patient lies on his or her back with a headrest bringing the head and torso up at a 45-degree angle.

Eponym: A condition named after a person.

Coders use a variety of credible resources when coding, including medical dictionaries and the Merck Manual.

Medical Necessity: The determination that the health care professional was acting according to standard practices in providing a particular procedure for an individual with a particular diagnosis. Also referred to as medically necessary.

The American Hospital Association publishes the Coding Clinic quarterly.

Anomaly: Abnormal, or unexpected, condition.