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| Frage | Antworten |
| What are the two Computer-Assisted Coding (CAC) application designs? | -Natural language processing (NLP): uses technology based on artificial intelligence that extracts data and terms from a text-based document and converts them into medical codes. -Structured data input: used when menu selections and drop-down pick lists are used for documentation rather than handwritten or dictated notes, which is automatically generated and reviewed by a coding professional. |
| Why is an encoder important and what does it promote? | - Enables coders to assign codes based on using text typed into a look-up screen analogous to the coder looking up a term in the index of the printed codebook. Cites official coding guidelines and provides code optimization guidance, which requires user interaction. -Encoders Promote accuracy and consistency in the coding of diagnoses and procedures. |
| What are the differences between the two levels of the Healthcare Common Procedure Coding System (HCPCS)? | -Level I: composed of CPT codes; represents medical services and procedures performed by physicians and other healthcare providers; has five-digit numeric codes. -Level II: contains codes that represent products, supplies, and services not included in the CPT codes; has five-character alphanumeric codes. |
| Interpret the five axes of the Diagnostic and Statistical Manual of Mental Diseases (DSM) | -Axis I: includes the mental disorders or illnesses comparable to general medical illnesses. -Axis II: includes personality disorders. -Axis III: includes general medical illnesses -Axis IV: covers life events or social problems that affect the patient. -Axis V: the overall level of the patient’s functioning determined by the Global Assessment of Functioning (GAF). |
| Who maintains the Current Procedural Terminology (CPT), who is involved, and what is the objective? | -Maintained by the CPT Editorial Panel; the panel is made up of physicians, industry, and government; the objective is to revise, update, and modify the CPT. |
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