Solution Manual For Understanding Hospital Coding and Billing A Worktext 3rd Edition by Marsha S Diamond

Contents

Preface

Acknowledgments

Section 1: Hospital Billing and Coding Overview

Ch 1: The Flow of the Hospital Organization

Introduction

Accrediting Bodies and Regulatory Guidelines

The Hospital Revenue Cycle

Understanding the Patient Billing Process

Services Provided in the Facility Setting

Career Opportunities in the Hospital Setting

Conclusion

Ch 2: Hospital Coding Overview

Introduction

Introduction to Facility Coding

ICD-9/10-CM Diagnostic Coding Guidelines

CPT/HCPCS Procedural Coding Guidelines

Review of Appropriate Coding Assignments

Documentation Review

Conclusion

Ch 3: Hospital Billing Overview

Introduction

Admission/Preadmission Process

Capturing Patient Services

Coding and the Health Information Department

Third-Party Payor (Insurance) Billing Process

Billing/Accounts Receivable Processes

Collection and Payment Processes

Compliance Process

Conclusion

Ch 4: UB-04 (CMS-1450) Overview

Introduction

General Overview of the Hospital Billing Form

FL 1-7: Facility/Provider Information

FL 8-17: Patient Information

FL 18-30: Condition Codes

FL 31-37: Occurrence Codes/Dates

FL 38-41: Responsible Party and Value Codes/Amounts

FL 42-49: Revenue Codes/Information

FL 50-65: Third-Party Information (Payer, Insured, Employer)

FL 66-75: Diagnosis/Procedure Codes

FL 76-79: Attending Physician Information

FL 80-81: Remarks Section

Chapter Summary Exercises

Conclusion

Section 2: Inpatient Coding/Billing

Ch 5: Inpatient Coding

ICD-9/10-CM Diagnostic Coding Tools

Inpatient ICD-9/10-CM Diagnostic Coding

Special Inpatient ICD-9/10-CM Coding Considerations

ICD-9/10-CM/PCS Procedural Coding

Conclusion

Ch 6: Inpatient Billing

Methodologies for Inpatient Services

Conclusion

Section 3: Outpatient Coding/Billing

Ch 7: Outpatient Coding

Introduction

Documentation Review for Key Elements

General ICD-9/10-CM Coding Guidelines

ICD-9-CM/ICD-10-PCS Procedure Coding

General Procedure Coding Guidelines (CPT/HCPCS)

CPT Specific Section Guidelines

Conclusion

Ch 8: Outpatient Billing

General Concepts of Outpatient Prospective Payment System (OPPS)

Ambulatory Payment Classifications (APCs)

The Outpatient Billing Process

Other Outpatient Billing Considerations

Conclusion

Appendix I: Revenue Codes for the UB-04 (CMS-1450) Form

Appendix II: Instructions for UB-04 (CMS-1450) Claim Completion

Appendix III: Case Studies

Appendix IV: Outpatient Case Scenarios

Appendix V: ICD-10-CM Chapter Layout with Code Ranges

Appendix VI: ICD-10-PCS Tables and Guidelines

Glossary

Index