Match the following
-The term used when a code reports a procedure that is more involved than that documented in the patient chart.
A) downcoded
B) retrospective
C) internal
D) prospective
E) complete review of systems
F) upcoded
G) external
H) code edits
I) extended review of systems
J) problem-pertinent review of systems

Question

Quizplus · Accepted Answer

Upcoding is the term used when a code reports a procedure that is more involved than that documented in the patient chart.

Answer: A 
 Downcoding is the opposite of upcoding and occurs when a code reports a procedure that is less involved than that documented in the patient chart.

Answer: D 
 Prospective refers to pre-authorization or pre-approval for a procedure or service before it is performed.

Answer: G 
 External refers to edits or reviews performed by third-party organizations or entities, such as insurance companies, Medicare, or Medicaid.

Answer: C 
 Internal refers to edits or reviews performed by the healthcare organization or facility itself.

Answer: H 
 Code edits are automated software tools that check or validate the accuracy and appropriateness of codes submitted for reimbursement.

Answer: E, I, J 
 These are all types of review of systems, which are part of the medical history taken by healthcare providers to identify any current or potential health issues. Examples include a problem-pertinent review (focused on a specific issue), an extended review (going into more detail), and a complete review (a comprehensive assessment of all body systems).

Match the Following -The Term Used When a Code Reports a Procedure That