Index

References are by chapter and section number.

"After study," principal diagnosis — 9.4
"And," convention — 8.8
"Has anything changed?" — 24.2
"See condition" redirect — 8.2
"See" and "see also" — 8.4
"Stable," and what it does and does not mean — 36.7
"With" convention — 9.7
"With" convention, boundaries of — 9.7
"With," convention — 8.8
0001F — 36.9
1995 and 1997 documentation guidelines — 15.3
1P / 2P / 3P / 8P exclusion modifiers — 36.9
2021 E/M rewrite — 15.3
2023 E/M extension — 15.3, 16.1
270 / 271 — 27.2
270/271 — 24.3
275 transaction — 27.8
277CA — 27.6
278 — 27.2
3044F — 36.9
835 — 27.2, 28.1
837, structure of — 27.3
837I — 26.1
837I versus 837P — 27.3
837P, relationship to the form — 25.1
99201, deletion of — 15.2, 15.3
99211 — 15.2
99417 — 15.9
999 — 27.6

A

A4550, surgical tray — 20.10
AAPC credentials, the six core — 39.3
AAPC, origin and orientation — 39.2
ABN, Advance Beneficiary Notice — 22.8
ABN, defective — 22.8
ABN, three options — 22.8
Abuse, definition — 5.2
Accept assignment — 25.6
Accident and injury information — 24.2
Accommodation codes — 26.4
Accommodations, testing — 39.9
Account 10-4471, audited as an external reviewer would — 37.11
Account 10-4471, complete file assembled — 40.1
Account 10-4471, engine output on the March 14 note — 38.1, 38.5, 38.10
Account 10-4471, orthopedic counterfactual — 35.3, 35.5, 35.10
Account 10-4471, the diabetes revisit — 36.11
Account 10-4471, what it cost to work the denial — 40.2
Account 10-4471, what the finished file does not prove — 40.1
Account 22-7788 (the ED bill), packaged lines explained — 34.1, 34.5
Account 22-8891 (the inpatient admission) — 33.1, 33.2, 33.3, 33.4, 33.5, 33.7, 33.10
Account 22-8891, read by a risk model — 36.4
Account 22-9107 (the screening colonoscopy) — 34.3, 34.11
Account 31-2245, the extrapolation counterfactual — 37.6
Accountable care organization (ACO) — 36.10
Accounts receivable — 1.3, 1.7
Accounts receivable, what it is — 31.1
Accumulators — 2.2, 2.7
Accuracy, code-level versus chart-level — 37.3
Acknowledgments, the three — 27.6
Activity code — 12.7
Acuity criteria set, properties of — 35.6
Acuity leveling, facility — 16.9
Acute and chronic, both reported — 9.8
Acute conditions, and not carrying them forward — 36.4, 36.6
Add-on codes — 13.7
Add-on codes in specialty families — 35.2, 35.8
Add-on codes, modifier 51 and — 14.6
Add-on codes, no edit lookup required — 21.9
Addendum — 4.5
Addendum B and Addendum D1 (OPPS) — 34.4
Additional diagnoses, outpatient — 9.3
Additional documentation request (ADR) — 37.4, 37.7
Address, wrong — 24.2
Addressed, definition of — 15.5
Adjacent roles, as a route into coding — 40.4
Adjacent tissue transfer — 17.6
Administrative Simplification — 27.1
Admission and discharge same date — 16.2
Admitting diagnosis, FL 69 — 26.2
Admitting diagnosis, versus principal — 33.2
ADR deadline, distinguished from timely filing — 37.4, 37.7
Advance Beneficiary Notice, introduced — 3.5
Adversarial reading, scheduled — 37.8
Adverse effect — 12.6
Adverse effect, column — 8.9
Adverse selection — 36.2
Affordable Care Act risk adjustment (HHS-HCC) — 36.3
Aftercare — 12.9
Aftercare, not for fractures — 12.4, 12.9
Aggregate-only error, not findable by sampling — 37.2, 37.10
Aging report, buckets and build choices — 31.2
Aging, flow versus stock reading — 31.2
Agreement rate, and why it corrupts — 38.4
Algorithms in coverage decisions (Medicare Advantage) — 38.4, Case Study 1
Allergy testing and immunotherapy — 19.8
Allowed amount — 1.1, 1.2, 1.5
Allowed amount, on the remittance — 28.5
Alphabetic Index — 8.2
Ambulance modifiers — 20.2
Ambulatory payment classification (APC) — 34.2, 34.3
Ambulatory surgery center (ASC) payment system — 34.9
Amendment of the record — 4.5
Amendment, prohibited in response to a records request — 37.7, 37.8
Americans with Disabilities Act, testing accommodations under — 39.9
AMLOS (arithmetic mean length of stay) — 33.8
Amount in controversy — 30.6
Amounts generally billed (AGB) — 32.8
Anatomic groupings, repair — 17.5
Anatomic modifiers — 14.8
Anemia in chronic kidney disease — 10.7
Anemia in neoplastic disease — 10.7
Anesthesia claim workflow — 35.7
Anesthesia formula — 18.11
Anesthesia record as source document — 35.1, 35.7
Anesthesia time — 18.11
Anesthesia time versus room time — 35.7
Annotation of code books — 6.2
Annotation rules, the general shape of — 39.8
Annotation rules, why they exist — 39.8
Annotation, code book — 39.8
Annual reset — 36.6
Annual update cycle — 6.7
Annual wellness visit as a recapture vehicle (G0439) — 36.6
Annual wellness visit, Medicare (G0439) — 35.5
Answer choices, reading before searching the book — 39.9
Antepartum care — 18.6
Anti-Kickback Statute — 5.4
Anti-Kickback Statute, cost-sharing waiver — 2.3
Appeal deadline — 1.3, 1.7
Appeal letter, six-part structure — 30.3
Appeal log — 30.10
Appeal overturn rate — 29.7
Appeal versus corrected claim — 30.1, 30.2
Appeal, cost of working one to overturn — 40.2
Appeal, defined — 30.1
Appeal-paragraph library — 30.3
Appeal-paragraph library, value of — 40.2
Appealable amount (allowed, not charge) — 30.1, 30.11
Appealing edit denials, which are worth it — 21.11
Appeals, when they are not worth writing — 40.3
Appendices, CPT — 13.3
Apprentice designation — 39.10
Apprentice designation, circularity of — 39.10
Apprentice designation, routes to removing — 39.10
Apprentice designation, the job search around it — 40.4
AR over 90, decomposition of — 31.4
Arthroscopy — 17.9
Arthroscopy, diagnostic included in surgical — 17.9
Artifact, bringing one to an interview — 40.4
ASC claim format, CMS-1500 versus TOB 831 — 34.9
Assertion register — 37.10
Assertion register, applied to a coding engine — 38.5, 38.7, 38.8
Assertion register, its limits — 37.10
Assessment section, primacy of — 4.2, 4.10
Assignment versus participation — 2.3
Assignment, Medicare — 3.4
Assistant surgeon — 18.10
Asthma classification — 11.5
Attachments — 27.8
Attending provider, FL 76 — 26.7
Attestation, signature — 4.4
Attribution, prospective and retrospective — 36.10
Audio-only telehealth — 35.9
Audit finding, category 4 (supported but fragile) — 40.1
Audit plan, one page — 37.2
Audit response letter, structure — 37.8
Audit trail — 4.5, 4.8
Audit universe — 37.2, 37.6
Audit, definition and purpose — 37.1
Auditor, transition from coder to — 40.7
Authorization denials — 29.2
Authorization, documenting scope — 24.6
Authorization, who obtains it — 24.9a
Authorized representative — 30.5, 30.9
Auto and liability coverage — 2.9
Automated, semi-automated, and complex review — 37.5
Automation bias — 38.8
Autonomous coding — 38.7
Autonomy test, the four properties — 38.7, 38.10
Autoposting — 28.7
Average sales price — 20.3

B

B20 versus Z21 — 10.2
Bad debt versus charity care — 31.10
Balance billing — 1.2, 1.9
Balance billing protections — 32.4
Balance billing, defined — 32.4
Balancing a remittance line — 28.1, 28.5
Base rate, labor and non-labor shares — 33.5
Base units, anesthesia — 18.11
Batch submission — 27.9
Batch versus real-time eligibility — 24.3
Behavior, neoplasm — 10.4
Behavioral health, code families — 35.8
Benchmark, in a shared-savings contract — 36.10
Benchmark, per member per month — 36.4
Benefit period, Part A — 3.2
Bilateral reporting conventions — 14.8, 18.9
Bilateral surgery indicator — 18.9
Bill classification digit — 26.3
Biller, role of — 1.4, 1.7
Billing and coding article — 3.5, 22.4
Billing provider — 25.6
Birthday rule — 2.8
Blanket ABN — 22.8
Block, ICD-10-CM — 7.2
Body system, method for entering — 10.1
Borderline diagnosis — 9.8
Braces — 8.8
Brackets, Index versus Tabular — 8.8
Break-even allowed amount, building your own — 40.3, 40.11
Break-even allowed amount, derivation — 40.3
Break-even, four things it may never decide — 40.3
Budget neutrality — 23.4
Budget neutrality in OPPS — 34.2
Bullets, counting of (obsolete) — 15.1, 15.3
Bundled critical care services — 16.7
Bundled service — 13.8
Bureau of Labor Statistics, occupational profile — 39.5, 40.4, 40.11
Burns versus corrosions — 12.5
Burns, depth site extent — 12.5
Business associate — 5.7
Business associate, vendor as — 40.8

C

CAC pipeline, seven steps — 38.5
CAHIIM accreditation — 39.4, 39.5
Candidate handbook, as the authority — 39.6, 39.8, 39.9
Capitation — 2.6
Capitation, and why it failed without risk adjustment — 36.2
Capped rental — 20.5
CAQH CORE operating rules — 27.1
CARC — 28.4
Carcinoma in situ — 10.4
Cardiac catheterization families — 35.2
Cardiovascular section, structure of — 18.4
Career ladder, the three tracks — 40.7
Case mix index (CMI) — 33.6
Case mix index, as a CDI target — 38.4
Case rate — 2.6
Case-based exam items — 39.6
Casting and splinting — 17.8
Casting supply, separately reportable — 35.3
Categories I, II, III — 13.2
Categories, denial — 29.2
Category — 7.3
Category 1, 2, 3 (data) — 15.6
Category 4 finding (supported but fragile) — 37.3, 37.11
Category II codes (CPT) — 36.9
Category III, mandatory use — 13.2
Catheterization, bundling of — 18.4
CC (complication or comorbidity) — 33.3
CCA (Certified Coding Associate) — 39.4
CCS (Certified Coding Specialist) — 39.4
CCS-P (Certified Coding Specialist — Physician-based) — 39.4
CDI, payment consequence of — 33.10
Cerebrovascular disease — 11.4
CERT (Comprehensive Error Rate Testing) — 37.5
Certainty (NLP qualifier), and the inpatient/outpatient flip — 38.6
Certificate of medical necessity — 20.5
Certification on the claim, never transfers — 40.8
Certification, claim as — 5.1
CFO of a practice — 40.7
Channel for internal reports — 37.8, 37.10
Channel, designated appeals — 30.2
Chapter ranges by letter — 7.2
Chapters, twenty-two — 7.2
Character rules — 7.3
Charge — 1.1, 1.2
Charge capture — 1.8, 23.9
Charge lag — 6.8
Charge setting, method — 23.7
Charge uniformity — 23.7
Chargemaster — 1.2, 23.8, 26.5
Chargemaster decay — 23.8
Chargemaster root cause — 29.4
Charges on packaged lines, why they are maintained — 34.3, 34.5
Charges, role on an inpatient claim — 33.1, 33.8
Chart review, prospective — 36.8
Chart review, retrospective — 36.8
Charts, worked — 10.10
Checkpoint times, exam-day — 39.9
Chemotherapy encounter sequencing — 10.4
Chief complaint — 4.2
CHIP — 3.7
Chronic conditions, recapture of — 36.6
CIC (Certified Inpatient Coder) — 39.3
Civil Monetary Penalties Law — 5.5
CKD staging — 11.8
Claim status inquiry, 276/277 — 27.2, 27.9
Claim, definition — 1.2, 1.3
Classification, purpose of — 7.1
Clean claim — 1.7
Clean claim rate — 24.10
Clearinghouse — 6.5, 27.5
Clearinghouse edits — 27.5
Clearinghouse rejection — 1.7, 1.8
Clearinghouse, changing — 27.5
CLIA — 19.6
Clinic visit, facility reporting (G0463) — 34.8
Clinical documentation integrity (CDI), definition and boundaries — 38.1
Clinical indicator without a documented diagnosis — 38.2, 38.6
Clock, running out of versus knowledge — 39.9
Cloned documentation — 4.6
Cloning, as a named error — 5.8
Closed treatment — 17.7
CMI as diagnostic versus target — 33.6
CMS-1450 — 26.1
CMS-1500 — 1.5
CMS-1500, structure of — 25.1
CMS-HCC model, and its versions — 36.3
CO group code — 28.3
CO-16 — 28.4
CO-45 — 28.4
CO-97 — 28.4, 28.11
Co-surgeons — 18.10
COC (Certified Outpatient Coder) — 39.3
Code also — 8.6
Code anatomy — 7.3, 7.4
Code assignment, standard for — 4.7
Code book editions — 6.1
Code books, the three — 6.1
Code first — 8.6
Code of ethics, credentialing organization's — 39.4, 39.11
Coded wrong versus never covered — 22.11
Coder, role of — 1.4, 1.6
Coder-in-the-loop — 38.8
Coding Clinic — 7.10
Coding intensity adjustment — 36.4
Coding manager, what changes at that rung — 40.7
Coinsurance — 2.2
Coinsurance under OPPS, phase-down toward 20% — 34.2
Coinsurance, computed on allowed amount — 1.2
Collection agency oversight — 32.9
Collection agency placement — 31.10
Collection rate, gross — 23.10
Collection rate, net — 23.10
Collection year versus payment year — 36.6
Collection, point of service — 24.8
Collections, rules governing — 32.9
Colonoscopy family — 18.2
Colonoscopy, extent of — 18.2
Colonoscopy, screening to diagnostic — 18.2
Colorectal screening converted to diagnostic — 34.11
Column One and Column Two — 21.2
Combination code — 7.8
Combination code carries relationship, not specificity — 11.3
Comment period, LCD — 22.4
Commercial appeal levels — 30.5
Commercial-purpose pattern — 37.8
Companion guide — 25.9, 27.1, 27.5
Compartments, knee — 17.9
Compensation, and the direction of findings — 38.4
Compensation, how to research honestly — 40.4, 40.11
Competitive bidding — 20.5
Complete versus limited echocardiography (93306) — 35.2
Complete versus limited study — 19.2
Complex repair — 17.5
Complexity adjustment (comprehensive APC) — 34.6
Compliance channel, finding it in a new job — 40.5
Compliance program, auditing and monitoring element — 37.1
Compliance program, seven elements — 5.6
Compliant query, the seven elements — 38.3
Component question, per code — 35.2
Composite APC — 34.6
Comprehensive APC (C-APC), status J1 — 34.6, 34.11
Comprehensive observation APC, status J2 — 34.6, 34.10
Comprehensive/component logic — 21.7
Computer-assisted coding (CAC) — 38.5
Concurrency and provider-arrangement modifiers (anesthesia) — 35.7
Concurrent care — 16.4a
Concurrent review — 38.2
Condition category, mapping to — 36.3
Condition Code 44 — 16.3, 26.6
Condition code 44 workflow — 34.10
Condition code 51 (unrelatedness attestation) — 34.10
Condition codes — 26.6
Confidence interval, lower limit as the demand — 37.6
Confidence threshold as a compliance decision — 38.7, 38.9
Configuration making an assertion nobody chose — 37.2, 37.10
Configuration, never specializing in — 40.9
Conflict resolution hierarchy — 9.10
Consent, notice and (No Surprises Act) — 32.4
Conservative therapy, documented — 22.6, 22.11
Considered but not selected — 15.7
Consistency, why it raises an extrapolated demand — 37.6
Consolidated Appropriations Act, 2021, §122 — 34.11
Constructing an argument versus the record — 30.4, 30.11
Consultation — 16.5
Content outline, exam — 39.6, 39.7
Contingency fee, Recovery Audit Contractor — 37.5
Continuing education units (CEUs) — 39.11
Contract coding, terms to establish — 40.8
Contract, payer — 2.6
Contractual adjustment — 1.2, 28.6
Contrast, with and without — 19.2
Conventions versus Guidelines — 9.10
Conversion factor — 23.4
Conversion factor, OPPS — 34.2
Converted to open — 18.5
Cooperating Parties — 7.10, 9.1
Coordination of benefits — 2.8, 24.3, 24.7, 28.10
Copayment — 2.2
COPD — 11.5
COPD DRG family (190/191/192) — 33.4, 33.5
Copy-forward — 4.6
Copy-forward documentation — 15.12
Copy-forward, as a risk-adjustment liability — 36.7
Copy-forward, the operational answer — 38.1
Copyright, CPT — 13.1
Corporate integrity agreement — 5.5
Corrected claims — 29.6
Corrective action plan (CAP), six fields — 37.10
Corrective action, six fields — 40.3
Cost asymmetry, false positive vs. false negative — 38.9
Cost of an error by stage — 24.1
Cost of certification, and who bears it — 39.1, 39.5
Cost of the denial versus cost of the claim — 40.2
Cost to collect — 31.7, 31.11
Cost-to-charge ratio, in outlier computation — 33.8
Coverage determination versus clinical determination — 22.1
Coverage determination, local — 3.5
Coverage determination, national — 3.5
Coverage with evidence development — 22.3
Covered entity — 5.7
Covered, five conditions of — 2.1
CPB (Certified Professional Biller) — 39.3
CPC (Certified Professional Coder) — 39.3
CPMA (Certified Professional Medical Auditor) — 39.3
CPT Editorial Panel — 13.1
CPT structure — 6.1
CRC (Certified Risk Adjustment Coder) — 39.3
Credential as hiring filter — 39.1
Credential, what it does and does not certify — 39.1, 39.6, 39.12
Credentialing denials — 29.4, 29.6
Credit balance — 1.2, 1.7
Credit balances, causes and triage — 31.8
Credit line on the statement — 32.6, 32.11
Credit reporting of medical debt — 32.9
Critical care — 16.7
Critical care, neonatal and pediatric — 16.7
Crossover — 28.10
Crossover claim — 3.8
Crosswalks and GEMs — 6.7
Cytopathology — 19.4

D

Dash, trailing — 8.2
Dashboard, AR — 31.11
Data element — 27.4
Data reviewed and analyzed — 15.6
Date of service, governs code set — 6.7
Date-of-service rule for scoring — 37.2, 37.3
Days in AR, computation and gaming — 31.3
Deadlines, running from the determination date — 30.5
Debridement, depth and area — 17.6
Decay of collectability with age — 31.1
Decision table, modifiers — 14.12
Decision-for-surgery visit — 17.1
Decision-to-inject argument, constructed — 30.4, 30.11
Deductible — 2.2
Deductible, embedded versus aggregate — 2.2
Deductible, lagging figure — 24.3, 24.4
Default values in templates — 15.12
Deferred-interest financing — 32.7
Deficit Reduction Act of 2005 — 33.7
Definitions, printed on the dashboard — 31.3, 31.11
Degree requirement, RHIT and RHIA — 39.4, 39.5
Deletion count, as evidence of a defensible program — 36.8
Deliberate ignorance — 5.3, 21.10
Delivery mode, testing center versus remote proctor — 39.6, 39.8, 39.9
Dementia coding — 10.8
Demographic component of a risk score — 36.4
Denial log — 29.7
Denial log, sorted by value — 40.3
Denial rate, definitions of — 29.7
Denial report as a specialty map — 35.10
Denial versus rejection — 1.7, 29.1
Denials below the break-even, what to do — 40.3
Denials resolved versus worked — 29.7
Denominator discipline, applied to accuracy — 37.3
Denominator problem — 29.7
Denominator problem, applied to engine metrics — 38.6, 38.9
Deposit reconciliation — 28.1, 28.5
Descriptor, revised — 13.5
Designated health services — 5.4
Designated record set — 4.8
Destruction of lesions — 17.4
Device and drug pass-through status — 34.4
Device families, cardiovascular — 18.4
Diabetes categories E08–E13 — 10.6
Diabetes, "with" convention applied — 10.6
Diabetes, type 2 default — 10.6
Diagnosis fields, the three — 26.2
Diagnosis linkage — 22.6
Diagnosis pointers — 25.5
Diagnosis pointers, and engine defaults — 38.10
Digestive combination codes — 11.6
Direct supervision — 15.11
Director, revenue cycle — 40.7
Discharge day management — 16.4
Discharge status and the transfer rule — 33.8
Discharge status, FL 17 — 26.7, 26.10
Discharge summary — 4.3
Discharge-time template field — 38.1
Discontinued procedure — 14.10
Discontinued procedures, modifiers 73 and 74 — 34.6, 34.9
Discounted cash price — 32.5
Discounting, multiple procedures under OPPS — 34.6
Discussion period — 37.5, 37.8
Disease coefficient — 36.4
Displaced default, fractures — 12.4
Dispute resolution, patient-provider (GFE) — 32.3
Distant site and originating site — 35.9
Distractors, constructed from specific mistakes — 39.6
Distribution analysis, needing no chart — 37.2, 37.10
Distribution test, ED facility levels — 35.6
DMEPOS — 20.5
Document completeness as a pre-coding check — 38.5
Documentation elements required by code type — 4.7
Documentation of your own experience — 40.4, 40.8
Documentation templates, prevention by — 29.8
Documentation, Guidelines' dependence on — 9.1
Documented negatives — 38.1, 38.10
Documented words that decide codes — 35.1
Domiciliary care codes, deletion of — 16.8
Dominant versus non-dominant — 11.4
Dosage in the descriptor — 20.3
Downcoding, why not safe — 5.8
DRG assignment pipeline — 33.4
DRG creep — 33.10
DRG reconciliation, working vs. final coded — 38.2
Drug testing, presumptive and definitive — 19.4
Drugs and Chemicals, Table of — 8.9
Dual eligible — 3.8
Duplicate denials — 29.2
Durability ladder for corrective actions — 37.10
Durable medical equipment, four-part test — 20.5

E

E11.9 versus E11.22 + N18.31 — 36.11
ED facility acuity leveling — 35.6
ED professional levels (99281–99285), no time option — 35.6
EDI — 27.1
EDI enrollment — 27.5
Edit files, downloading — 21.2
Edit override, four steps — 21.8
Edition rule, code books at an exam — 39.6, 39.8
Edits, prevention by — 29.8
Educator, transition from coder to — 40.7
EFT enrollment — 27.5
Eight-minute rule — 19.11
Eight-minute rule, contrasted — 35.8
Electrocardiogram codes, 93000 / 93010 / tracing only — 35.2
Electronic health record — 6.4
Electronic remittance advice — 28.1
Eligibility denials — 29.2
Eligibility response, reading — 2.7
Eligibility verification — 24.3
Eligibility, when to run — 24.3
Emergency department as outpatient — 9.5
Emergency department billing — 1.1, 1.2, 1.5
Emergency department facility levels versus professional levels — 34.8
Emergency department levels — 16.6
Employer preference, regional variation in — 39.5
Employer reimbursement of certification — 39.1, 39.5
Encoder — 6.3
Encoder, what it does not decide — 6.3
Encounter, definition — 1.2, 1.3
Endoscopic base-code rule — 18.1
Enforcement, False Claims Act and risk adjustment — 36.8
Engine output, reading and disposing of — 38.5, 38.8, 38.10
Enrollment, duplicate denials and — 16.4a
Entity identifier — 27.6
EOB, patient's — 28.2
EPO — 2.4
ERA enrollment — 27.5
ERA enrollment, as autoposting prerequisite — 28.7
ERISA — 2.5
ERISA appeals, self-funded plans — 30.5
Error log, four columns — 39.7
Error log, personal — 40.5, 40.11
Error log, the first month — 35.10
Error rate, and what it does not say — 37.3
Escalation (Medicare) — 30.6
Escalation ladder, payer follow-up — 31.6
Escalation path for a coding disagreement — 40.5
esMD — 27.8
Essential modifier — 8.3
Established patient — 15.2
Estimate, patient — 32.2, 32.11
Estimate, pre-service — 24.9
Estimate, provider-based setting and — 32.2
Ethics obligation, credential holders' — 39.4, 39.11
Ethics, professional — 5.10
Etiology and manifestation — 7.8
Evaluation and Management, first section — 13.3
Evaluation and management, what it measures — 15.1
Event-fed queue versus aging-fed queue — 31.5
Evidence rule at reconsideration — 30.7
Evidence test, run against a transmitted claim — 38.5, 38.8
Evidence, four kinds — 30.4
Exam parameters, verifying rather than assuming — 39.6, 39.8, 39.9, 39.11
Exam preparation, week by week — 39.7
Exam rules for code books — 6.2
Exception queue — 28.7
Excision versus Resection (ICD-10-PCS) — 33.9
Excludes1 — 8.5
Excludes1, unrelated-condition exception — 8.5
Excludes2 — 8.5
Exclusion — 5.5
Exclusion screening — 5.5
Expected allowed amount — 28.8
Expected value, sorting by allowed amount — 31.5
Experience verification letter — 39.10
Experiencer (NLP qualifier) — 38.6
External cause codes — 12.7
External cause codes, never first-listed — 12.7
External Cause Index — 8.9
External review — 30.9
External, definition of — 15.6
Extraordinary collection action (ECA) — 32.8, 32.9
Extrapolation, arithmetic — 37.6
Extrapolation, Medicare preconditions and appealability — 37.6
Eye codes — 19.8

F

Face-to-face encounter requirement — 36.6
Facility claim — 16.1, 16.9
Facility exams, emphasis of — 39.6
Facility type digit — 26.3
Facility versus non-facility — 23.5
Facility versus professional claim — 1.5
Facility versus professional claim, same encounter — 34.1, 34.8
Falling behind a study plan — 39.7
False Claims Act — 5.3
False Claims Act, introduced — 1.4
False Claims Act, unbundling as a theory — 21.10
False negative — 38.9
False positive — 38.9
Family history codes — 12.9
Favorable trend, treated as a question — 37.2
Fee schedule — 1.2, 2.6
Fee schedule, building — 23.6
Fee-for-service adjuster (RADV) — 36.8
Female genital section — 18.6
Fetus identification character — 11.9
Financial assistance policies — 23.8
Financial assistance policy (FAP) — 32.8
Financial assistance screening before collection — 31.10
Financial clearance checklist — 24.9
Finite population correction — 37.6
First-listed diagnosis — 9.3
First-pass resolution rate — 29.7
Fix, cost of building once — 40.3
FL 3a, patient control number — 26.2, 26.10
FL 3b, medical record number — 26.2
FL 48, non-covered charges — 26.2
FL 6, statement covers period — 26.8, 26.10
FL 63, treatment authorization — 26.7
FL 80 and the fields nobody adjudicates — 37.10
FL 80, remarks — 26.7, 26.10
Float, transferred from practice to payer — 40.2
Follow-up call discipline — 31.6
Follow-up versus aftercare — 12.9
Foreign body removal — 17.4
Form locators, blocks of — 26.2
Formula, RVU to allowed amount — 23.4, 23.6
Four-per-line rule — 25.5
Fracture care decision — 17.7
Fracture seventh characters — 7.6, 12.4
Fracture-care decision, documented in the plan — 35.3
Fraud versus abuse — 5.2
Fraud, definition — 5.2
Free authoritative sources — 6.6
Frequency digit — 26.3, 26.10
Frequency limitations — 22.7
Frightened patient, explaining a bill to — 32.10
Front end, middle, back end — 1.4
Front end, prevention at — 29.8
Front-end denial rate — 24.10
Front-loading the record — 30.7
Fully loaded cost of staff time (\$36.00/hour, \$0.60/minute) — 31.7

G

G-codes — 20.6
G0105 and G0121 — 20.6
G0105 and G0121 (colorectal screening codes) — 34.11
G0439 (subsequent annual wellness visit) — 36.6
G2211, visit complexity add-on — 15.9a
G2212 — 15.9, 20.6
G89 pain category — 10.9
GA, GX, GY, GZ — 14.11
GA, GX, GY, GZ in practice — 22.9
Geographic practice cost index — 23.3
Geometric mean length of stay (GMLOS) — 33.8
Global package, splitting — 18.8a
Global period indicators — 17.2
Global period modifiers — 14.9
Global period, living inside a 090 — 35.3
Global service — 19.1
Good faith estimate — 23.8
Good faith estimate (GFE) — 32.3
Grafts — 17.6
Gross AR versus adjudicated AR — 31.1
Ground ambulance, exclusion of — 32.4
Group codes — 28.3
Grouper — 6.3
Grouper, versioning by fiscal year — 33.4
Guessing to keep up, the new coder's failure — 40.5
Guidance, imaging — 19.3
Guidelines, binding nature of — 7.10
Guidelines, four sections — 9.2
Guidelines, section and subsection — 13.4
Guidelines, status of — 9.1

H

Habit of looking it up — 6.10
HAC (hospital-acquired condition) payment provision — 33.7
HAC Reduction Program, distinguished — 33.7
Harborview MRI, the appeal not written — 30.1
Hard and soft denials — 29.3
HCPCS Level II structure — 6.1
HCPCS Level II, quarterly updates — 20.1
HCPCS Level II, structure of — 20.1
Health information management (HIM) — 39.2, 39.4
Health risk assessment, as a diagnosis source — 36.6, 36.8
Heart failure axes — 11.3
Hernia repair — 18.2
HFMA MAP Keys — 31.3
HHS-HCC model — 36.3
Hierarchy, injection and infusion — 19.9
Hierarchy, within a disease family — 36.5
High charge, myth of — 23.7
HIPAA, Privacy Rule — 5.7
HIPAA, Security Rule — 5.7
HIPAA, Transactions and Code Sets — 5.7
Hiring manager's evaluation problem — 39.1
History and examination, removal from level selection — 15.1, 15.3
History and physical — 4.3
History codes — 12.9
History of present illness — 4.2
History of, as a documentation trap — 36.7
HIV coding rules — 10.2
HIV status, state confidentiality laws — 10.2
HMO — 2.4
Home or residence services — 16.8
Hospital outpatient department, as a setting — 34.1
Hypertension with chronic kidney disease — 11.1
Hypertension with heart disease — 11.1
Hypertension, asymmetry of presumption — 11.1

I

I50.32, in a hierarchy and an interaction — 36.4, 36.5, 36.9
ICD indicator — 25.3
ICD-10-CM structure — 6.1
ICD-10-PCS, scope — 6.1
ICD-10-PCS, seven-character structure — 33.9
Identification, and when the sixty-day clock starts — 37.9
Identification, matching registration — 39.9
Identity verification — 24.2
Immunization administration — 19.10
Impending or threatened condition — 9.8
Implementation guide — 27.1
Improper payment, statutory definition — 37.5
In-network status — 2.3
Incident-to — 15.11
Incident-to, whose NPI — 25.6
Inclusion terms — 8.4
Increased procedural services — 14.10
Independence of the auditor — 37.2
Independent dispute resolution (plan–provider) — 32.4
Independent historian — 15.6
Independent interpretation — 15.6
Independent review organization — 30.9
Index, anatomic site as entry point — 13.10
Index, CPT — 13.10
Infectious agent, additional code — 10.2
Inference, forbidden kinds — 4.7
Informational modifiers — 14.2
Infusion start and stop times — 19.9
Initial denial rate — 29.7
Initial encounter, definition — 7.6, 12.3
Initial service — 19.9
Initial versus subsequent care — 16.2
Injuries, coding rules — 12.2
Inpatient status — 16.3
Inpatient-only list (status C) — 34.4
Institutional versus professional billing — 26.1
Instructions, cascade of — 8.4
Insurance AR versus patient AR — 31.1
Integral signs and symptoms — 9.6
Integrated triage — 29.4
Interaction terms — 36.4, 36.5
Interest on late payments — 28.9
Interim claims — 26.3, 26.8
Intermediate repair — 17.5
Internal audit, business case — 37.1, 37.2
Internal reports, counting as a metric — 37.8
Interpretation and report, as a document — 35.2
Interview, the denial walkthrough — 40.4
Invalid code versus less specific — 7.3
IPPS, origins and scope — 33.1
Item 14 and 15 qualifiers — 25.3
Item 17b, referring provider NPI — 25.3, 25.9
Item 19, narrative field — 25.3
Item 21, diagnosis codes — 25.3
Item 22, resubmission code — 25.3
Item 23, authorization or CLIA — 25.3
Item 24, columns — 25.4
Item 27, accept assignment — 25.6
Item 29, amount paid — 25.10
Item 32, service facility — 25.6
Item 33, billing provider — 25.6
Item 4, the insured — 25.2
Items 10a–10c, accident questions — 25.2
Items 9a–9d, other insured — 25.2

J

J-codes — 20.3
January, error concentration in — 24.2
Job posting, reading duties versus requirements — 39.5
Job search without experience — 40.4
Joint injection and aspiration — 17.7
Judicial review — 30.6
JW modifier — 20.4
JZ modifier — 20.4

K

Kidney transplant status — 11.8
Knee, arthroscopy of — 17.9
Knowingly, three prongs — 5.3
Knowledge decay in a long career — 40.10
KX modifier — 19.11

L

Labor-related share and the wage index (OPPS) — 34.2
Laparoscopy, diagnostic included in surgical — 18.6
Lapse of a credential, and where it surfaces — 39.11
Late entry — 4.5
Laterality — 7.7
Laterality modifiers — 14.8
Laterality, variation by category — 7.7
LCD reconsideration — 22.4
LCD, local coverage determination — 22.4
Leading query, the five markers — 38.3
Leaks, the six — 1.8
Left heart catheterization with coronary angiography (93458) — 35.2
Legal health record — 4.8
Lesion excision measurement rule — 17.4
Letter families — 20.2
Level selection, two methods — 15.1
Levels of Medicare appeal, the five — 30.6
Liability modifiers — 14.11
Licensure, absence of in this field — 39.1
Lidocaine, correctly absent from the claim — 37.11
Limiting charge — 3.4
Line order, claim — 18.8
Line-level posting — 28.5
Local chapter and component association — 39.5, 39.11
Local-market survey, thirty postings — 39.5
Long-term drug therapy status codes — 10.6
Look-up resources, free — 3.10
Looking up, three search techniques — 6.6
Lookups, worked — 8.10
Loop — 27.4
Loop 2300, the claim — 27.4
Loop 2400, the service line — 27.4
Lost charges — 23.9

M

M17.11, and chronic conditions that carry no weight — 36.6
MA130, closing without appeal — 29.5, 29.6
MAC medical review — 37.5
Machine-readable file — 32.5
MACRA — 36.9
MAI 1, 2, and 3 — 21.4
Main term — 8.2
Main terms are conditions — 8.2
Maintenance of a credential — 39.11
Making the case for prevention — 29.9
Malpractice RVU — 23.2
Manifestation codes, brackets — 7.8
Manipulation — 17.7
Margins — 17.4
Materiality — 5.3
Maternity global package — 18.6
MCC (major complication or comorbidity) — 33.3
MDC (major diagnostic category) — 33.4
Measurement, keeping your own record — 40.6, 40.7
MEAT criteria — 36.7, 36.11
Medicaid — 3.7
Medicaid managed care — 3.7
Medicaid, payer of last resort — 3.7
Medical debt, held by the insured — 32.1
Medical decision making — 15.4
Medical decision making, introduced — 4.2, 4.7
Medical direction — 18.11
Medical direction, documented checklist — 35.7
Medical identity theft — 24.2
Medical necessity — 22.1
Medical necessity determinations, individualized — Case Study 1
Medical necessity screening — 24.9
Medical policy, commercial — 22.10
Medical record, contents — 4.1
Medically unlikely edits — 21.4
Medicare Administrative Contractor — 3.3
Medicare Advantage — 3.2, 3.6
Medicare Advantage, auto-forwarded appeals — 30.9
Medicare Advantage, payment mechanism — 36.1, 36.2, 36.4
Medicare Appeals Council — 30.6
Medicare as commercial reference — 3.1
Medicare Coverage Database — 3.10, 22.5
Medicare limitation on recoupment, appeals and — 31.9
Medicare Part A — 3.2
Medicare Part B — 3.2
Medicare Part C — 3.2, 3.6
Medicare Part D — 3.2
Medicare Program Integrity Manual — 37.2, 37.5, 37.6
Medicare Redetermination Notice — 30.7
Medicare Secondary Payer — 3.8
Medicare Shared Savings Program — 36.10
Medicare Summary Notice — 3.9
Medicare, as commercial reference point — 2.6, 2.10
Medicine section — 13.3
Medicine section, contents of — 19.8
Member identification number — 24.2
Membership requirement — 39.11
Mental and behavioral chapter, documentation demands — 10.8
Methodology page of a findings letter — 37.6
Metric pairing — 31.11
Microbiology units — 19.4
Minimum necessary — 5.7
Minimum necessary in appeal packets — 30.4
Minimum necessary, in a vendor relationship — 40.8
Minimum savings rate — 36.10
MIPS — 36.9
MIPS Value Pathways — 36.9
Misrepresenting the provider — 5.8
Modality — 19.2
Model drift, three drivers — 38.9
Moderate sedation — 18.11
Modifier 22 — 14.10
Modifier 24 — 14.9
Modifier 24 appended by rule — 35.3
Modifier 25 — 14.4
Modifier 25 in preventive and problem visits — 35.4, 35.5
Modifier 25, audited both directions — 37.3, 37.11
Modifier 25, different diagnosis not required — 14.4
Modifier 26 — 14.7, 19.1
Modifier 33 (preventive service) — 34.11
Modifier 50 — 14.8
Modifier 51 — 14.6
Modifier 51 versus 59 — 14.6
Modifier 52 — 14.10
Modifier 53 — 14.10
Modifier 57 — 14.4, 14.9
Modifier 58 — 14.9
Modifier 59 — 14.5
Modifier 59, last resort rule — 14.5
Modifier 76, 77 — 14.10
Modifier 78 — 14.9
Modifier 79 — 14.9
Modifier 90 — 19.5
Modifier 91 — 14.10, 19.7
Modifier 95 as a technology assertion — 35.9
Modifier 99 — 14.3
Modifier indicator 0, 1, 9 — 21.3
Modifier PD (wholly owned or operated entity) — 34.10
Modifier PT (screening converted to diagnostic) — 34.9, 34.11
Modifier QW — 19.6
Modifier, definition — 14.1
Modifier-51 exempt — 13.7
Mohs micrographic surgery — 17.4
MOON notice — 16.3
MSP employee thresholds — 3.8
MSPQ — 24.7
MUE values, unpublished — 21.4
Multiple procedure indicator — 18.8
Multiple-procedure payment reduction — 18.8
Musculoskeletal specificity burden — 11.7
Mutually exclusive logic — 21.7
Myocardial infarction, four-week rule — 11.2
Myocardial infarction, subsequent — 11.2

N

N19 — 28.4, 28.11
Nail procedures — 17.4
Natural language processing (NLP) — 38.6
NCCI Policy Manual — 21.5
NCCI Policy Manual as appeal evidence — 30.4
NCCI, as Medicare output — 3.1
NCCI, why it exists — 21.1
NCD, national coverage determination — 22.3
NCHS — 7.10
NDC — 20.8
NDC format and rejections — 20.8
NEC — 8.7
Negation detection — 38.6
Neoplasm table, six columns — 10.4
Neoplasm, active versus history — 10.5
Neoplasms, Table of — 8.9
Nervous system section — 18.7
Net recovery on Account 10-4471 — 40.2
Netting of credits, why never — 31.2, 31.3
New patient — 15.2
New problem, incident-to and — 15.11
Ninety days, the first — 40.5
Ninety-second rule — 39.9
No Surprises Act — 32.3, 32.4
Non-covered charges — 26.2
Non-integral signs and symptoms — 9.6
Non-participating provider — 3.4
Nonessential modifier — 8.3
Normalization factor — 36.4
NOS — 8.7
Note bloat — 15.3
Note-reading method — 4.10
NPI as a standard identifier — 27.1
NPI, Type 1 and Type 2 — 25.7
NU, UE, RR — 20.5
NUBC — 26.1
NUCC — 25.1
Nuclear medicine — 19.2
Nursing facility services — 16.8

O

OA group code — 28.3, 28.10
Observation — 16.3
Observation, skilled nursing facility qualification and — 16.3
Obstetric episode log — 35.4
Obstetric global package, what falls outside — 35.4
Obstetric globals 59400 / 59510 — 35.4
Obstetric priority — 11.9
Occurrence codes — 26.6
Occurrence span codes — 26.6
Offset — 28.9
Offshore coding, constraints on — 40.8
OIG Self-Disclosure Protocol — 37.9
OIG Work Plan — 37.2, 37.5
Old myocardial infarction — 11.2
Omitted codes, undetectability of — 15.9a
One word, \$1,867.44 — 33.5, 33.10
One-way ratchet (chart review) — 36.8
Open treatment — 17.7
Open/closed default, fractures — 12.4
Operating provider, FL 77 — 26.7
Operating rules — 27.1
Operative report — 4.3
Operative report, reading — 17.3
Opt-out — 3.4
Optical character recognition — 25.1
Optical character recognition, silent errors — 38.5
Option set, and "clinically undetermined" — 38.3
Order of benefit application — 2.2
Order, signed, as separate requirement — 4.4
Ordering versus performing — 19.5
Organism question — 10.2
Origin and destination modifier — 20.2
Out-of-network — 2.3
Out-of-pocket maximum — 2.2
Out-of-pocket maximum, absence in Original Medicare — 3.2
Outcome measure — 36.9
Outcome of delivery — 11.9
Outlier payments — 33.8
Outpatient Code Editor (OCE) — 34.7
Outpatient hospital versus practitioner files — 21.2
Outside-in audit — 37.10
Outsourcing, what travels and what does not — 40.8
Overpayment, sixty-day rule — 5.1
Overpayment, the break-even has no authority over — 40.3
Overpayments, identification and return — 31.9
Overriding an edit — 21.8
Overturn rate, why it goes in the denominator — 40.3

P

Packaging — 16.9
Packaging and patient cost-sharing — 34.5
Packaging, conditional (Q1, Q2, Q4) — 34.4, 34.5
Packaging, outpatient — 1.1, 1.5
Packaging, unconditional (status N) — 34.4, 34.5
Pain management encounter, sequencing — 10.9
Pain management, interventional — 18.7
Pain, acute versus chronic — 10.9
Panel rule — 19.4
Panel, counted as one test — 15.6
Paper claim requirements — 25.1
Parentheses — 8.3, 8.8
Parenthetical notes — 13.6
Participating provider — 3.4
Pathological versus traumatic fracture — 12.4
Pathology on an outpatient facility claim — 34.6, 34.11
Pathology report, wrong source for measurement — 17.4
Patient as payer — 32.1
Patient responsibility — 1.2
Patient statement, design of — 32.6
Patient statement, timing of — 32.6, 32.11
Pattern versus instance, reporting — 21.10
Patterns versus instances, giving up on — 31.7
Payability, four reasons a code does not pay — 20.10
Payer error as a category — 29.4
Payer process failure, raising it — 40.3
Payer's own policy as the standard — 30.3, 30.4
Payer, definition — 1.2
Payment convention, as the unit purchased — 35.1
Payment modifiers — 14.2
Payment plan — 32.7
PC/TC indicator — 19.1
Peer comparison of distributions — 37.10
Peer-to-peer review — 22.10
Peer-to-peer, preparation and the call — 30.8
Per diem — 2.6
Per member per month (PMPM) — 36.2, 36.4, 36.10
Per-question time budget — 39.9
Percentage of billed charges — 2.6
Percentage of Medicare — 23.6
Percutaneous skeletal fixation — 17.7
Permanent versus temporary codes — 20.1
Person versus control, as a source of findings — 37.1, 37.8, 37.10
Physical medicine, timed codes — 19.11
Physical status modifiers — 18.11
Physical status modifiers P1–P6, applied — 35.7
PI group code — 28.3
Pipeline, following a claim through — 27.10
Place of occurrence — 12.7
Place of service 02 and 10 (telehealth) — 35.9
Place of service codes — 23.5
Place of service, item 24B — 25.8
Placeholder X — 7.5
Plan types compared — 2.4
POA indicators (Y, N, U, W, exempt) — 33.7
Point estimate versus demand — 37.6
Point-of-service collection scripting — 24.8
Poisoning — 12.6
Poisoning versus adverse effect — 8.9
Policy landscape, concentrated in a specialty — 35.1, 35.10
Policy, finding the governing — 22.5
POS — 2.4
Post-procedural complication, characterization of — 11.6
Postings, reading duties against requirements — 40.4, 40.9
Postoperative diagnosis, coding from — 17.3
Postoperative pain — 10.9
Postpayment review — 37.4, 37.5
Potentially misvalued codes — 23.2
PPO — 2.4
PR group code — 28.3
PR-1, PR-2, PR-3 — 28.3
Practical-experience program — 39.10
Practice expense RVU — 23.2
Practice management system — 6.4
Practice size and role structure — 1.4
Pre-MDC cases — 33.4
Precertification — 24.5
Precision — 38.9
Predetermination — 24.5
Predicting the adjudication — 2.7
Premium — 2.2
Preparation hours, budgeting honestly — 39.7
Prepayment review, and its effect on cash — 37.4
Prescription drug management — 15.7
Pressure ulcer staging — 11.7
Presumptive eligibility — 32.8
Preventable administrative write-off — 40.3
Preventable denials — 29.3, 29.10
Prevention as a fixed cost — 29.8
Prevention, three levels of — 40.3
Preventive medicine services (99381–99387 / 99391–99397) — 35.5
Price transparency — 23.8
Price transparency, hospital — 32.5
Principal diagnosis — 9.4
Principal diagnosis, FL 67 — 26.2, 26.10
Principal diagnosis, inpatient rules — 33.2
Prior authorization — 22.10, 24.5, 24.6
Prior authorization transparency and published metrics — Case Study 1
Probe audit — 37.2, 37.5
Problem list, why it is not documentation — 36.7, 36.11
Problems addressed — 15.5
Process measure — 36.9
Proctored exam — 39.6, 39.9
Product-specific networks — 2.4
Production standard, converted to minutes — 40.6
Productivity standard, what it implies about a day — 40.6
Productivity standards — 6.9
Productivity standards, reset for review work — 38.8, 38.10
Professional and technical components — 14.7
Professional claim — 16.1, 16.9
Professional network, as an information system — 40.10
Prolonged services — 15.9
Prompt-pay statutes — 31.6
Propensity to pay — 32.9
Proprietary payer edits — 21.11
Prospective payment, concept — 33.1
Prostate procedures, sections involved — 18.5
Protected health information — 5.7
Provider-based billing — 16.9
Provider-based clinic billing — 1.5
Provider-based conversion, arithmetic of — 26.9
Provider-level adjustment — 28.1, 28.9
Provider-performed microscopy — 19.6
Psychiatry codes — 19.8
Psychotherapy time conventions — 35.8
Pulmonary function testing — 19.8
Pulse oximetry, bundling of — 16.7
Purchased diagnostic test — 19.5
Purposes of the code set — 7.1

Q

Q-codes — 20.7
Q4, could the denial have been prevented — 40.3
QMB, billing prohibition — 28.10
Qualified Independent Contractor — 30.6, 30.7
Qualified Medicare Beneficiary — 3.8
Qualified payment amount (QPA) — 32.4
Qualifying circumstances — 18.11
Quality gate — 36.10
Quality measure, denominator/numerator/exclusions — 36.9
Quality standard, the six questions — 40.6
Quality standards — 6.9
Query practice guidance, revision history — Case Study 2
Query rate, and why it corrupts — 38.4
Query response, landing in the record — 38.3
Query retention, the two models — 38.3
Query, compliant — 4.9
Query, compliant versus leading — 1.6
Query, leading — 4.9
Query, when to send — 4.9
Question file, personal — 6.10
Queue ordering — 29.5
Qui tam — 5.3, 21.10

R

Radiation oncology — 19.2
RADV (risk adjustment data validation) — 36.8
RARC — 28.4
RAT-STATS — 37.6, 37.9
Re-aging — 31.2
Reading a code outward — 7.4
Reading a facility claim — 26.10
Reading habit, the — 40.10, 40.11
Real-time transactions — 27.9
Reasonable and necessary — 22.2
Rebuttal of an audit finding — 37.2, 37.3
Recall — 38.9
Recapture worklist — 36.6, 36.8
Reckless disregard — 5.3, 21.10
Reconciliation, charge capture — 23.9
Reconsideration — 30.6, 30.7
Records request, amending in response to — 4.5
Records request, responding to — 37.7
Recoupment demands, working — 31.9
Recovery Audit Contractor (RAC) — 37.5
Recurrent hernia — 18.2
Red drop-out ink — 25.1
Redetermination — 30.6, 30.7
Reference laboratory — 19.5
Referral versus authorization — 24.5
Referring provider denials — 19.5
Refusing an improper instruction — 5.9
Registration fields — 24.2
Reinstatement of a lapsed credential — 39.11
Rejection causes — 25.9
Rejection rate — 29.7
Rejection versus denial — 27.7
Relative value unit — 23.2
Relative weight — 33.5
Remedy versus root cause — 29.4
Remittance advice — 1.3, 1.7, 28.1
Remote coding, trade-offs — 40.8
Remuneration — 5.4
Rendering provider — 25.6
Rental versus purchase — 20.5
Repairs, adding lengths — 17.5
Resequenced codes — 13.5
Respiratory failure sequencing — 11.5
Respiratory failure, sequencing with COPD — 33.2
Respiratory section — 18.3
Response obligation on a reported concern — 37.10
Response to comments — 22.4
Retake policy — 39.9
Retaliation, prohibition on — 5.3
Returned to provider (RTP), versus denial — 34.7
Revenue code — 16.9
Revenue code 0636 — 26.4, 26.5, 26.10
Revenue codes — 26.4
Revenue codes, introduced — 1.1
Revenue cycle stages — 1.3
Revenue-code-to-HCPCS pairing — 26.5
Reversal and correction — 28.9
Review of systems — 4.2
RHIA (Registered Health Information Administrator) — 39.4
RHIT (Registered Health Information Technician) — 39.4
Risk adjustment data validation (RADV) — 37.5, 37.11
Risk adjustment factor (RAF), construction — 36.4
Risk adjustment, purpose of — 36.2
Risk of complications and morbidity — 15.7
Risk pooling — 2.1
Risk score growth cap — 36.10
Room and board — 26.4
Root operation (ICD-10-PCS) — 33.9
Root-cause category list — 29.4
Root-cause classification — 29.4
Rounding, per-line versus aggregate — 2.7
Routine ABN — 22.8
Routing table of sources — 6.6
RUC — 13.1
RUC and RVU determination — 23.2
Rule of nines — 12.5
Rulemaking cycle, annual — 23.4
RxHCC model — 36.3

S

S-codes — 20.7
Safe harbor — 5.4
Salary data, sources and limitations — 39.5
Same-date office visit and admission — 16.2
Sample size, internal audit — 37.2
Sampling frame — 37.6
Scoring sheet, four finding categories — 37.3
Screening as intent, not outcome — 34.11
Screening colonoscopy, patient billing of — 32.2, 32.10
Screening versus diagnostic — 12.9
Scrubber — 6.5
Scrubber edit, may stop but not answer — 40.3
Scrubber rule inventory — 6.5
Seam, owning the unowned — 40.3, 40.7
Secondary billing — 28.10
Section 501(r), extraordinary collection actions — 31.10
Section detection, and the right fact in the wrong section — 38.6
Section guidelines, CPT — 6.1
Section I — 9.2
Section I.C, chapter-specific guidelines — 10.1
Section II and III — 9.2, 9.4
Section III, reportable secondary diagnoses — 33.2, 33.3
Section IV — 9.2, 9.3
Sections, six — 13.3
Segment — 27.4
Selection, as the leading act — 38.4, 38.6
Self-administered drugs — 16.3
Self-disclosure, the four doors — 37.9
Self-funded plans — 2.5
Self-pay and uninsured patients — 23.8
Semicolon convention — 13.10
Separate procedure — 13.8
Separate procedure designation — 17.9
Separate procedure designation, edits implementing — 21.6
Sepsis — 10.3
Sepsis sequencing — 10.3
Septic shock — 10.3
Sequela — 7.6
Sequela sequencing — 12.3
Sequelae, cerebrovascular — 11.4
Sequencing — 9.9
Sequencing of modifiers — 14.3
Sequencing, special chapters — 12.10
Sequencing, what fixes it — 9.9
Sequential procedures — 21.6
Setting and claim, identifying first on an exam item — 39.2, 39.6
Seven questions of the statement — 32.6
Seventh character — 7.6
Seventh character, context-dependent meaning — 7.6
Seventh character, definitions — 12.3
Severe sepsis — 10.3
Severity split, three tiers — 33.3, 33.4
Shaded area, service line — 25.4
Shadowing, four half-days — 35.10
Shared savings — 36.10
Shave removal — 17.4
Shoppable services — 32.5
Signature on file — 25.2
Signature requirements — 4.4
Signature, illegible versus absent — 37.7
Simple repair — 17.5
Simulations, full-length timed — 39.7
Single-dose versus multi-dose vials — 20.4
Sinus endoscopy, unilateral codes — 18.3
Site convention, multiple sites — 11.7
Site of service differential — 23.5
Site of service, three prices for one procedure — 34.9
Situational data elements — 27.1
Sixty-day overpayment rule, the decision layer — 37.9
Sixty-day rule, operational mechanics — 31.9
Skilled nursing facility three-day rule — 16.3
Skin substitutes — 17.6
Skin tag removal — 17.4
Small balance write-off thresholds — 31.7
SMRC (Supplemental Medical Review Contractor) — 37.5
SOAP note — 4.2
Social determinants of health, risk and — 15.7
Source document, learning its layout — 35.1, 35.10
Source-text audit trail — 38.5, 38.10
Special chapters, why different — 12.1
Special investigations unit, commercial — 37.5, 37.6
Special report — 13.9
Specializing, when to — 40.9
Specialty credentials, placed after a core credential — 40.9
Specialty credentials, taken after a core one — 39.3
Specialty grid, six columns per code — 35.10
Specialty intake, five questions — 35.1, 35.10
Specialty societies, guidance versus payer policy — 35.10
Specific beats general — 9.10
Specificity, and the loss under risk adjustment — 36.3, 36.7
Specificity, cost of unspecified — 7.9
Specimen, as unit of service — 19.4
Spine surgery — 18.7
Split/shared visit — 15.11
Stable, definition of — 15.5
Standard code sets — 27.1
Standard identifiers — 27.1
Standard paper remittance — 28.1
Standard stack, the six authorities — 37.2
Standard written order — 20.5
Standards of medical and surgical practice — 21.6
Standards, interrogating before accepting — 40.6
Standing orders — 19.5
Stark Law — 5.4
Statement covers period — 26.8
Statement cycle cost — 31.7
Statement, the \$47.58 — 32.6, 32.11
Statistical sampling — 37.6
Status category codes — 27.6
Status codes — 12.9
Status indicators, as a system — 34.4
Status note that says nothing — 31.5
Status S versus status T — 34.4, 34.6
Statutorily excluded services — 3.5, 22.8, 22.9
Stem, reading the last sentence first — 39.6
Stratified sampling — 37.6
Stroke, three coding situations — 11.4
Study plan, twelve-week — 39.7
Subcategory — 7.3
Subrogation — 2.9
Subscriber relationship — 24.2
Subsequent encounter — 7.6
Subsequent encounter, definition — 12.3
Substance use disorder records, confidentiality — 10.8
Substance use hierarchy — 10.8
Substantive portion — 15.11
Substitutions for experience — 39.10
Subterm — 8.2
Superbill — 6.4
Superficial injury with severe injury — 12.2
Supplier standards — 20.5
Supplies, usual, included in procedures — 20.10
Surgery section, contents — 13.3
Surgical package — 17.1
Surgical partition, OR-designated procedures — 33.4, 33.9
Surgical pathology — 19.4
Surprise billing — 32.4
SV1 segment — 27.4
SV107, diagnosis pointers — 27.4
Symbols, CPT — 13.5
Symptom codes, when correct — 12.8
Symptom coding when no diagnosis established — 9.6

T

T-codes — 20.7
TA1 — 27.6
Tabs, code book — 6.2
Tabs, structural — 39.8
Tabular List — 8.4
Takeback — 28.9
TAMPER (alternative mnemonic) — 36.7
Targeted Probe and Educate (TPE) — 37.5
Taxonomy code — 25.7
TC modifier — 14.7
Team surgery — 18.10
Technical component — 19.1
Telehealth across specialties — 35.9
Templates — 4.6
Temporality (NLP qualifier) — 38.6
Third-party administrator — 2.5
Third-party patient financing — 32.7
Thirty-day plan — 40.11
Three Rs, the — 16.5
Three-convention collision, CKD — 11.8
Three-day payment window — 26.8, 34.10
Three-pass method — 39.9
Three-year rule — 15.2
Time conventions, the four — 35.8
Time thresholds, hospital families — 16.2
Time units, anesthesia — 18.11
Time, total on the date of the encounter — 15.8
Time, what does not count — 15.8
Timed therapy units (97110) — 35.8
Timely filing — 1.3, 1.8
Timely filing appeal, with proof — 30.1
Timely filing denials — 29.2, 29.3
Timely filing for appeals — 30.5
Timely filing, contract clause — 2.6
Timely filing, proof of — 27.7
Top-twenty lists, by volume and by dollars — 35.10
Touches on a denial — 29.10
Toxic effect — 12.6
Tracking, two calendars — 30.10
Transaction numbers (270/271, 276/277, 278) — 24.3
Transaction set, the — 27.2
Transfer DRG rule, per-diem arithmetic — 33.8
Transfer of care — 16.5
Transfer rule — 26.7
Transitional care management (99495 / 99496) — 35.5
Transmitted claim, testing a configuration against — 37.10
Transparency in Coverage (payer files) — 32.5
TRICARE — 2.9
Trimester determination — 11.9
Trumping — 36.5
Two claims from one visit — 16.1, 16.9
Two clocks, filing and appeal — 1.3
Two organizations, two rooms — 39.2
Two-midnight benchmark — 16.3
Two-midnight benchmark, as a rule replacing an audit — 37.5
Two-of-three rule — 15.4
Two-step rule — 8.1
Two-times rule — 34.3
Two-week method for a new specialty — 35.10
Type of bill — 16.9, 26.3, 26.10
Type of bill 131 (hospital outpatient) — 34.1

U

U-chapter, special purposes — 7.2
UB-04 — 1.5
UB-04, structure of — 26.2
UCR — 2.6
UHDDS — 33.2
Unapplied cash — 31.8
Unbundling — 5.8, 21.10
Unbundling, arthroscopic — 17.9
Uncertain diagnosis at discharge, inpatient — 33.2
Uncertain diagnosis, inpatient — 9.5
Uncertain diagnosis, outpatient — 9.5
Uncertain versus unspecified behavior — 10.4
Unclassified drug codes — 20.3
Underdosing — 8.9, 12.6
Underdosing, reason codes — 12.6
Underpayment detection method — 28.8
Underpayment identification — 1.7
Undiagnosed new problem with uncertain prognosis — 15.5
Unique test — 15.6
Units of service, drugs — 20.3
Units, laboratory — 19.4, 19.7
Unlisted procedure codes — 13.9
Unspecified codes, cost of — 36.2, 36.3
Unspecified codes, when correct — 7.9
Upcoding — 5.8
Update cycle checklist — 6.7
Update cycle, and which edition you sit with — 39.6, 39.8, 39.11
Update cycle, arriving in lumps by section — 35.1
Update cycle, as a personal reading calendar — 40.10
Update cycle, January 1 — 13.1
Update cycle, October 1 — 7.10
UPIC (Unified Program Integrity Contractor) — 37.5
Urinary section — 18.5
Use additional code — 8.6
Utilization Management Committee — Case Study 1
Utilization review committee, role in status change — 34.10

V

Vaccine administration pairing (90686 + 90471 / 90472) — 35.5
Vaccine supplied by public program — 19.10
Vaccine supply source, outside the record — 35.5
Value codes — 26.6
Value-based contract, the four terms — 36.10
Variance classification — 28.8
Variance versus error, in a scoring sheet — 37.3
Vascular procedures, per vessel — 18.4
Vendor oversight, what a provider still owns — 40.8
Venipuncture, location in Surgery — 13.3
Verbal query, and its documentation obligation — 38.2, 38.3
Version 5010 — 27.1
Views, radiographic — 19.2
Visit complexity add-on — 15.9a
Void — 29.6
Volume slice, twenty codes — 35.1, 35.10

W

Wage index — 33.5
Waived tests — 19.6
Waiver of cost sharing — 2.3
Waiver of cost sharing, compliance limits — 31.7
Waiver of cost sharing, routine — 32.8
Waiver of cost-sharing — 24.8
Waste, drug — 20.4
Weeks of gestation code — 11.9
Well-child visit with a separately identifiable problem — 35.5
What an appeal must contain — 30.2
When CPT and HCPCS both have a code — 20.9
Wholly owned or operated entity — 26.8, 34.10
Work queue, AR follow-up sort order — 31.5
Work queue, denial — 29.5
Work queue, design of — 6.8
Work queue, sorting — 1.3, 1.7
Work RVU — 23.2
Work RVU as productivity measure — 23.2
Workers' compensation — 2.9
Working a denial, six steps — 29.5
Working DRG — 38.2
Worklist design, CDI — 38.1, 38.2, 38.6
Write-off categories — 28.6
Write-off, never silent — 40.3
Write-offs beside days in AR — 31.3, 31.11
Wrong turns, index — 8.10

X

X12 — 27.1
X{EPSU} modifiers — 14.5
X{EPSU} modifiers, preferring over 59 — 21.8

Y

Yes/no queries, the narrow permission — 38.3, Case Study 2

Z

Z-codes, categories — 12.9
Z-codes, first-listed versus secondary — 12.9, 12.10
Z85 personal history codes — 10.5
Zero-dollar allowed line, reading correctly — 34.5, 34.7
Zero-pay lines — 28.5
ZZZ indicator — 17.2

§501(r) — 32.8