Table Of ContentA Guide to Billing and Reimbursement
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A Guide to Billing and Reimbursement
Michelle A. Green, MPS, RHIA, FAHIMA
CMA (AAMA), CPC, PCS
SUNY Distinguished Teaching Professor
Alfred State College, Alfred NY
JoAnn C. Rowell
Founder and Former Chairperson
Medical Assisting Department
Anne Arundel Community College, Arnold MD
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Understanding Health © 2011, 2008, 2005 Delmar, a part of Cengage Learning
Insurance, A Guide to Billing
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1 2 3 4 5 6 7 14 13 12 11 10
Contents
List of Tables / xi
Preface / xiii
Chapter 1 Health Insurance Specialist Career . . . . . . . . . . . . . . . . . . . 1
Health Insurance Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2
Health Insurance Career Opportunities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Education and Training . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4
Job Responsibilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6
Professionalism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9
Chapter 2 Introduction to Health Insurance . . . . . . . . . . . . . . . . . . . 19
What Is Health Insurance? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20
Major Developments in Health Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20
Health Insurance Coverage Statistics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21
Medical Documentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26
Electronic Health Record (EHR) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .29
Chapter 3 Managed Health Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
History of Managed Health Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .38
Managed Care Organizations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .40
Managed Care Models . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .44
Consumer-Directed Health Plans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .47
Accreditation of Managed Care Organizations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .48
Effects of Managed Care on a Physician’s Practice . . . . . . . . . . . . . . . . . . . . . . . . . . .48
Chapter 4 Processing an Insurance Claim . . . . . . . . . . . . . . . . . . . . . 53
Processing an Insurance Claim . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .54
Managing New Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .57
Managing Established Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .64
Managing Office Insurance Finances . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .64
Insurance Claim Life Cycle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .68
Electronic Data Interchange (EDI) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .69
Maintaining Insurance Claim Files . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .80
Credit and Collections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .84
v
vi CONTENTS
Chapter 5 Legal and Regulatory Issues . . . . . . . . . . . . . . . . . . . . . . . . 93
Introduction to Legal and Regulatory Considerations . . . . . . . . . . . . . . . . . . . . . . . . .94
Federal Laws and Events That Affect Health Care . . . . . . . . . . . . . . . . . . . . . . . . . . . .99
Retention of Records . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .104
Health Insurance Portability and Accountability Act (HIPAA) . . . . . . . . . . . . . . . . . .105
Chapter 6 ICD-9-CM Coding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131
Overview of ICD-9-CM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .133
Medical Necessity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .134
Overview of ICD-10-CM and ICD-10-PCS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .135
Outpatient Coding Guidelines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .139
ICD-9-CM Coding System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .145
ICD-9-CM Index to Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .150
ICD-9-CM Tabular List of Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .156
ICD-9-CM Index to Procedures and Tabular List of Procedures . . . . . . . . . . . . . . . . .164
ICD-9-CM Index to Diseases Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .168
ICD-9-CM Supplementary Classifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .180
Coding Special Disorders According to ICD-9-CM . . . . . . . . . . . . . . . . . . . . . . . . . .184
Reminders to Ensure Accurate ICD-9-CM Coding . . . . . . . . . . . . . . . . . . . . . . . . . . .188
Chapter 7 CPT Coding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201
Overview of CPT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .202
CPT Sections, Subsections, Categories, and Subcategories . . . . . . . . . . . . . . . . . . .208
CPT Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .212
CPT Modifiers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .214
Coding Procedures and Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .225
Evaluation and Management Section . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .227
Anesthesia Section . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .244
Surgery Section . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .249
Radiology Section . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .254
Pathology and Laboratory Section . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .257
Medicine Section . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .260
National Correct Coding Initiative . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .264
Chapter 8 HCPCS Level II Coding . . . . . . . . . . . . . . . . . . . . . . . . . . . 273
Overview of HCPCS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .274
HCPCS Level II National Codes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .275
Determining Payer Responsibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .282
Assigning HCPCS Level II Codes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .283
Chapter 9 CMS Reimbursement Methodologies . . . . . . . . . . . . . . . 287
Historical Perspective of CMS Reimbursement Systems . . . . . . . . . . . . . . . . . . . . . .288
CMS Payment Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .289
Ambulance Fee Schedule . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .290
Ambulatory Surgical Center Rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .291
CONTENTS vii
Clinical Laboratory Fee Schedule . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .292
Durable Medical Equipment, Prosthetics/Orthotics,
and Supplies Fee Schedule . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .293
End Stage Renal Disease (ESRD) Composite
Payment Rate System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .294
Home Health Prospective Payment System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .295
Hospital Inpatient Prospective Payment System . . . . . . . . . . . . . . . . . . . . . . . . . . . .295
Hospital Outpatient Prospective Payment System . . . . . . . . . . . . . . . . . . . . . . . . . . .300
Inpatient Psychiatric Facility Prospective Payment System . . . . . . . . . . . . . . . . . . . . .301
Inpatient Rehabilitation Facility Prospective Payment System . . . . . . . . . . . . . . . . . .302
Long-Term (Acute) Care Hospital Prospective Payment System . . . . . . . . . . . . . . . .304
Skilled Nursing Facility Prospective Payment System . . . . . . . . . . . . . . . . . . . . . . . . .305
Medicare Physician Fee Schedule . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .306
Chargemaster . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .312
Revenue Cycle Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .315
UB-04 Claim . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .316
Chapter 10 Coding for Medical Necessity . . . . . . . . . . . . . . . . . . . . . 337
Applying Coding Guidelines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .338
Coding and Billing Considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .342
Coding from Case Scenarios . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .346
Coding from Patient Reports . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .349
Chapter 11 Essential CMS-1500 Claim Instructions . . . . . . . . . . . 371
Insurance Billing Guidelines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .373
Optical Scanning Guidelines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .375
Entering Patient and Policyholder Names . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .378
Entering Provider Names . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .378
Entering Mailing Addresses and Telephone Numbers . . . . . . . . . . . . . . . . . . . . . . . .379
Recovery of Funds from Responsible Payers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .379
National Provider Identifier (NPI) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .379
Assignment of Benefits Versus Accept Assignment . . . . . . . . . . . . . . . . . . . . . . . . .380
Reporting Diagnoses: ICD-9-CM Codes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .381
Reporting Procedures and Services: HCPCS/CPT Codes . . . . . . . . . . . . . . . . . . . . . .382
National Standard Employer Identifier . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .387
Signature of Physician or Supplier . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .388
Reporting the Billing Entity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .388
Processing Secondary Claims . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .388
Common Errors That Delay Processing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .390
Final Steps in Processing Claims . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .391
Maintaining Insurance Claim Files for the Practice . . . . . . . . . . . . . . . . . . . . . . . . . . .391
Chapter 12 Commercial Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . 395
Commercial Health Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .396
Automobile, Disability, and Liability Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . .397
Commercial Claims . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .399
viii CONTENTS
Claims Instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .400
Commercial Secondary Coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .408
Commercial Group Health Plan Coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .413
Chapter 13 Blue Cross Blue Shield . . . . . . . . . . . . . . . . . . . . . . . . . . . 419
History of Blue Cross Blue Shield . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .420
Blue Cross Blue Shield Plans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .424
Billing Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .429
Claims Instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .430
Blue Cross Blue Shield Secondary Coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .438
Chapter 14 Medicare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 447
Medicare Eligibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .449
Medicare Enrollment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .450
Medicare Part A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .452
Medicare Part B . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .454
Medicare Part C . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .455
Medicare Part D . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .456
Other Medicare Health Plans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .456
Employer and Union Health Plans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .457
Medigap . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .457
Participating Providers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .458
Nonparticipating Providers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .459
Surgical Disclosure Notice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .461
Mandatory Claims Submission . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .462
Private Contracting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .462
Advance Beneficiary Notice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .463
Experimental and Investigational Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .465
Medicare as Primary Payer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .466
Medicare as Secondary Payer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .467
Medicare Summary Notice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .469
Billing Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .469
Claims Instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .472
Medicare and Medigap Claims . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .480
Medicare-Medicaid (Medi-Medi) Crossover Claims . . . . . . . . . . . . . . . . . . . . . . . . .482
Medicare as Secondary Payer Claims . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .482
Roster Billing for Mass Vaccination Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .487
Chapter 15 Medicaid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 493
Medicaid Eligibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .494
Medicaid-Covered Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .498
Payment for Medicaid Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .500
Billing Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .504
Claims Instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .506
Medicaid as Secondary Payer Claims . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .513
Mother/Baby Claims . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .516
CONTENTS ix
SCHIP Claims . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .519
Chapter 16 TRICARE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 525
TRICARE Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .526
TRICARE Administration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .529
CHAMPVA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .531
TRICARE Options . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .531
TRICARE Programs and Demonstration Projects . . . . . . . . . . . . . . . . . . . . . . . . . . . . .536
TRICARE Supplemental Plans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .536
Billing Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .537
Claims Instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .540
Primary TRICARE with a Supplemental Policy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .545
TRICARE as Secondary Payer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .548
Chapter 17 Workers’ Compensation . . . . . . . . . . . . . . . . . . . . . . . . . 555
Federal Workers’ Compensation Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .556
State Workers’ Compensation Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .558
Eligibility for Workers’ Compensation Coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . .559
Classification of Workers’ Compensation Cases . . . . . . . . . . . . . . . . . . . . . . . . . . . . .559
Special Handling of Workers’ Compensation Cases . . . . . . . . . . . . . . . . . . . . . . . . .561
Workers’ Compensation and Managed Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .561
First Report of Injury Form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .562
Progress Reports . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .564
Appeals and Adjudication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .566
Fraud and Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .566
Billing Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .567
Claims Instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .568
APPENDICES
Appendix I Case Studies: Set One . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .579
Appendix II Case Studies: Set Two . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .601
Appendix III Forms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .623
CMS-1500 Claim . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .624
Coding Case Study Form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .625
E/M CodeBuilder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .626
Appendix IV Dental Claims Processing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .631
Appendix V Abbreviations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .641
Appendix VI Common Medical Terminology . . . . . . . . . . . . . . . . . . . . . . . . . . .645
Bibliography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 647
Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 651
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 677
