Medical Terminologies for Medical Administrative Staff and Support

When speaking of Medical Terminologies for Medical Administrative Staff and Support we are speaking of not only uniformity but also of accuracy. Medical Terminologies are often referred to as Medical coding. The primary importance of medical coding is to ensure that the company gets reimbursed by the insurance companies used by the patients. This is also particularly important for maintaining records and data such as the illness, injury and treatment methods afforded to the patient.

Medical and Science Courses provide a training class solely for the purpose of learning Medical Terminologies. Generally speaking though, let us touch and explain the commonly used terms and codes used by Medical Administrative Staff and Support.

Let us start with the ANSI code 835. It is one of the most important codes used when speaking of the business side of Medical Administration. 835 is the standard format for both remittance and electronic payment used when claiming health care benefits. 835 by HIPAA regulations covers the rules set for replacing paper EOB's when electronic payments are received by health care and insurance providers.

Since we mentioned EOB, let us go ahead and define it too. EOB via medical standards stands for Explanation of Benefits which is very much self explanatory, wouldn’t you agree?

The most basic of all codes required when claiming benefits are ICD codes. ICD stands for International Classification of Diseases. Since it classifies the diseases, these are codes used for the diagnosis. These set of codes includes the symptoms the patient has; the current condition, complaint and problem; and the treatment given to the patient.

ICD codes more often than not are combined with HCPCS codes. HCPCS in medical terms stands for Healthcare Common Procedure Coding System and has three levels. The first level is usually 5 numeric digits. This is used for identification of medical procedures and services ordered by licensed professionals and physicians.

The second level is usually 5 alphanumeric digits with only the first digit as an alphabetical letter the rest of which are all numbers. This is used for identification of services not made by physicians such as pharmacy and ambulance services.

The third level is usually 5 alphanumeric digits using the letters for W to Z followed by numbers. This is used to for identification of all services not quantifiable by the first two levels.

The next set of codes is called DRG’s. DRG by medical terms stands for Diagnosis Related Groups and is considered complex and confusing by most people working in the medical field. This code is used when patients are hospitalized. These codes have to be accurate or else insurers would not pay and reimburse the claims made. Payment and reimbursement is dependent on the DRG codes used.

Speaking of Abbreviations, there are two abbreviations commonly used but often times forgotten. These are NEC and NOS. By medical terms they stand for Not Elsewhere Classifiable and Not Otherwise Specified respectively. These codes are often used in conjunction with the level three ICD codes which we tackled earlier.

Since we’re done with abbreviations, let us then tackle ICD symbols. But we are only to tackle those commonly used symbols and not the full list as we may end up having a full class merely with symbols alone. New codes are symbolized by bullet points. Revised codes are symbolized by a triangle with the appendix pointing upward. Revised texts are symbolized by the text enclosed by a triangle whose appendix is pointing inwards.

Newborn is symbolized by the letter N in a box. Pediatric Age is symbolized by the letter P in a box. Maternity is symbolized by the letter M in a box (note though that maternity age is from 12 to 55). Adult Age is symbolized by the letter A in a box (note that adult is defined by the ages for 15 to 124). All boxes should be colored yellow and all letters should be colored white.

In cases where hospitalization is required for treatment to be given this is symbolized by the letter H in a box. Like all other letters, the Letter H should be colored white but by standard the box should be colored blue instead of the normal yellow colored box.

Speaking of colors and color coding schemes, Blue is used to describe a condition which was an effect of a precondition and could never be used for primary diagnosis. Yellow is used for codes ending in 8 and 9 to include 0 but is only used when the information is not sufficient.