Anatomy and physiology for medical billing and coding

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ABC/123 Version X

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Weekly Overview: Week 1

HCS/214 Version 2

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Weekly Overview

Week 1
Overview
The health care system is composed of a variety of health care settings, departments, providers, and specialties. This week you will be able to describe the various health care setting departments and identify different health care providers. You will understand the relationship between anatomy and physiology and the association with medical billing and coding. Anatomy terms are used to describe medical diagnoses and procedures. The medical terms include root words, a prefix, and a suffix. It is important to understand medical terminology and to have knowledge of anatomy, physiology, and body system functions in order to provide medical billing or coding services correctly.

What you will cover
1. Introduction to anatomy & physiology and coding and billing

a. Define coding and billing.

The medical billing and coding process requires communication between the health care provider and the insurance company or payer, which begins with the initial visit and continues through the billing and collections process. The diagnosis and procedure codes are determined based on the treatment documented, as rendered. Each procedure is assigned a CPT (current procedural terminology) code that must also correspond to the diagnosis code and match any documentation for data of service. These codes are used for billing and reimbursement.

b. Define anatomy and physiology.

1) Anatomy and physiology are the studies of body parts and the function of the body parts in relation to the body as a whole.

a) Anatomy is the study of the internal and external structures of animals and plants. Anatomy can be subdivided into microscopic anatomy and macroscopic anatomy.

b) Physiology focuses on the functions and processes of the various structures that make up the human body, as well as how a structure actually functions.

2) Anatomy and physiology are the foundation for all medical practice. Disease is something that upsets the normal structure or functions of body process. This is how anatomy and physiology relate to medicine.

c. Describe the relationship of anatomy and physiology to coding and billing.

Medical coding focuses on patient medical records and what is documented or performed during an encounter. Codes have been established for every type of medical procedure, encounter, test, examination, surgical procedure, and diagnosis code imaginable. To ensure accurate medical coding for billing purposes, knowledge of anatomy and physiology and medical terms is necessary. Medical billing specialists and coders may translate a provider’s documentation of treatment and procedures into treatment and procedure codes that are used for claims processing and reimbursement. It is important to understand the basic function of body systems and basic anatomy and physiology so claims are coded and billed correctly.

d. Identify common medical terms in health care.

The study of disease is called pathology. The language of pathology is based on medical terminology. Each medical term contains a word root combined with prefixes and suffixes that change the meaning.

1) Word root or root word

a) The word root is the basic word structure that has been derived from Latin and Greek.

b) Examples at https://www.learnthat.org/pages/view/roots.html

Root words

arth- joint

cephal- head

cholecyst- gallbladder

chondro- cartilage

colp- vagina

derm- skin

enter- intestine

episi- vulva

gastro- stomach

gloss- tongue

hepato- liver

hyster- uterus

lapar- abdomen

lact- milk

lith- stone

mast- breast

myo- muscle

nat- birth

oopho- ovary

oste- bone

pneum- lung

rhin- nose

salping- fallopian tubes

stomat- mouth

2) Suffixes

a) The suffix comes after the word root.

b) Examples at https://www.learnthat.org/pages/view/suffix.html

Diagnostic suffixes

Procedural suffixes

-algia pain

-anemia blood condition

-iItis inflammation

-megaly enlargement

-meter measure

-oma tumor, mass

-osis abnormal condition

-pathy disease, condition

-rrhagia bursting forth of blood

-rrhea discharge, flow

-sclerosis hardening

-centesis surgical puncture

-ectomy removal, resection, excision

-gram record

-graphy process of recording

-lysis separation, breakdown, destruction

-Pexy surgical fixation

-plasty surgical repair

-rrhaphy suture

-scopy visual examination

-stomy opening

-therapy treatment

-tomy incision, to cut in

1) Prefixes

a) The prefix comes before the word root.

b) Examples at https://www.learnthat.org/pages/view/roots.html

Prefixes

a, an without

ante before

anti against

brady slow

dys painful, difficult

endo inside, within

epi upon, above

ex out, out of

hemi half, partial

hypo below, deficient

infra below

inter between

neo new

oligo scanty, little

pan all

para beside

per through

poly many

pre before, in front of

pseudo false

sub under

supra above, beyond

tetra four

b. Describe the major functions of departments in health care facilities.

1) Health care facilities

a) Hospitals: Inpatient facilities are equipped for patients to stay overnight and provide 24-hour services. A hospital is a self-contained facility that provides acute care to patients with injuries or illnesses.

b) Ambulatory care settings: a freestanding facility or possibly hospital-based department that provides care to patients without the need for admission, such as same-day surgery, urgent care, and diagnostic testing. Outpatient (ambulatory) care settings do not provide services overnight. Treatment is same-day treatment with no overnight admission. Examples include urgent care, outpatient surgery centers, and diagnostic facilities

c) Mental health or behavioral health: A range of settings can include an inpatient hospital or outpatient facility equipped to manage mental health issues.

d) Long-term care: An extended care facility that provides ongoing skilled nursing services and rehabilitation for individuals who have experienced recent acute declines in body function

e) Urgent care: ambulatory setting that is equipped to provide outpatient urgent treatment to a patient

f) Clinics: Clinics are usually staffed with a PA (physician assistant) or NP (nurse practitioner); they are walk-in clinics. Treatment provided is for common illnesses and minor injuries, vaccinations, wellness exams, and physicals. CVS, Walgreens, and Rite Aid are minute clinics.

g) Internal and family medicine: These are generally primary care providers and do not specialize in one specific form of treatment. The primary care provider in internal medicine is responsible for meeting the needs of patients of all ages and address a wide range of health concerns

h) Intensive care: a specialty unit equipped with life-sustaining medical treatment with staff able to provide intensive care treatment to a patient (examples include, an intensive care unit, coronary care unit, pediatric intensive care unit, and surgical intensive care unit)

2) Departments

a) Admissions: department that oversees registering patients on admissions to a facility by verifying patient demographics and insurance information and that provides consent forms for treatment

b) Cardiology: department equipped to treat patients with heart and vascular issues and that can perform a variety of cardiology testing, including angiography, stent placement, echocardiogram, EKG, EEG, and stress testing

c) Dermatology: specialization in treating medical conditions that affect the integumentary system (skin and hair)

d) Dialysis unit: department equipped to provide dialysis treatment to patients with acute or chronic kidney failure

e) Dietary: department that manages the dietary needs of patients

f) Emergency room: department in a medical facility equipped to handle accidents and emergencies, specializing in the acute care of patients, some of which may be life-threatening and that require immediate attention. This is where patients are treated initially and stabilized for any type of emergency situation.

g) Financial services- Patient financial services department assists patients with billing questions and financials during the patient stay

h) Labor and delivery: department equipped to treat patients in labor and manage delivering newborns

i) Laboratory: department equipped to perform a variety of testing on specimens (blood, body fluids, and tissue specimens) and that may also process blood products in the blood bank. The pathology department is generally included in the laboratory.

j) Pathology: specialization in the study of disease

k) Medical Records Department: referred to as health information management; the area can be a centralized or decentralized location where patient medical records are stored and filed. Billing and coding may take place in the health information management department

l) Nursing units: This is the area or floor in a facility that specialize in the ongoing management and treatment of a patient. Most units are divided into a specialty unit that include medical surgical and telemetry, rehabilitation, post-operative care, cardiology, intensive care, surgical intensive care, pediatrics, oncology, endoscopy, behavioral health, nursery, labor and delivery, dialysis, obstetrics, and orthopedics.

m) Pediatrics: responsible for meeting the needs of infants, children, and teenagers and addresses a wide range of health concerns. The pediatrician is generally the primary care provider for pediatric patients.

n) Operating room: department in a facility where surgical operations are performed

o) Post-operative anesthesia (PACU): an area generally attached to the operating room or close to the operating room equipped to provide care to patients recovering from anesthesia after a surgical procedure

p) Psychology unit: department equipped to provide treatment and to manage patients with acute mental health disorders

q) Radiology: department equipped to perform a variety of testing that includes X-rays, CAT scans, MRIs, mammography, and barium swallow

r) Rehabilitation (physical therapy, occupational therapy, and speech therapy): departments equipped to manage physical rehabilitation services

s) Respiratory: department in a facility equipped to perform a variety of diagnostic respiratory testing that includes spirometry, lung volumes and diffuse capacity, pulmonary stress test and oximetry, methacholine challenge, bronchoscopy, and pulmonary rehabilitation

t) Social services: department that provides services to patients and their families to assist in discharge planning, ongoing services, and making use of resources in the community