Common Coder Acronyms

CCS-P (Certified Coding Specialist-Physician) – AHIMA credential for coders for providers similar to CPC. Other AHIMA coding credentials include CCS; and these:
RHIT (Registered Health Information Technologist – Associate degreed health information worker who has passed an AHIMA exam and is found mostly in facilities.
RHIA (Registered Health Information Administrator) – Bachelor degreed health information manager who has passed an AHIMA exam and is found mostly in hospitals and other job sites requiring advanced skills.
CDC (Centers for Disease Control) – The agency that not only helps us stay healthy but tracks diseases.
CDT (Current Dental Terminology) – The American Dental Association’s proprietary coding system. Often called “D codes,” these alphanumeric codes are included in HCPCS Level II. See HCPCS.
CMS (Centers for Medicare and Medicaid Services) – The federal agency that develops the policies and procedures for paying Medicare and Medicaid claims. Part of HHS. Was once HCFA.
OIG (Office of Inspector General) – Audits and enforces federal rules and payments for CMS. They do the Work Plan.
CPT (Current Procedural Terminology) – The AMA’s proprietary procedural code set. Developed in the 1960’s, it is also called HCPCS Level I. Was called CPT-4 until 2003. It’s a five-character, alphanumeric system. See HCPCS.
DME (Durable Medical Equipment) – Medical equipment ordered by an authorized professional for use in the home. Codes are found in HCPCS Level II.
EMR (Electronic Medical Record) – Broad term, along with EHR, for computerized patient and billing management systems required to be used by providers seeing federal patients by mid-decade.
ESRD (End Stage Renal Disease) – Federal system pays for kidney dialysis differently.
GEMs (General Equivalence Mappings) – Federal crosswalk tables between ICD-9-CM and ICD-10-CM and ICD-10-PCS. It’s the data behind our ICD-10 Code Translator.
HCPCS (Healthcare Common Procedure Coding System) – CMS’ national coding system. It consists of two parts:
HCPCS Level II – This five character alphanumeric system includes ambulance, ESRD, procedures, drugs, supplies, DME, dental, BCBS, and codes for tracking and studies. Codes sometimes evolve to CPT codes.
HHS (Health and Human Services) – The executive branch department that includes CMS, CDC, and others.
HIPAA (Health Insurance Portability & Accountability Act) – “Kassebaum-Kennedy Law” Among other things standardizes codes sets, protects patient privacy, and simplifies data management.
HIT (Health Information Technology) – The practice of people who manage the actual computer-based processes of EMRs. ASHIM is the organization for these people.
HITECH (Health Information Technology for Economic and Clinical Health Act) – Part of the American Recovery and Reinvestment Act of 2009, it toughens the rules for privacy and security for electronic transmission of health information.
ICD (International Classification of Diseases) – Code set for tracking and reporting diseases, conditions, injuries, and procedures in facilities. See MS-DRG, ICD-10-PCS, and NCVHS.
ICD-10-PCS (Procedure Coding System) – New “smart code” system developed by 3M HIS for reporting procedures. Effective for hospitals 2013.
IPPS (Inpatient Prospective Payment System) – The federal payment system and rules for reimbursing facilities for inpatient care.
MS-DRG (Medicare Severity Diagnosis Related Groups) – The group-based system hospitals use to report inpatient care. It relies on accurate coding of ICD-9.
LCD (Local Coverage Decision) – MAC or federal decision on coverage of service that applies only to the MAC’s service area.
MAC (Medicare Administrative Contractor) – Companies that handle Medicare claims.
MGMA (Medical Group Management Association) – Professional association of medical group managers.
MPFS or PFS (Medicare Physician Fee Schedule) – The federal table and rules that determines how much a physician will be paid based on service, location, specialty, place of service, and other factors. It includes information on acceptable modifiers, global days, etc.
RVU (Relative Value Unit) – Units determined for elements of care that are used to calculate fees.
NCCI (Correct Coding Initiative) – Federal unbundling guidelines that are updated quarterly for both providers and OPPS facilities. (What’s unbundling? Think ala carte.)
NCD (National Coverage Decision) – Federal decision on coverage of service that applies nationally.
NCVHS (National Committee for Vital Health Statistics) – The people who track diseases for CDC. They manage ICD-9 and ICD-10-CM and PCS.
NDC (National Drug Codes) – A coding system administered by the Food and Drug Administration where every time a drug is packaged, it is assigned a 10-13 character alphanumeric “smart code.” There are more than 100,000 NDCs and they’re often used to report the usage of a drug to a payer.
NPI (National Provider Identifier) – Unique number assigned to providers so they can report services to Medicare contractors.
OPPS (Outpatient Prospective Payment System) – The federal rules and formula for paying hospitals via APCs and ASCs for most outpatient procedures.
APC (Ambulatory Patient Categories) – Groupings of HCPCS codes that help reimburse the facility for the whole service.
ASC (Ambulatory Surgery Center) – Freestanding surgical centers, most often independent of hospitals.
OCE (Outpatient Code Editor) – A free application from CMS that helps facilities calculate and report APCs.
PECOS (Provider Enrollment, Chain and Ownership System) – Internet-based registration and tracking system for providers seeking to serve Medicare patients.
PQRS (Physician Quality Reporting System) – Formerly called PQRI. A number of quality initiatives (tracked by HCPCS codes) that, if a practice demonstrates satisfactory participation in a requisite number of initiatives, brings financial benefit.
RAC (Recovery Audit Contractor) – A vendor who helps implement the Recover Audit Program through which chosen vendors (RACs) audit claims for over and underpayments.
SNF (Skilled Nursing Facility) – Facility staffed for long-term care and rehabilitation.

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