Download What you will cover

Weekly Overview: Week 1
HCS/214 Version 2
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.
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Weekly Overview: Week 1
HCS/214 Version 2
b) Examples at https://www.learnthat.org/pages/view/roots.html
Root words
arthcephalcholecystchondrocolpdermenterepisigastroglosshepatohyster-
joint
head
gallbladder
cartilage
vagina
skin
intestine
vulva
stomach
tongue
liver
uterus
laparlactlithmastmyonatoophoostepneumrhinsalpingstomat-
abdomen
milk
stone
breast
muscle
birth
ovary
bone
lung
nose
fallopian tubes
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
-anemia
-iItis
-megaly
-meter
-oma
-osis
-pathy
-rrhagia
-rrhea
-sclerosis
-centesis
-ectomy
-gram
-graphy
-lysis
-Pexy
-plasty
-rrhaphy
-scopy
-stomy
-therapy
-tomy
pain
blood condition
inflammation
enlargement
measure
tumor, mass
abnormal condition
disease, condition
bursting forth of blood
discharge, flow
hardening
surgical puncture
removal, resection, excision
record
process of recording
separation, breakdown, destruction
surgical fixation
surgical repair
suture
visual examination
opening
treatment
incision, to cut in
3) Prefixes
a) The prefix comes before the word root.
b) Examples at https://www.learnthat.org/pages/view/roots.html
Prefixes
a, an
ante
anti
brady
dys
endo
epi
ex
hemi
hypo
infra
inter
neo
without
before
against
slow
painful, difficult
inside, within
upon, above
out, out of
half, partial
below, deficient
below
between
new
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Weekly Overview: Week 1
HCS/214 Version 2
oligo
pan
para
per
poly
pre
pseudo
sub
supra
tetra
scanty, little
all
beside
through
many
before, in front of
false
under
above, beyond
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 24hour 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
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Weekly Overview: Week 1
HCS/214 Version 2
f)
g)
h)
i)
j)
k)
l)
m)
n)
o)
p)
q)
r)
s)
t)
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 lifethreatening and that require immediate attention. This is where patients are treated
initially and stabilized for any type of emergency situation.
Financial services- Patient financial services department assists patients with billing
questions and financials during the patient stay
Labor and delivery: department equipped to treat patients in labor and manage delivering
newborns
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.
Pathology: specialization in the study of disease
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
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.
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.
Operating room: department in a facility where surgical operations are performed
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
Psychology unit: department equipped to provide treatment and to manage patients with
acute mental health disorders
Radiology: department equipped to perform a variety of testing that includes X-rays, CAT
scans, MRIs, mammography, and barium swallow
Rehabilitation (physical therapy, occupational therapy, and speech therapy): departments
equipped to manage physical rehabilitation services
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
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
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