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...Treatment Soap Note
Patient: A 12-year-old patient visiting the physician for well-child examination.
Source and Reliability: Mother and father, both reliable sources.
Patient Case, Age and Clinical Setting: 12 years patient visiting a physician.
Chief Complaint: Few minor illnesses over the past 2 years.
HPI: The patient last visited the physician for a well-child examination 2 years ago. He has a few minor illnesses since then. He is currently in the puberty stage of development.
Past Medical History: Few minor illnesses.
Family History: None
Social History: Patient lives with his mother and father.
Risk Factors: Sexual maturation, pubertal growth spurt, and abnormal pubertal development.
ROS: Premature adrenarche.
VS: BP - 115/70, Temp - 98, weight - 80 pounds, height – 59 inches, HR – 90.
· The patient is alert but does not fully understand changes in his body.
· He started developing some underarm……
ICD10 Data. (2018). 2020 ICD-10-CM Diagnosis Code E30.1. Retrieved January 22, 2020, from https://www.icd10data.com/ICD10CM/Codes/E00-E89/E20-E35/E30-/E30.1
Oberfield, S.E., Sopher, A.B. & Gerken, A.T. (2011, June). Approach to the Girl with Early Onset of Pubic Hair. The Journal of Clinical Endocrinology & Metabolism, 96(6), 1610-1622.
Treatment Versus Punishment: That Is the Question!
When it comes to the question of whether treatment or punishment should be used for juvenile offenders, it is important to remember that juveniles are still developing into adults: their minds, bodies, … the scale of what they are for adults. The focus of juvenile justice should be on rehabilitation—not punishment. This paper will explain why treatment is the better option when it comes to juvenile justice.
Differences between Treatment and Punishment
The concept of treatment focuses on the idea that juveniles who commit a crime, whether it is selling drugs, robbing a house, rape, or murder, are still … and evil influences. Children need a helping and guiding hand to navigate the conflicts that they face in the early stages of development. Treatment is what provides that helping hand. It can come in the form of therapy, mentoring, a Big Brother,……
Agnew, R. (2008). Strain Theory. In V. Parrillo (Ed.), Encyclopedia of social problems. (pp. 904-906). Thousand Oaks: SAGE.
Cramer, M. (2014). Parole Board releases 2nd man convicted of murder as juvenile. Retrieved from https://www.bostonglobe.com/metro/2014/08/06/parole-board-releases-man-convicted-murder-while-juvenile/REwVVe3aR9leuRVMpZsN6O/story.html
Diskin, M. (2018). New law will put limits. Retrieved from https://www.vcstar.com/story/news/local/2018/10/11/new-california-law-means-teen-suspect-oxnard-murders-cannot-tried-adult/1535518002/
Fritz, J. K. (2015). Diverting young offenders from prison is ‘smart justice.’ Education Digest, 81(2), 53-55.
Jannetta, J., & Okeke, C. (2017). Strategies for Reducing Criminal and Juvenile Justice Involvement. Building Ladders of Opportunity for Young People in the Great Lakes States, brief, 4. Retrieved from https://www.urban.org/sites/default/files/publication/94516/strategies-for-reducing-criminal-and-juvenile-justice-involvement_2.pdf
Johnson, T., Quintana, E., Kelly, D. A., Graves, C., Schub, O., Newman, P., & Casas, C. (2015). Restorative Justice Hubs Concept Paper. Revista de Mediación, 8(2), 2340-9754.
McCarthy, P., Schiraldi, V., & Shark, M. (2016). The future of youth justice: A community-based alternative to the youth prison model. US Department of Justice, Office of Justice Programs, National Institute of Justice.
Meli, L. (2014). Hate Crime and Punishment: Why Typical Punishment Does Not Fit the Crime. U. Ill. L. Rev., 921.
Fair treatment of workers is a priority for any employee given that it is a right guaranteed by the Constitution and protected by labor laws. … settings and procedures the ensure all employees are treated in a fair and equal manner. Existing labor laws protect employees from discrimination, unfair treatment, retaliation, and other work-related issues. For this large company, making business decisions in consideration of employment protections is essential toward ensuring fair treatment of employees. The significance of fair treatment of all employees in this large company with respect to applicable federal antidiscrimination laws, federal health and safety laws, and state laws is … seek to segregate an individual or group based on their unique attributes from other individuals. According to Jennings (2018), workplace discrimination incorporates “disparate treatment, disparate impact, and pattern or practice of discrimination” (p.731). These three concepts were the premise for initial federal laws enacted to protect……
Coble, C. (2015, June 11). Can Undocumented Immigrants Get Workers’ Comp? Retrieved March 12, 2020, from https://blogs.findlaw.com/injured/2015/06/can-undocumented-immigrants-get-workers-compensation.html
Grabell, M. & Berkes, H. (2018, February 7). Florida Bill Seeks to Stop Arrests of Injured Immigrant Workers. National Public Radio. Retrieved March 12, 2020, from https://www.npr.org/sections/thetwo-way/2018/02/07/583995647/florida-bill-seeks-to-stop-arrests-of-injured-immigrant-worker s
Jennings, M. (2018). Business: Its Legal, Ethical, and Global Environment (11th ed.). Mason, OH: Cengage Learning.
Lenard, P.M. (1987). Unjust Dismissal of Employees at Will: Are Disclaimers a Final Solution? Fordham Urban Law Journal, 15(2), 533-565.
Lindsay, D.C. & Moore, L.M. (2011). State and Federal Leave Laws: How Recent Legislative Changes Have Complicated Leave Administration. Employment Relations Today, 38(1), 77-90.
Macgillivray, E.D., Beecher, H.J.M. & Golden, D. (2010, December). Legal Developments – Recent Action, Federally and in the Workplace. Global Business and Organizational Excellence, 73-81.
Mello, J.A. (2019, August 9). Why the Equal Pay Act and Laws Which Prohibit Salary Inquiries of Job Applicants Can Not Adequately Address Gender-Based Pay Inequity. SAGE Open, 9(3), https://doi.org/10.1177/2158244019869106
Muhl, C.J. (2001, January). The Employment-at-will Doctrine: Three Major Exceptions. Monthly Labor Review, 3-11. Retrieved from Bureau of Labor Statistics website: https://www.bls.gov/opub/mlr/2001/01/art1full.pdf
Diagnosis and Treatment Plan
In the present scenario, the patient presents with symptoms similar to those of acute myocardial infarction AMI. It therefore follows that the … older one gets, the higher the risk). Coronary heart disease can in some instances result in a heart attack.
The relevance of quick treatment cannot be overstated in this case. The restoration of the flow of blood would be the very first step. To reduce blood clotting … Coronary Artery Disease: Historical Perspectives. Heart Views, 18(3), 109-114.
Lu, L., Sun, R., Zheng, Y. & Zhang, P. (2015). Myocardial Infarction: Symptoms and Treatments. Cell Biochem Biophys, 72(3), 865-867.…
Hajar, R. (2017). Risk Factors for Coronary Artery Disease: Historical Perspectives. Heart Views, 18(3), 109-114.
Lu, L., Sun, R., Zheng, Y. & Zhang, P. (2015). Myocardial Infarction: Symptoms and Treatments. Cell Biochem Biophys, 72(3), 865-867.
The medication, Lomotil, combines two drugs, namely, atropine and diphenoxylate. The artificial narcotic, employed in the treatment of acute limited-duration diarrhea, is associated, chemically, with Demerol or meperidine. Akin to other narcotic drugs, diphenoxylate decreases diarrhea owing to its hindrance of intestinal contents' forward ……
Agzew, Y. (2005). Clostridium difficile–Associated Diarrhea and Colitis: A Significant Cause of Nosocomial Infection. Retrieved from https://www.the-hospitalist.org/hospitalist/article/122898/clostridium-difficile-associated-diarrhea-and-colitis-significant-cause
Joob, B., & Wiwanitkit, V. (2014). Lomotil dependence. Indian J Psychol Med, 36(3), 348-349. Doi: 10.4103/0253-7176.135401
Ogbru, O. (2019). Diphenoxylate and atropine (Lomotil). Retrieved from https://www.medicinenet.com/diphenoxylate_and_atropine/article.htm#what_is_diphenoxylate_and_atropine_and_how_does_it_work_mechanism_of_action
WebMD. (2019). Lomotil. Retrieved from https://www.webmd.com/drugs/2/drug-6876/lomotil-oral/details
Case Study Assessment
Chemical Use Assessment/History and Treatment Recommendations
Dates of Interviews: July 10-15, 2019
Reason for Assessment
Alan is addicted to pornography and masturbation … know how to do it.
Sources of Information
Alan is the sole source of information for this case. He has presented himself for treatment with the understanding that the chemical dependency from which he is suffering can be treated. His current wife Becky could become a secondary … is most likely to feel tempted—and that is his office at work and, on occasion, when with his wife. The first step to treatment will be to identify ways for Alan to reduce……
Brand, M., Snagowski, J., Laier, C., & Maderwald, S. (2016). Ventral striatum activity when watching preferred pornographic pictures is correlated with symptoms of Internet pornography addiction. Neuroimage, 129, 224-232.
Doweiko, H. E. (2015). Concepts of chemical dependency (9th ed.). Stamford, CT: Cengage Learning.
Gilbert, D. (2014). The Novena to St. Boniface of Tarsus: A Pastoral Program for Addressing Sexual Addiction in Colonial Mexico. Catholic Social Science Review, 19: 87-109.
Laaser, M. (2004). Healing the wounds of sexual addiction. Grand Rapids, MI: Zondervan.
Manley, G., & Koehler, J. (2001). Sexual behavior disorders: Proposed new classification in the DSM-V. Sexual Addiction &Compulsivity: The Journal of Treatment and Prevention, 8(3-4), 253-265.
McKeague, E. L. (2014). Differentiating the female sex addict: A literature review focused on themes of gender difference used to inform recommendations for treating women with sex addiction. Sexual Addiction & Compulsivity, 21(3), 203-224.
Park, B., Wilson, G., Berger, J., Christman, M., Reina, B., Bishop, F., ... & Doan, A. (2016). Is Internet pornography causing sexual dysfunctions? A review with clinical reports. Behavioral Sciences, 6(3), 17.
Young, K., Pistner, M.,O’Mara, J., & Buchanan, J. (2009). Cyber disorders: the mental health concern for the new millennium. CyberPsychology & Behavior, 2(5), 475-479.
...Treatment Abnormal Psychology Questions
Q1. According to your text please describe how negative reinforcement increases the avoidance behaviors often associated with anxiety.
Negative reinforcement refers to the withdrawal of an unpleasant stimulus to reward behavior. Using operant conditioning in a laboratory experiment, this might be accomplished by the withdrawal of an unpleasant sound when the desired behavior is completed. However, in the real world, for someone experiencing anxiety, the usual way in which someone suffering from this psychological disorder deals with the unpleasant feelings of anxiety (pounding heart, sweating, and racing thoughts) is to withdraw from the situation and avoid the triggering stimulus. Although this, on the surface, might seem to be sensible on the one hand, on the other hand it can result in the anxious individual becoming socially withdrawn or avoiding positive life experiences because of the fear. For fears of very common things—such as driving—it can significantly impair……
Cameron, O.G. (2007). Understanding comorbid depression and anxiety, 24 (14). Retrieved from: https://www.psychiatrictimes.com/anxiety/understanding-comorbid-depression-and - anxiety
Facts and Statistics. (2020). Anxiety and Depression Association of America. Retrieved from: https://adaa.org/about-adaa/press-room/facts-statistics
… person’s life including personal relationships, school and work. There are various kinds of obsessive-compulsive disorders with different signs and symptoms as well as treatment approaches. This paper discusses treatment recommendations for an adult patient suffering from Body Dysmorphic Disorder. The discussion includes analysis of medical management, community resources and follow-up plans for … focused on fixing the perceived defects/flaws, comparison with others, perfectionist tendencies, preoccupation with perceived defects, and attempts to hide the perceived defect.
The treatment of obsessive-compulsive disorders…[break]…maintenance of treatment for this patient requires a comprehensive follow-up involving collaboration of healthcare professionals as part of a treatment alliance (Phillips & Hollander, 2008). Primary care physicians should collaborate with other clinicians to conduct monthly assessment of the patient and make necessary … Hollander, 2008). Primary care physicians should collaborate with other clinicians to conduct monthly assessment of the patient and make necessary changes to the treatment……
Ahmed et al. (2019, October 3). Body Dysmorphic Disorder Treatment & Management. Retrieved October 10, 2019, from https://emedicine.medscape.com/article/291182-treatment#d12
Harris, P.M. & Drummond, L.M. (2016, October). Compliance of Community Teams with Specialist Service Recommendations for Obsessive-Compulsive and Body Dysmorphic Disorders. BJPsych Bulletin, 40(5), 245-248.
Mayo Clinic Staff. (2016, April 28). Body Dysmorphic Disorder. Retrieved October 10, 2019, from https://www.mayoclinic.org/diseases-conditions/body-dysmorphic-disorder/diagnosis-treatment/drc-20353944
Phillips, K.A. & Hollander, E. (2008, March). Treating Body Dysmorphic Disorder with Medication: Evidence, Misconceptions, and a Suggested Approach. Body Image, 5(1), 13-27.
Phillips, K.A. (2006, July). The Presentation of Body Dysmorphic Disorder in Medical Settings. Primary Psychiatry, 13(7), 51-59.
… (Sertraline) happens to be largely effective. According to Hritzak and Culhane (2004), “Sertraline (Zoloft) is effective and generally well tolerated for the short-term treatment of major depressive disorder in both children and adolescents” (17). In essence, Sertraline, which is essentially an SSRI, impacts unbalanced brain chemicals in ……
American Academy of Pediatrics (2020). Sertraline - Zoloft (Oral Solution). Retrieved from https://www.aap.org/en-us/professional-resources/Psychopharmacology/Pages/Sertraline-Zoloft-Oral-Solution.aspx
Fainzang, S. (2011). Discourse on safe drug use: symbolic logics and ethical aspects. Drug Saf., 33(8), 623-629.
Hritzak, K. & Culhane, N.S. (2004). Sertraline effective for children and adolescents with major depression. J Fam Pract., 53(1), 8-14.
Milev, D.R. (2015). Does Sleep Quality Change after Switch from Wellbutrin SR to Wellbutrin XL in Patients with Major Depressive Disorder? Retrieved from https://clinicaltrials.gov/ct2/show/NCT00616915
Mullen, S. (2018). Major depressive disorder in children and adolescents. Ment Health Clin., 8(6), 275-283.
Navels, R.M., Gentkovsky, S.T. & Williams, B.E. (2016). Paroxetine—The Antidepressant from Hell? Probably Not, But Caution Required. Psychopharmacol Bull., 46(1), 77-104.
Patel, K., Allen, S., Haque, M.N., Angelescu, L., Baumeister, D. & Tracy, D.K. (2016). Bupropion: a systematic review and meta-analysis of effectiveness as an antidepressant. The Adv Psychopharmacol., 6(2), 99-144.
… practices and programs within psychological health via literature review on various studies that exist on this matter.
When it comes to the treatment and management of depressive disorders, psychological interventions play a key role as an alternative treatment. Several treatments have been developed mainly founded on cognitive-behavioral, psychodynamic, humanistic, or interpersonal approaches. According to one latest huge network meta-analysis involving 198 random trials … huge network meta-analysis involving 198 random trials conducted on patients suffering from depression, even though the amount of proof differed across the individual treatments, the health impacts appeared to be of the same magnitude (Barth et al., 2016).
The majority of the trials involved in this huge … 2016).
The majority of the trials involved in this huge meta-analysis were conducted in specialized mental healthcare surroundings. Two questions arise about the treatment and management of depression, particularly in primary care.
One, can we infer……
Australian Psychological Society. (2010). Evidence?based psychological interventions in the treatment of mental disorders: A literature review. Victoria: Australian Psychological Association.
Barth, J., Munder, T., Gerger, H., Nüesch, E., Trelle, S., Znoj, H., ... & Cuijpers, P. (2016). Comparative efficacy of seven psychotherapeutic interventions for patients with depression: a network meta-analysis. Focus, 14(2), 229-243.
Castelnuovo, G. (2017). New and old adventures of clinical health psychology in the twenty-first century: standing on the shoulders of giants. Frontiers in psychology, 8, 1214.
Hofmann, S. G., Asnaani, A., Vonk, I. J., Sawyer, A. T., & Fang, A. (2012). The efficacy of cognitive-behavioral therapy: A review of meta-analyses. Cognitive therapy and research, 36(5), 427-440.
Hughes, A. M., Gordon, R., Chalder, T., Hirsch, C. R., & Moss?Morris, R. (2016). Maximizing the potential impact of experimental research into cognitive processes in health psychology: A systematic approach to material development. British journal of health psychology, 21(4), 764-780.
Kirkham, J. G., Choi, N., & Seitz, D. P. (2016). Meta?analysis of problem solving therapy for the treatment of major depressive disorder in older adults. International Journal of Geriatric Psychiatry, 31(5), 526-535.
Lenz, A. S., Hall, J., & Bailey Smith, L. (2016). Meta-analysis of group mindfulness-based cognitive therapy for decreasing symptoms of acute depression. The Journal for Specialists in Group Work, 41(1), 44-70.
Linde, K., Rücker, G., Sigterman, K., Jamil, S., Meissner, K., Schneider, A., & Kriston, L. (2015). Comparative effectiveness of psychological treatments for depressive disorders in primary care: network meta-analysis. BMC family practice, 16(1), 103.
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Note: my source for new terms has stopped sending me daily email messages, so for now this page will not be updated unfortunately.
The information here has been gathered from the online version of Smart Computing Magazine daily emails, which I subscribe.
Content management software lets you manage Web content. Using such software, you can quickly update specific Web pages, remove content, or add new content to your Web site without any technical expertise such as HTML knowledge. A CMS typically consists of a content management application (CMA) and a content deliver application (CDA).
CERN, which is short for the European Organization for Nuclear Research (or Conseil Europeenne pour la Recherche Nucleaire), performs several different types of research in its Geneva, Switzerland, headquarters. Those who developed the Web interface, Tim Berners-Lee and Robert Cailliau, both were scientists at CERN when they developed the Web in late 1990. Berners-Lee generally receives the bulk of the credit for conceiving and developing the Web with some help from Cailliau. (Keep in mind the Web is a communications system that exists on the Internet; it's not the same thing as the Internet, although many people use the two terms synonymously.)
Berners-Lee, a computer scientist at CERN, originally conceived of the Web as a method for sharing information concerning high-energy physics experiments between physicists working all over the world. No one knew the Web would be the favorite hangout for tens of millions of Internet users within 10 years.
Berners-Lee worked with Cailliau to write the first Web browser and editor software. They also wrote software for the first Web server and defined the communications protocols, such as URLs (uniform resource locators), HTML (Hypertext Markup Language), and HTTP (Hypertext Transfer Protocol). For Berners-Lee, the key element of the Web protocols was to ensure they were easy to use and didn't exclude any type of computer from participating. He felt it was vital that any type of computer running any type of software could run Web protocols.
Although a nuclear research laboratory might seem like a strange place for creating the Web, it was a natural solution to a problem at CERN. CERN is an international organization where about 6,500 scientists from more than 80 countries visit to perform research. It is one of the world's largest scientific laboratories. CERN performs scientific research on a number of fronts, focusing on laws of matter and on experiments concerning particle physics.
Because the scientists collaborating on various projects needed a visual medium over which to share data and because they used computers extensively, communicating using computers over the Internet seemed natural. However, in the late 1980s, communicating across the Internet had plenty of obstacles. The variety of computers and networks in use made smooth communications difficult. Scientists became frustrated with the amount of time they had to spend to make the electronic communications methods work properly. Berners-Lee's development of the Web at CERN filled a growing need by standardizing communications methods for the Internet.
Berners-Lee initially proposed the concept of the Web in 1989. He and Cailliau refined it and had a workable, basic demonstration system by the end of 1990. To encourage CERN scientists to use the Web interface, Berners-Lee made sure to incorporate the ability to view existing documents and Usenet newsgroups within the Web browser. This backward compatibility was a key component for adoption of the Web at CERN.
With the overwhelming presence the Web currently enjoys, it might seem hard to believe that the Web was in its infancy just one decade ago. After its creation, several components had to fall into place before the Web could enjoy widespread use. After completion of the early components of the Web, CERN and Berners-Lee posted the functions to the CERN program library early in 1991, giving universities and research laboratories around the world access to them. By 1993, more than 50 Web servers were up and running. However, with limited resources available to further develop the Web and to develop more user-friendly Web browser technology, Berners-Lee put out a plea for help from other developers. With the idea for the Web in hand, Marc Andreessen and NCSA (National Center for Supercomputing Applications) developed a graphics-based Mosaic browser, which eventually became available for Macintosh computers and PCs. As Mosaic's use began to spread across the world, more and more information became available on the Web. Consequently, the Web's usage also grew, much faster than almost anyone envisioned.
Although CERN doesn't focus on computer technology research, it does operate a massive computer network at its headquarters, consisting of nearly 10,000 desktop computers all running through a powerful network of servers. And, through its high-speed Internet connections, CERN scientists can collaborate with colleagues around the world.
CERN, founded in 1954, provides scientists with state-of-the-art research facilities. Beyond the Web, scientists at CERN are responsible for dozens of inventions and discoveries that have led to advancements in cancer therapy, medical imaging, industrial imaging, food preservation, and destruction of toxic products. Several amazing research tools are available at CERN, including a particle accelerator that is more than 16 miles around and in which particles travel near the speed of light. CERN also owns the world's largest magnet, which weighs more than the Eiffel Tower.
A group of servers used to balance heavy request loads coming into a single DNS (domain name server) and IP (Internet Protocol) address. Instead of forwarding all Web browser requests for a page’s content to a single server, the requests are spread out among several machines for that specific URL (universal resource locator). Web farm setups are also good for providing content and service backup in case one server in the group fails.
Provides additional information about variables within programs. Before Hungarian notation was widely used, programmers often forgot important details about a variable, such as its data type (a data type determines what you can and cannot do with a variable). Charles Simonyi, a Microsoft programmer, developed the method of notation that requires programmers to place a three-letter prefix before a variable name. Therefore, a list box entitled “Files” might be called “lstFiles” so the programmer would know the variable refers to a list box. The convention is widely used within Microsoft and its development community.
A halftone is a printing term that refers to a copied image that is rendered in black-and-white (or another single shade) by means of reproducing it in dots of varying size or concentration. Halftones are created from continuous-tone pictures, such as a photograph where the shades and images are seamlessly blended together. For instance, a dark area in a picture represented in halftone is created by large dots spaced closely together.
Most laser printers, which don’t have the capacity to reproduce images using differently sized dots, use a technique called dithering to create halftones. Dithering means that the printer simulates different shades by spacing the dots closer together for a darker look or spacing them farther apart for a lighter appearance. The human eye naturally fills in the space between the dots to make the area look blended, much as a pointillist painting from a distance looks as if it were created with smooth brush strokes.
Frederic Eugene Ives [1856-1937] is attributed with the invention of halftone technology, which he revealed to the public in 1888. He achieved the photomechanical process by photographing an image through a screen. The density of the mesh would determine how clear or grainy the final product would appear, which is measured in lines per inch. DP (desktop publishing), on the other hand, doesn’t use screens; it just simulates the photographic process. Some programs even require the user to specify a screen frequency even though there is no such equipment in sight.
Halftones are monochromatic by definition, but you can use them to reproduce full-color pictures. In traditional printing, four halftone plates of an image are rendered in yellow, cyan, magenta, or black. When laid over one another, the dots merge together in the viewer’s eye and the image appears to have all the same shades as the original.
Newspapers, magazines, and other printed matter from letterpress, offset, rotogravure, or silk-screen processes use the halftone technique to deliver images. In DP, halftones are usually used for artistic effect.
Communication in which data bits don't need to wait for a certain event or time to be transmitted. Telephone communication is one example because both parties can speak at the same time. Synchronous transmission, on the other hand, occurs at regular, structured intervals. Most of the communication between a computer and a device, such as a printer or a modem, is asynchronous; communication within a computer system generally is synchronous because it is regulated by the microprocessor. Because of the freedom involved in asynchronous transmissions, a computer system must determine the starting and stopping points of a string of transmitted data with data bits known as start and stop bits. Compare to synchronous transmission.
Abandonware is a designation given to software that developers no longer support or sell. Old arcade and console games generally are labeled as abandonware, as are old computer games and outdated applications. Abandonware should not be confused with freeware, which the authors or owners intended to be free from the outset, nor should it be confused with shareware, which is created to make a profit. Abandonware is commercial software that once sold for a price and is no longer available.
The Internet has magnified the issues surrounding abandonware by making it easier to distribute, but all Internet users should be aware that it is illegal to download most of the abandonware you find online. Although the software may no longer be supported or sold in stores, the individuals who own the rights to the software still have the right to distribute it as they see fit.
The fact also remains that a company potentially can begin selling its old software again, and abandonware distribution in the meantime will cut into any future profits it would receive by doing so. For these reasons and many more, most companies are sending cease and desist letters to the leading abandonware sites and occasionally taking legal action to protect their software. The IDSA (Interactive Digital Software Association) is perhaps the most proactive antipiracy group trying to stop the spread of illegal abandonware, but individual companies, such as Nintendo, also police the Internet and attempt to shut down sites illegally distributing copies of their software.
Sometimes designers, developers, or people with the rights to distribute their software grant the computing community rights to copy and distribute their old commercial titles, and this is the only circumstance where obtaining abandonware is legal.
An acronym for describing storage media such as a DVD as double-sided high-density.
A chip architecture that provides the microprocessor with the capability to process more than one instruction in every clock cycle.
An infrared data transmission that can reach 115 kilobits per second. SIR is part of the IrDA 1.1 standard.
An encryption term that refers to normal text prior to encryption (a process that transforms normal, readable text into coded text that cannot be read without the assistance of specific encryption software) and following decryption. The term cleartext can be used interchangeably with the term plaintext. See decryption. See encrypt.
A modem that uses your cable TV connection instead of a phone line to connect to the Internet. Because the bandwidth of coaxial cable is much higher than that of the standard phone line your telephone company uses, the speed advantage of cable modems versus regular phone modems is profound. Cable modem speeds range from 500Kbps to 10Mbps. The top speed of phone modems, by comparison, is almost 10 times slower, at 53Kbps. Cable modems' highest speeds are for downloading; you won't be able to send data nearly as fast because cable TV networks are designed primarily to send information out to homes. Overall speed also varies widely because bandwidth on a cable TV network is a shared resource. If everyone on your block signs up for cable modem service and downloads large files, the available bandwidth--and speed--will drop dramatically. Most cable modems are currently external models that connect to a computer via an Ethernet port. Compare to Asymmetric Digital Subscriber Line (ADSL).
Seat is a term often used in business software licenses. A seat refers to number of users a license supports at any one time. If you license software for ten seats and eleven people are using the software, you’re violating your software license and need to purchase an additional seat.
Fonts that simulate rough handwriting. Many script fonts really do look much like someone’s scribbles, but the eveness of the spacing gives away the fonts' digital origins.
A simple program that activates when a computer has been inactive for a specified period of time. Screen savers, often moving image or graphic displays, were originally designed to prevent images from being burned into monochrome monitors. Any image left unchanged on a monochrome monitor for an extended length of time ran the risk of leaving a permanent imprint. Today's new monitors no longer run the risk of having their screens imprinted by images, but screen savers are still popular for their entertainment value.
A clear film that covers a PDA or desktop computer screen to protect it from scratches and dust. Screen protectors are also available for screens on other items such as MP3 players, cell phones, or GPS navigation devices and usually last between one and three months.
Refers to a computer monitor's ability to display a range of shapes without distortion. Many monitors do a poor job of reproducing polygons and other shapes.
The appearance of a flicker or unsteadiness in an image on a monitor's screen. The flicker can have several causes. If the refresh rate is too slow for the application currently running, the image is not being redrawn quickly enough to display the most current image. Low-persistence phosphors are more likely to cause flicker.
The process of copying information found on a Web page, such as an email address, into a database or other program. Spammers sometimes employ robot software (sometimes referred to as bot, crawler, or spider software) to scrape email addresses found on the Internet.
Term applied to the actual structure of a database, usually used to describe the graphical interface such as tables, columns, or fields.
On a video monitor, this is the number of vertical or horizontal sweeps per second.
Refers to the beam projected by the electron gun in a traditional CRT (cathode-ray tube) monitor.
The part of a scanner that moves over an image and then scans it.
The higher the contrast in a scanned image, the bigger the span between black values and while values.
In a scanner, this is the area to which movement of the scan head is limited.
A particularly bright color that, when displayed on a monitor, tends to “bleed” at its edges, which results in a blurry image.
In Twitter, the commercial “at” symbol (@) goes in front of a person’s username to create a link to the person’s profile page. Many tweets will include multiple @usernames to call out friends, co-workers, customers, prize winners, and other Twitter users.
If you see a tweet (a Twitter post) that you would like to share with your followers, you can retweet it. When you retweet, a small retweet icon will appear at the bottom of the post, along with your username. Some users add "RT" to retweets to make it clear that the post is a retweet. The "RT" acts as symbol rather than a command; you don’t need to use it to retweet. You can click the Retweet icon in Twitter to retweet a message.
An online seminar. Such Web conferences are often interactive: the person giving the seminar can receive live input from the people in virtual attendance. Webcasts, on the other hand, are generally one-way presentations.
A hashtag (#) is used in Twitter (and sometimes on other social media sites) to designate a keyword. It’s meant to help people (who are searching for posts on the same topic) to find your post. For example, you might put a hashtag in front of “computer” (#computer) when you tweet about repairing your business’ workstation. People searching for #computer will see your tweet.
An Internet meme is an image, phrase, video, that not only goes viral, but is adopted by users across the Internet. An example is the lolcat: an image of a cat, along with a caption that is supposedly written by the cat. Public relations teams sometimes attempt to create Internet memes that feature certain products.
Short for "permanent link," a permalink is a URL (uniform resource locator) that isn’t expected to change. You may encounter a permalink when you are reading a news piece on a website’s main page, for example. The main page will replace that piece with new content soon, so you’ll want to follow the permalink and bookmark that link if you intend to return to it.
In social networks, your profile is your presence on the network. Many social networks have a profile page that includes a biography, images of you , and any other information you’d like to share. Keep this sharing in mind as you fill out such profiles; many profiles give you the opportunity to provide personal contact information. Sharing that sort of information with the public can lead to spam an junk mail.
In Twitter, a direct message is a private message that you send to a specific user. It isn’t shared with your followers.
Percentage of time that a machine, component, or computer periperhal is actually in use. The lifespan of a product may be roughly estimated based on its duty cycle. The lifespan of the product is measured in total hours of use and may exceed 1,000,000 hours.
A list of data contained in a computer's memory when a program is prematurely terminated. The data list is either saved to diskette or sent directly to a printer. A dynamic dump lets program developers track what is happening in the memory during any given moment in the execution of an application.
In a GUI (graphical user interface), a menu that is opened when the menu name is clicked, letting the user choose one command from a list of several options. The File menu of a word processing document is an example of a drop-down menu.
A phrase used to describe languages and systems that make use of objects, or distinct pieces of data. Object-oriented programming features reusable, somewhat standardized code pieces linked together to create new applications.
Wire speed refers to the physical speed support by a wire. Wire speed can be used when describing hardware, however. Switches, routers, and other networking hardware are said to run at wire speeds if they can operate at the same speed as the wire.
This is the term used most frequently to describe a computer that is not connected to the Internet. When you’re working offline, you’re not connected to or actively browsing on the Internet. This term also describes a computer within a network that is not connected to the computer network at that time. Another Internet-related meaning for the term “offline” relates to offline browsers or readers. These software programs let users download e-mail and information from Web sites and browse the material after disconnecting from the online service. Being able to read Internet transmitted data while offline may save the user online fees and free up her phone lines.
Hardware components, such as printers or scanners, may be connected to a system and may even be turned on, but if they’re not in the Ready mode, they’re considered offline. Often, some kind of an error sends a printer offline.
The term can also refer to storage. Offline storage usually refers to the floppy diskettes, discs, Zip disks, and tapes of computer data stored in a physical library.
Adjusting the size of the space between lines to make the top and bottom margins equal. This feature is found mostly in word processing and desktop publishing software.
Refers to the number of fields placed on a monitor screen per second.
In computing, 3-D graphics are created by combining numerous triangles to form a desired shape. The term “vertex” typically refers to the individual points or corners of these triangles—the points where two sides of a triangle meet. These vertices are, in fact, the very “virtual matter” that creates a 3-D object.
When a graphics card processes an object, the card receives information on all of the vertices used to build it. Each vertex carries information about the 3-D coordinates x, y, z, and w (weight). Color information is often specified in the form of a diffuse as well as a specular color, and then coded in the RGBA (red, blue, green, and alpha) format. One or more coordinates representing the texture and position for the vertex are also supplied, along with fog effect and point size information, and the vector that points orthogonal off the vertex’s surface. Although the vertex is the smallest unit in a 3-D image, it carries a tremendous amount of information.
Certain graphics processing units offer what is called the vertex shader as a graphics processing function that is capable of adding special effects to objects within a 3-D scene. It accomplishes this by performing mathematical calculations on the objects’ vertex data. As mentioned above, vertices carry data about color, coordinates, textures, lighting, and more. Vertex shaders do not actually change the type of data related to a vertex; they simply change the values so that a vertex appears on-screen with a different color, texture, or position. This process enables realistic movements, motion blur, blending, morphing, and so forth.
Vertex skinning (sometimes called vertex blending) is a technique used in 3-D graphics. It lets programmers blend the edges of computer-generated shapes at their vertices. Vertex skinning takes care of the miniscule gaps often found between the joints of a 3-D character. The triangles and vertices that make up these parts of an image can be blended where they intersect with each other.
A slang term used to describe a software program or piece of hardware that is plain or has very few added features.
A unique name assigned to a storage medium, usually at the time it is formatted. DOS-based systems rarely use volume labels, but Macintosh systems frequently refer to them on-screen as volume names.
Software designed to perform certain housekeeping tasks, such as those related to managing system resources (such as diskette drives and printers) and file capabilities (such as sorting and copying). Utilities also can be used to diagnose a problem on a PC. Utilities are usually installed as memory-resident programs permanently stored in memory.
The amount of storage on a storage medium, or the name of the medium itself. A single diskette, for example, may contain several volumes, as in situations where a hard drive is partitioned into several drives, each of which is a volume.
This term is often used to describe a type of keyboard key. A linear key offers consistent resistance to your finger as you press it. Many, if not most, keyboards have linear keys. An alternative is the tactile key, which provides peak resistance part of the way through the key press. The resistance signals to the typist that the key has been pressed far enough for the character to register; fast typists take advantage of this by not pressing the key any farther and moving on to the next key. Tactile keys are also helpful for typists who “pound” their keyboards.
Marks on a page that help ensure all elements are aligned properly.
In a paint program, the act of filling in an area with a specific color or pattern.
Reformat is a term used to describe the process of re-initializing a floppy diskette or hard drive. When you reformat a floppy diskette, the data on the diskette is erased, and the diskette is then initialized to the type of computer operating system you’re using. For example, not all computer operating systems read data off floppy diskettes in the same way. Windows-based computers can’t read diskettes formatted for a Macintosh and vice versa unless a third-party program is used to interpret how the data is stored on the floppy. Without the third-party program, the operating system will think the diskette is bad and should be reformatted. Many store-bought floppy diskettes come preformatted by the diskette manufacturer for a particular type of computer. So if you mistakenly purchase preformatted diskettes for a Macintosh and you have a Windows-based computer, you will have to reformat all of them before you can use them on your computer.
When it comes to hard drives, there are two types of reformatting. One is called a low-level reformat, and the other is called a high-level reformat. The most common of the two is a high-level reformat. A high-level reformat on a hard drive works exactly like reformatting a floppy diskette. All the data on the drive is erased, and it’s initialized to the type of operating system you are using. Where a high-level reformat only erases user data from the hard drive, a low-level reformat removes all physical information about the hard drive from the drive itself.
The physical information about the hard drive contains information such as how many sectors, cylinders, and tracks are on the hard drive. Physical information also includes the type of disk controller the hard drive is accessing. Most modern hard drives (IDE [Integrated Drive Electronics]- and SCSI [Small Computer Systems Interface]-based) come low-level formatted by the hard drive manufacturer. It’s not recommended for a novice computer user to perform a low-level reformat on a hard drive because if it’s done inocorrectly, your hard drive will become useless, and you’ll have to either send it back to the manufacturer to reset its settings or take it to a reputable computer repair shop in the hope that they can reset the drive.
A way of signifying that certain text has been edited. Redlined text isn't necessarily marked in red; it can appear in any color, or in bold, so long as it stands out from the other text. This technique is used to distinguish text added or changed by one user in a document that is being worked on by two or more people. For instance, Microsoft Word's Revision mode lets one or more people make editing suggestions to a file. The changes made can be shown on-screen and/or on the hard copy, with a particular color used for each person.
To send input or output through a device other than the one usually used for that operation. For example, output can be redirected so a saved file goes to the A: drive instead of the C: drive.
Raster, in relation to computer displays, is a rectangular pattern of lines traced by an electron beam to create an image called horizontal scan lines. Raster is short for raster scan. Rasters appear on both TV screens and computer monitors. The raster is slightly smaller than the physical dimensions of the display screen. Also, the raster varies for different resolutions. For example, a VGA (Video Graphics Array) resolution of 640 x 480 on a 15-inch monitor produces one raster. An SVGA (Super Video Graphics Array) resolution of 1,024 x 768 produces a slightly different raster.
Most monitors can sense the size of the raster and automatically use the optimal raster depending on the monitor’s size and the video adapter’s resolution. In addition, most monitors have controls that let the user move the raster, resize it, and even rotate it. A raster graphic, also known as a bit-mapped graphic, is a type of graphic that consists of rows and columns of dots that make up the image. The value of each dot is stored in one or more bits of data.
Raster graphics are often compared to vector graphics: Vector images are generated by using mathematics to determine the position, length, and direction in which the lines of the image are to be drawn. Unlike raster graphics, which are made up of millions of mapped dots, vector graphics are composed of a collection of lines. A raster graphic file is usually larger than a vector graphic file because it contains all the information about the image within rather than being calculated upon viewing or printing. Raster graphics are more difficult to manipulate than vector graphics because in a raster graphic, you’re working with each dot that makes up the image instead of working with the one formula that draws the lines of a vector graphic. Examples of raster graphics file types include BMP (bitmap), GIF (Graphics Interchange Format), JPEG (Joint Photographic Experts Group), and PNG (Portable Network Graphics).
Term associated with raster:
RIP (raster image processor): In order to print vector-based images, you’ll need a RIP (raster image processor). This is a device that converts vector images into raster graphic or bit-mapped images. RIPs compute the brightness and color value of each pixel on the page based on the vector graphic’s calculations so that the resulting pattern of pixels re-creates the graphic and text as originally described in the vector image. All Postscript printers contain a RIP that converts Postscript command into raster-based pages that the printer can output. RIPs are also used to enlarge images for printing, phototypesetting, or electrostatic plotters. They use special algorithms, such as error diffusion, to enlarge images without sacrificing clarity.
A computer graphic technique used to render photographic-quality, realistic images. Radiosity is based on dividing an image into smaller polygons, or patches, to determine shadow and light patterns when creating images from 3D models. Unlike ray tracing, which follows rays of light between a light source and the objects it illuminates, radiosity takes into account both the light emitted from a light source and the light reflected by all objects in the image’s environment. That is, radiosity accounts not only for a source of illumination (such as a light bulb) but also for the effects of that illumination as it is absorbed by, and reflected from, every object in the “picture.”
Radiosity, sometimes known as secondary illumination, takes into account that the surface light from a reflection is a source of light within a picture. The amount of light a surface produces is based on the texture of the surface. For example, a wall color in a matted material will reflect less light than a wall with a glossy material.
Cindy Goral, Kenneth Torrance, and Donald Greenberg introduced this technique in a paper entitled “Modeling the Interaction of Light Between Diffuse Surfaces” at Cornell University in 1984. They derived the first radiosity image from a thermal engineering technique of the same name that was popular in the 1960s. Radiosity is one of the cornerstones of global illumination techniques for rendering physically realistic images.
Radiosity has become an integral part of many computer games and motion picture special effects. Many computer game developers are using radiosity to provide a greater sense of photorealistic imagery and depth to their games. If radiosity techniques were not used in computer games, games such as Quake, Project Gotham Racing, and Final Fantasy X would look very two-dimensional. The game player would feel that there was a lack of detail and depth to what he was seeing on the screen. Many of the game developers who have an understanding of radiosity program their own radiosity engines to work in conjunction with 3D-enabled video cards in your computer, such as the graphics engine built in third-person 3D game Max Payne.
If radiosity techniques were not used in special effects in movies, many of the background images, set props, and explosions would not have any real depth to them, and their presence would defeat their purpose in the movie. This is because the human eye is sensitive to the absence of radiosity in a three-dimensional image. Your brain will let you know when an image you’re looking at is not real. This is why many special effects studios such as Lucas Digital’s Industrial Light + Magic and animation studios such as Pixar Animation Studio are constantly working on computer programs to offer more realistic effects.
The proliferation of the PC has brought desktop publishing to the masses. Having a license to publish brochures, newsletters, and Web pages doesn’t mean that everyone should, though. Some things, such as page layout, sometimes are best left to the experienced user.
Layout is the pattern or arrangement by which a user places the elements of a publication on the document itself. Those elements can consist of a variety of items, including text blocks, headlines, photographs, and graphical images.
The layout the publisher creates should determine which elements on the page he would like to emphasize. A good page layout also should organize the information through proximity and alignment, and it should be visually appealing. Graphical elements, color usage, and type styles are also important components in layout. A poor layout can hinder the publisher’s attempts to make his message understood. Several books, magazines, and Web sites are available to help you with design principles. Of course, everyone has his idea of what makes a visually appealing layout, but following a few basic design and layout principles will give you a better chance of success.
Fortunately, for those of us who have limited design and layout skills, nearly every type of publishing software contains tips, hints, and templates to help you create appealing, useful layouts. In Microsoft Word, for example, you can set type size, font, line spacing, and text alignment to create a layout that organizes your text in a much more visually appealing manner than using a single kind of text can. Presentation and publishing software packages are especially helpful in providing templates that fit a variety of topics and situations. All you have to do is enter your text and graphical elements in the positions that the template indicates.
Layout and design are especially important for Web pages because visitors need to be able to navigate the site easily. Visitors also want to be able to quickly decipher the information at your site. If Web visitors find the site’s layout too difficult to use or understand, they’ll jump to another site as quickly as they can click a mouse.
Although you can use the term launch in several different computer-related contexts, it nearly always refers to starting a process. Starting a piece of computer software commonly is called launching the software; in this instance, launch is synonymous with run or execute. For example, most OSes (operating systems) launch automatically when you turn on your computer.
Windows 98 includes a Quick Launch Toolbar, which contains buttons that give users quick launch access to commonly used programs, such as Microsoft Internet Explorer. The Quick Launch Toolbar is just to the right of the Start button on the toolbar. You can add buttons to the Quick Launch Toolbar by dragging files onto it. Remove buttons by dragging them to the Recycle Bin.
Many computer companies use the term launch to describe the release of a new software or hardware product. Companies often will hold launch parties for employees and members of the media to publicize the new product. When a company or individual releases a new or redesigned Web site to the public, the site is relaunched.
Latency is the delay between the moment you make a request from a computer’s storage device and the moment the storage device has located the data and is ready to deliver it. Essentially, latency is wasted time because other computer components must wait for the data before they can work again.
Nearly every piece of computer hardware related to data storage and retrieval, including hard drives, network connections, and memory chips, experiences some type of latency. Of course, the computer’s latency isn’t like the latency you experience waiting in the doctor’s office or for the final minute of an NBA game to end; computer hardware latency usually is over within a small fraction of a second.
One common form of latency occurs with your computer’s RAM. RAM latency, usually called CAS (column address strobe) latency, measures the amount of time it takes the RAM to find and deliver data from memory to the microprocessor. CAS latency involves a miniscule amount of time—it’s usually measured in nanoseconds, or billionths of a second—but CAS latency can cause a drag on the performance of the microprocessor while it waits for data from memory. Another common form of latency, called rotational latency, occurs within the hard drive. Rotational latency measures the amount of time it takes the hard drive’s platters to find and deliver the requested data. Smaller rotational latency measurements allow the hard drive to deliver its data more quickly. Again, rotation latency only involves a small fraction of a second—newer hard drive platters typically spin at 10,000rpm (revolutions per minute)—but even small delays can hinder the performance of the microprocessor.
In networking, latency is used to describe the amount of time a packet of data needs to travel from the source to the destination.
Allows users to edit and then save files.
In a transmission, any data or application preceding and/or following a bigger, more important program or chunk of information that helps launch or run the main application successfully. For example, the http:// part in a Web address could be described as a preceding wrapper for the URL address that follows. Wrappers are also used to determine authorization for users who want to change or view the “wrapped” information or program.
A group of computers connected with networking hardware and software so users working toward a common goal can share resources, such as an accounting department or marketing division information. Workgroups can be connected to other workgroups in a larger network structure or can stand alone as separate, mininetworks.
The automatic placement of words on a new line when they reach the right margin of a document and are too large to fit on the current line but, if moved to the next line in their entirety, would leave a blank space on the previous line. If an automatic hyphenation feature is turned on, a portion of a word may be placed on one line, split with a hyphen, and continued on the next line.
A bordered area on-screen that contains an application or document, often used in GUIs (graphical user interfaces) such as Microsoft Windows or Apple Macintosh. Each window can be enlarged, reduced, or minimized to an icon, which temporarily removes it from view. A window provides for multitasking (meaning several programs can be run at once) and lets users cut, copy, and paste information from one window to another. Additionally, windows can be arranged side-by-side (tiled) so that the user can see the full window for a document or application, or overlaid so that the front-most window is seen in full while only the title bars show for windows in the background (called cascading). Windows are enlarged or reduced by clicking on zoom buttons in the far upper-right corner of a display. When an application is open, there is another zoom button (similar in appearance to the aforementioned ones) that resizes a document window within a program, letting the user see, for example, several Microsoft Word files at once. Reduced windows can be resized further by placing the mouse pointer on their borders, pressing the left mouse button, and dragging to the desired position.
Miniwindows often referred to as "floating palettes" because they are always on top of other windows, such as a document or page layout window, and can be moved anywhere on-screen. Generally lacking title bars and minimize/maximize buttons, they do have close icons. Common examples include the Control Palette in PageMaker or the Trap Information palette in Quark XPress.
A description for the layering of windows, one on top of the other, on the display of a windows-based OS (operating system). Compare tiling.
Often used to represent some generic product, as in "Company ABC sells widgets." In programming terminology, a widget is a combination of a graphical component of an application and some programming (a scroll bar or checkbox are common examples of widgets). The widget has a defined look and function. Although it’s possible to create widgets from scratch, most graphical environments come with a predesigned set of widgets that let programmers quickly plug visual components into their applications.
Created at MIT in the 1950s, Whirlwind was the first electronic digital computer. Also the first to use magnetic core memory.
The code name for Microsoft's Windows XP operating system, based on the Windows NT kernel. Originally set to debut in March 2001, Whistler was first called Neptune before Microsoft combined it with another operating system called Odyssey. The result, Windows XP, was released on October 25, 2001.
Named after Whetstone, England. A floating point operation benchmark ("Whetstones per second").
The characters, including spaces, tabs, and characters, that only appear as blanks in on-screen or printed text. In desktop publishing, white space is a section of a page that is unused by text, graphics, or other design elements. White space often is used as a design element to call attention to other objects on a page or to prevent objects from appearing crowded.
A hacker who breaks into a computer system for the thrill of it. White hat hackers don’t deliberately destroy or steal data that belongs to others. Instead, they usually notify the system’s owner to the vulnerability before someone else has a chance to exploit the weakness.
The level of whiteness in a video signal.
Refers to wireless hacking. Hackers target vulnerable devices such as PDAs, wireless phones, and others.
Help available from an OS (operating system) program at the request of the user.
There are three types of code (a system of symbols presented in a manner a computer can understand): source code, object code, and machine code. In the before, during, and after of programming, source code is the before. Programmers design programs using source code. They then run the source code through something called a compiler. Although programmers can usually read and manipulate object code, nonprogrammers typically cannot read or understand object code or, in many instances, source code. The compiler creates object modules. All the different modules are then linked together or assembled to execute a program or function.
The intermediary code that’s been compiled is the object code, or the “during” of software programming. This code may or may not be the same as the final stage of code, the machine code. Computers cannot read high-level language (language generally intelligible to humans) or source code, and frequently, computers can’t read object code either. A link editor takes the object code and translates it into low-level language, or machine code, which then runs the program or function.
The foundational material of a hard disk platter, tape, flexible magnetic disk, or optical disc. For example, a hard disk’s substrate may be aluminum or glass, while a diskette’s substrate may be plastic such as polyethylene terepthalate. Manufacturers apply appropriate data storage coatings to the substrate to make a usable medium.
A programming language that uses call-by-value function calls, which evaluate their arguments before entering the body of the function.
A secret-key (symmetric) encryption algorithm that typically works on a single bit of a message’s data at a time. In the most common type of stream cipher, a key (comprised of a stream of bits) is generated without regard to the data being encrypted. The key, or keystream, is then combined with the data to encrypt it. There are many types of stream ciphers, and they are generally considered fast forms of encryption. A stream cipher with a randomly generated keystream forms the basis of the popularized “one-time pad" or Vernam cipher, which despite its impracticality offers an extremely high level of security.
A process developed by IBM and announced in June 2001 whereby a microchip's silicon is stretched so that the atoms that make up the silicon are aligned. This results in silicon with rows of aligned atoms, which lets electrons flow at speeds up to 70% faster than nonstretched (or nonstrained) silicon. This, in turn, enables the microchips that use strained silicon to operate up to 35% faster than ordinary microchips.
Short for keystroke, or the act of pressing a key on a keyboard to enter data into a computer.
A sleeve is a protective shell for your mobile device. Slimmer than a typical laptop bag, a sleeve gives your tablet or laptop basic protection against day-to-day bumps and scratches. This sort of case is handy for users who bring a laptop from one meeting to another, as it offers protection without the bulk of a standard case.
A picture of the contents of a monitor's screen. Press the PRINT SCREEN key to take a screen shot. Next open an image-editing application (such as Microsoft Paint, which comes with Windows) and then paste the contents of the Windows clipboard onto the canvas (press CTRL-V). Your screen shot will appear.
For as long as we’ve had office software, sharing digital document files (among users who have different types of office software) has been problematic. If a colleague creates a document with one brand of office software, you might find that important formatting is lost when you open it in your (different) office software. In fact, it might not open at all. To improve widespread (and long-term support) for digital documents, the Open Document Format Alliance created an open-source document standard. The format is supported by many popular office suites, including modern versions of Corel WordPerfect Office, Google Docs, OpenOffice.org, and Microsoft Office. To save a document as an ODF document, click Save As and look for the ODT (text), ODS (spreadsheet), or related extension.
Wherever you find a fan on your computer case, you are also likely to find a fan grille (sometimes referred to as a fan grill). Not to be mistaken for a fan filter (which blocks dust from being sucked into your system), a fan grille prevents curious children and pets from touching the rotating fan blade. Business PCs typically have nondescript grilles, while gaming PCs often have grilles in eye-catching shapes.
The definitions for "cloud" and "cloud computing" are still evolving and subject to debate, but you’ll find that many people are referring to online services when they say something is "in the cloud." Such services include online photo-editing services, Web-based email services, online storage services, and more. Businesses often think of cloud computing in terms of scalability: Internet-based services that can scale to meet the changing usage needs of a growing business. SaaS (Software as a Service), for example, is software that his hosted online (instead of being installed to your computers). It can be scaled for use by your growing company.
Yet another example of the real world catching up with science fiction, augmented reality describes technology that provides up-to-date information about the world around you. An augmented reality app on your smartphone, for example, may display information about a monument when you aim the phone’s camera at the monument.
A feature in word processors by which a word or phrase has a line or lines drawn through it, indicating that the word or phrase should be ignored or deleted.
An LCD (liquid-crystal display) distortion in which a dark area abutts a light area, and the border between the two shades becomes discolored instead of maintaining a sharp delineation.
A static link is a constant link. A static link is the opposite of a dynamic link.
A diskette that contains the necessary part of the operating system so the computer can boot up. Most computers with hard drives boot from that, but older computers might boot from diskettes in the A: or B: drive. It is a good idea to keep a bootable diskette handy in case something goes wrong with the hard drive, as most computers first check the diskette drives for bootable diskettes before checking the hard drive. A faulty hard drive can be bypassed this way.
Some search engines automatically “stem” keywords you use to search. For example, if you type “heads,” the engine actually only looks for “head,” ostensibly to find more matches. This is an uncommon practice and can sometimes be avoided by putting quotation marks around the keyword.
A Web site that offers incentives for visitors to stay awhile. For example, a Web site with stock quotes, glossaries, or other such features deters users from leaving the site to find other information. Sticky sites have more opportunities to show more advertisements or other site material to visitors than nonsticky sites.
A term used to describe the amount of time a user stays on a Web site. Popular Web sites have a high level of stickiness.
Often used in addition to polymorphic techniques to enable a virus to hide within a computer’s OS (operating system) and remain undetected by antivirus software. By intercepting routines used by an OS to find infected files and documents, the stealth virus then inserts some of its code into uninfected data, tricking the computer into recognizing the file as the original, unmodified version.
A term for software hidden in some free applications. Some retail sites, such as Amazon.com, let affiliates collect orders for them. The affiliates are then given a cut of the sales placed through them. Stealware places a specific affiliate ID on orders from Web sites that use affiliates. If you order through an affiliate, the affiliate's ID is replaced by the stealware, thus “stealing” money from the affiliate. Stealware can remain on a system even after you remove the software that was originally bundled with the stealware.
An individual set of parameters and profiles designed for one user of a multiuser system, such as for each family member using a home PC. It often consists of information about the user, such as the user's name and the password required to access the system, in addition to information about which files and programs the individual can use.
A tool found in many image-editing programs that helps you sharpen the edges of certain colors. When scanning images, this feature usually helps to improve the image’s quality.
A hidden command in a document that will not be printed when the document is sent to the printer, because it usually represents formatting commands that tell the program to perform functions such as return and indent. Examples of these characters include the TAB, ENTER, ALT, and CTRL keys.
The cache controller in L2 cache memory receives fetch (read) requests from the CPU, looks up the appropriate cache lines in the cache’s tag RAM, and tells the cache’s data store to send the lines of data to the CPU.
A board inside the computer that provides quick storage. Some computers have built-in cache cards; others have slots where a cache card can be installed.
The cache memory areas on and near your microprocessor are a vital component for giving the microprocessor improved speed and performance. The cache (pronounced "cash") provides high-speed, temporary data storage areas the microprocessor can access quickly. You can think of the cache area as a high-speed memory subsystem for your computer.
Cache memory areas are able to improve the performance speed of a microprocessor through four means. First, the cache memory consists of memory technology that works more quickly than the traditional RAM in your computer; it's also far more expensive. (Cache memory typically consists of SRAM [static RAM] versus the DRAM [dynamic RAM] usually used as the computer's main RAM.) Second, the cache memory areas are much closer to the microprocessor than traditional RAM, meaning they can deliver the data more quickly. Third, most cache areas run at nearly the same clock speed as the microprocessor, letting them work more closely in tandem. RAM runs at a much slower clock speed than the microprocessor. Finally, because the microprocessor typically only uses a small portion of a program or a data file at a time, storing the commonly used portion in cache is useful, even if the original program or data file is far too large to fit entirely in cache.
Today's microprocessors make use of two cache areas: L1 (level 1) and L2 (level 2). L1 cache is also known as on-die cache, on-chip cache, and primary cache. L1 cache usually sits directly on the microprocessor and is a smaller memory area than L2 cache. L1 cache is the first area the microprocessor checks when looking for data stored in memory. The L2 cache usually resides on the motherboard, although some manufacturers include L2 cache as part of the microprocessor's packaging or on the microprocessor itself, and is the second area the microprocessor checks for data stored in memory. To improve the performance of the L2 cache, microprocessor manufacturers a few years ago began connecting the microprocessor and the L2 cache with a backside bus. The microprocessor checks both cache areas before checking RAM. When the microprocessor finds the data it wants in the cache areas, it's called a cache hit. If the cache doesn't have the needed data, it's called a cache miss. As the microprocessor's data needs change, it updates the data it stores in the L1 and L2 caches, overwriting the oldest data in the caches.
In newer microprocessors, such as the Pentium 4 from Intel, the microprocessor uses prediction technology to determine the best sets of data to place in the L1 and L2 caches. This prediction technology is important to overall performance because it increases cache hits and minimizes the amount of time the microprocessor must wait for memory searches.
Cache memory first appeared in a computer—the IBM System/360 Model 85—in 1968. Nearly every PC built since then has included some type of cache memory. The Intel 468DX microprocessor, which Intel introduced in 1989, featured L1 cache on the chip for the first time, but it only had 8KB of cache memory. Off-chip L2 cache areas appeared soon after with 486DX4 and Pentium microprocessor chips from Intel in the early 1990s. Intel's Pentium II microprocessor, introduced in 1997, was part of an SEC (Single Edge Contact) Cartridge that included a high-speed cache memory chip. Today's microprocessors usually have 128KB or more of L1 cache memory and 256KB or more of L2 cache memory.
Because of the expense of cache memory, some low-price computers from a few years ago might be missing the L2 cache on the motherboard or microprocessor. Intel's initial Celeron processor, for example, didn't include L2 cache. However, as microprocessor components have continued to shrink and memory components have continued to be less expensive, almost all recent and current microprocessors contain L2 cache. With microprocessor components continuing to shrink, nearly all future microprocessors probably will contain an on-chip L2 cache. Newer Athlon microprocessors from AMD (Advanced Micro Devices), for example, include the L2 cache on the chip, improving its performance by about 300%. Some industry analysts think that as on-chip L2 caches become commonplace, computer manufacturers will begin including an L3 cache on the motherboard.
Terms associated with cache:
cache buffer: A cache buffer is the area of RAM (usually 2MB or less in a PC) that exists within nearly all newer hard drives, CD-RW (CD-rewriteable) drives, and DVD-ROM drives, giving the microprocessor faster access to data that's normally in permanent storage. The cache buffer usually maintains a copy of the latest data the microprocessor retrieved from permanent storage. In most newer printers, manufacturers have included cache buffers, which hold data waiting to be printed. A similar process, called disk caching, reserves a portion of RAM to mirror the last data from the hard drive, giving the microprocessor faster access to the data if it's needed again.
Web browser cache:
Cache also refers to the portion of memory and the computer's hard disk that Web browsers use to store temporary Internet files, usually called the Web browser cache. Using a portion of the computer's resources to store Internet files, especially graphical images, lets the Web browser display Web pages more quickly than it could by downloading the graphics from the Internet. Using a cache area makes sense in this instance because the graphics on a Web page rarely change.
ISPs (Internet service providers) and Internet content providers also make use of cache servers (sometimes called cache appliances), which are specialized computers that store copies of commonly accessed Web pages. Cache servers usually use software to measure the most popular Web pages and then download those pages to the cache server during nonpeak Internet usage times. The cache servers then check back with the originating Web server from time to time to look for changes and updates. Cache servers are located throughout the world, and they help speed downloading of Web pages by two methods. First, they alleviate traffic on the server where the commonly accessed Web page resides, giving the server better overall performance. Second, because chances are good one of the cache servers is physically closer to your computer than the originating server is, the Web page has a shorter distance to travel to your computer and can arrive faster.
A map of the cables that connect components to a computer system. The map shows how each component is connected to the computer.
A device that divides the signals intended for the cable modem and the television. If your home is equipped with a cable modem, when data from a cable company arrives at your home using a coaxial cable, it passes through a splitter.
A category of cable organization products, such as split-loom tubing and heat shrink, that help keep cables neat and improve airflow inside the PC case.
Used when installing a PnP (Plug and Play) ATA/IDE (Integrated Drive Electronics) hard drive so that the computer automatically configures the drive as either master or slave.
When followed by a colon, C refers to the C: drive, usually the hard drive inside a computer. However, this designation can be changed by the user.
The area of a cable station where the satellite dishes and antennae that receive the video programming for the cable network are located. It also houses the routers that connect the feeder lines from the cable modems to the Internet.
A Microsoft archive format used for distributing Microsoft software. Distinguishable by its .CAB file extension, a CAB file contains one or more compressed files in a single file. Large files sometimes span from one CAB file to another.
Software that aids programmers as they develop other software. Such software can help in different phases of development, such as debugging, linking, editing, or others.
To be temporary or capable of change. For example, software gets its name from the idea that changes can be made by altering the programming code. By contrast, hardware is a physical contraption that can be added to or broken but cannot be changed. Also refers to a digital image that lacks definition and crispness. An image is said to be soft when it appears blurry or unfocused.
A record of the state of a system at a particular moment. Also can mean screen shot.
Text is data that a computer stores, and it is represented as words, sentences, paragraphs, and punctuation.
Terms associated with text:
text cursor: An on-screen indicator that marks a specific location within text. When typing text, the cursor marks the location where the next character typed will be placed. When editing existing text, the cursor is used along with the mouse or certain keyboard keys to select text for manipulation. Once text is selected, you can replace, delete, cut, or copy it, or you can change its attributes, such as the style of font. The cursor is moved to different locations using the mouse or directional arrow keys on a keyboard.
text editor: A program that lets a user input text and save the text as a file. Notepad, a standard Windows component, is an example of a text editor. Although programs, such as WordPerfect or Word, let a user edit text, they are generally referred to as word processing programs. The difference lies in the capability for advanced manipulation of text that is found in word processing programs but generally not in a text editor. Text editors tend to be basic programs that let a user enter and edit generic text, but they are not capable of performing a wide range of special formatting.
text flow: The spanning of one body of text across more than one text placeholder. In desktop publishing programs, documents may contain more than one text box, which is a defined region into which text is inserted. The automatic flow of text is something that you can turn on or off within the preferences of these programs. When automatic flow is enabled, if one text box becomes full without holding all of the entered text, the excess text will automatically be placed into the next text box.
text mode: A display mode in which a computer monitor displays only text characters and no graphics. This was the primary type of interface in the days of DOS.
text-only: A mode in which only text is displayed, without graphics. Some Web sites provide a text-only version that loads much faster than the graphics-based version.
text-to-speech: The technology of converting written text into audible words and sentences.
text wrap: A feature found in text editors and word processing programs that automatically starts a new line of text when the right edge of the text area or window has been reached.
Netbooks are tiny, laptop-like devices that owe their popularity to their portability. Because they are so small (and have built-in Wi-Fi), they make good companions for travelers who want to surf the Web. That portability can come at a performance price: some netbooks don’t have the power to rival traditional laptops.
E-readers, which are often referred to as ebook readers, are devices designed for displaying books. Examples of popular e-readers include the Amazon Kindle and Barnes & Noble NOOK. Many devices that are not designed specifically for digital books (such as PCs, smartphones, and tablets) can also display books (once ebook reader software is installed).
Social networks, such as Facebook, have given this term an additional meeting and even turned it into a verb. In social networks, friends are contacts; to friend someone is to add them to your list of contacts in the network.
Microsoft’s latest search engine has gained popularity by providing helpful search results and intriguing users with its main page picture, which changes daily. Run your cursor over the image and you’ll see links that you can click to learn more about the image subject. Bing is a rival to Google.
The maximum rate at which a system can transmit data over network lines. This rate is measured in bps (bits per second). Most current networks use 100Mbps (megabits per second) network cable.
Traditionally a centralized computer system that gives access to more than one person at a time, such as a mainframe. It is also used to describe software several people can access at once.
A control mechanism that lets two or more computers share a single peripheral, such as a printer, a scanner, or a monitor. With an A-B box in use, the user can decide which computer is able to use the device at any one time by turning a switch.
Short for motherboard, the circuit board that provides the foundation of a computer.
A shortened version of the word "modification." For example, a case mod is a modification made to a computer case. One popular example of a mod is a window cut into a side of a computer case to show the insides.
The interference problem caused by the many routes information takes in a wireless transmission. An RF (radio frequency) wireless network transmission, for example, might bounce off of various objects as well as strike the receiver directly, resulting in a jumble of signals of varying and sometimes conflicting properties such as phase differences. The receiver’s job is to sort out the problems caused by multipath and winnow out the best example of the transmission.for example, across a network.
A manufacturer of 12-volt, four pin connectors. The connectors allow your PC’s power supply to connect to other components. Computer enthusiasts often refer to these connectors as “Molex connectors.”
Morphing is an image transition effect used in graphics programs that is constructed by image sequencing between two or more images. In other words, the image in frame 1 is altered slightly in frame 2, then again in frame 3, and so on until the image has morphed, or experienced a metamorphosis, into another different image. For example, in a simple morph, animators may begin with an image of a sphere, and then through a series of frames, the sphere changes into a face. The transition between a man and a werewolf is another, more complicated example that may visually illustrate the effect more dramatically.
Morphing is used in video, graphics, and film and includes 2D and 3D morphs. For images generated from 3D models, 3D morphing can create intermediate 3D models directly from the original. The morphs are then rendered to produce an image sequence that depicts the transformation. In 2D morphing, a new morph must be recomputed every time the viewpoint or illumination of the 3D model is altered because the 2D techniques lack information on the model’s spatial configuration, so changes in illumination and visibility are impossible to control. For example, when a 3D object is morphed in 2D, features not visible in the original 2D image, such as a model opening her mouth, would display as thicker lips instead of showing her teeth. Not only are 3D morphs more realistic, but they are also easier to create.
Morphing is a popular transition effect used in films today, and animators are often awarded the Technical Achievement Award from the Academy of Motion Picture Arts and Sciences for excellence in this field.
Multicast is a one-to-many or multiple-to-many broadcast over the Internet where one or multiple sources send transmissions to multiple receivers; for example, corporate messages to employees, video- and audioconferencing for remote meetings and telecommuting, stock quotes to brokers, and the replication of databases and Web site information. With multicast, source providers can send a single copy of a message to multiple recipients, but only to those individuals who want to receive the information.
Receivers, or listeners, join specific multicast session groups as subscribers, and then only those individuals receive the multicast sessions that are broadcast to the members of that group. Senders are not required to maintain a list of the members because the members sign up for the multicast broadcasts they want to receive. Only one copy of a specific multicast broadcast passes over any link in the network, so copies of the broadcast are made only where paths diverge at a router.
As opposed to unicast broadcasts, which require each listener to make a separate connection to the source server (requires the source to send an individual copy of a broadcast to each requester, also known as point-to-point unicast), multicast sends one message, one time, to many listeners. Unicast receivers are limited by the bandwidth available to the sender, plus unicast causes a tremendous load on the source server, which results in major congestion across expensive WAN (wide-area network) links as the number of listeners increase.
For concerts and entertainment, lectures and educational seminars, and even board meetings, multicast broadcasts are the answer for one transmission source; a university, for example, can broadcast a professor’s lecture to an entire classroom of registered students. Only the students who sign up for the course will receive the multicast lecture, and the source computer at the university only has to make one connection and send one broadcast.
Analysts predict all of television and radio will eventually be delivered primarily over the Internet, and multicast is designed specifically for this function. Hundreds of radio stations already provide multicast sessions of their local broadcasts to the Internet population, and local television station broadcasts are on the horizon. Very soon, you won’t need cable to watch a program in Japan or listen to an underground radio station broadcasting from Russia. Multicast has the potential to expand the Internet beyond email, e-commerce, and billboard sites to global broadcast communications that will offer a true audiovisual window to the world.
Aligned with the right margin, side of a page, or side of a screen.
A measurement concerning the read/write heads in hard drives. Flying height describes how far from the disk surface a head flies while the drive is in use. The heads would normally rest upon the disk surface, but the disk’s spinning motion creates wind which buoys the aerodynamic head mountings (called sliders) like the wings of an airplane. The heads in modern hard drives fly about three millionths of an inch above the disks. Platter rotation speeds are matched to slider designs to produce a desired flying height. Flying height is a frontier in hard drive technology, as lower heights allow denser data. Manufacturers facilitate lower flying heights through smoother disk surfaces and alternative disk materials.
Aligned with the left margin, side of a page, or side of a screen.
A technique used by video cards to help create an illusion of depth. By using this method, objects can be made to gradually appear in the foreground from the background, rather than having an object suddenly pop into view in the horizon.
A short message (no more than 140 characters) on microblogging service Twitter. When you send a tweet, it is available to the public and anyone who has signed up to receive your tweets (known as "following"), depending on the security settings you choose in your account profile.
A daemon (pronounced da’mon or de’mon) is a memory resident computer program that runs in the background, typically without user interaction. Daemons are often started automatically at bootup in a process referred to as spawning. They respond to specific events or triggers to perform predefined tasks.
An example from the UNIX OS (operating system) is the spooling daemon. When an application writes a file to the LPT (line printer terminal) spooler’s directory, the spooling daemon is automatically invoked to print the file. The application wanting the file printed does not need to worry about resource competition or the complexities of LPT spooler. It simply drops the file in the directory and assumes the daemon will complete the task.
Non-UNIX OSes also use daemons, but they are usually known by a different name. Windows, for example, refers to these types of programs as System Agents (Windows 9x/Me) or services (Windows NT/2000/XP).
The term daemon is often used interchangeably with demon, especially in the UNIX world, where daemon is considered mildly archaic. In some circles, a slight distinction is made between the two, where daemons are part of the OS and demons are part of an application or program. In this context, a trigger in a DBMS (database management system) is considered a demon because it is part of the DBMS, not the OS.
The term daemon originates from Greek mythology, in which daemons were guardian spirits.
Appearing first in Microsoft Office 2007 programs, the Ribbon is a large menu that replaces the toolbars found in previous versions. The Ribbon groups icons for commonly used features, rather than storing them in drop-down menus. Although switching from the toolbars (of older Office programs) to the Ribbon can take some getting used to, many users have grown to prefer the Ribbon. In turn, other software publishers have incorporated Ribbon-like menus into the interfaces of their software.
Microblogging is a version of blogging in which posts are restricted in length. Twitter, for example, limits its messages (known as "tweets") to 140 characters. Microblogs are often used to make announcements and brief comments; blogs are better suited to detailed posts.
In forums and social networks, an avatar is usually a square image (an illustration or photo) that represents the person posting the message. Also referred to as profile pictures, avatars often have much smaller file sizes than today’s digital photos. Although your social network or forum will have instructions for resizing your photo, cropping the image to 180 x 180 pixels usually does the trick. "Avatar" also refers to your character in video games and other online worlds.
The paramount wavelength of a color. A shade of color combined with the brightness, contrast, and sharpness of a graphical, photographic, or virtual reality image.
Besides getting rid of the dust and debris that have accumulated on the surface of a computer and its peripherals, housekeeping also can mean optimizing the hard drive, getting rid of old or unused files, or making sure the system clock is running on time. Also a set of directions executed at the beginning of a program.
One of Microsoft’s bug fixes that replaces some current files with revised files in an application.
The open directory in which a user currently is working. When commands are executed within a directory that will affect that directory or its files, the commands can be typed without a path name. Also called the working directory.
A temporary method of bypassing bugs or inoperable features of software. Workarounds, not to be confused with a fix (which resolves a programming problem in a program), can themselves often be ineffective, time consuming, or otherwise problematic. Whenever possible, a vendor will issue a workaround to accommodate users until they have completed a solution to a problem that requires programming changes.
A means of preventing users from editing files or saving files to a storage medium. Information can be write-protected in at least three ways. Through an operating system's file management features, users can activate a read-only attribute on files by using a command such as MS-DOS' ATTRIB. On networks, sharing software can establish security settings that provide write access to some users but not others. Lastly, diskettes have fairly unsophisticated write-protect mechanisms. On a 5.25-inch diskette a square notch is carved out of the side of the diskette (probably next to the label); covering the notch with tape restricts users to read-only access. A 3.5-inch diskette has a square hole in the upper corner of the diskette (again, probably near the label). A tab slides over the hole to lock the diskette, sliding it away from the hole restores write access.
A pathname in relation to the root directory.
Using a serial cable and serial port to transfer data from one device to another.
A data structure which represents a virtual 3D environment, such as that used by developers under the Fahrenheit architecture. A scene graph contains the information for every object in the 3D environment, including its location, colors, transparency level, lighting, etc. It is organized spatially to help the developer keep track of object locations while programming. A scene graph is continually and automatically updated when the application is running to keep it current in light of moving objects in the 3D environment, such as the lead character in a game.
Although scanners were first used to import graphics for desktop publishing, since their introduction, scanners have become common office equipment. They are commonly used for desktop publishing, copying, electronic document distribution, and faxing.
In the past, scanners were specialized machines that required users to have expert knowledge to use them. Nowadays, scanning is simple. No longer do users need to understand such concepts as bit depth and ppi (pixels per inch). Instead, special software lets users get good results with little technical knowledge.
Some of the first scanners designed for home use were the ScanJet series of scanners that HP manufactured. You can use the ScanJet series to create greeting cards or store family documents, and students can even create reports for school assignments. HP’s ScanJet 5400cxi scanner, for example, has new CCD (charge-coupled device) scanning technology for 2,400dpi (dots per inch) photo-quality resolution and fast, 8-second preview scans.
Sawfish is a window manager for the Linux platform. As a window manager, sawfish draws and manages windows only. Other functions, such as configuring background images and creating application panels and docks are left to other applications. Sawfish, formerly known as sawmill, is commonly used in conjunction with GNOME.
A computer that is on a distant communications link to a more powerful system.
A computer expert hired to attempt to break into a computer network, thus helping a company spot its own weaknesses to illegal hacking.
Safe Mode is a Windows troubleshooting tool that lets computer users access Microsoft Windows using only the computer’s most basic drivers. For example, in Safe Mode of Windows 2000, the default settings (which is a VGA [Video Graphics Array] monitor, Microsoft mouse driver, no network connections, and the minimum device drivers required to start Windows) are used. You cannot access CD-ROM drives, printers, or other devices while in Safe Mode.
An example of a situation in which you will want to get into Safe Mode is if your computer won’t start after installing new software. To enter Safe Mode, click Start, Shut Down, and then choose Restart. Next, press and hold the CTRL key until the Startup Menu appears. On some OSes (operating systems), you will need to hold down the F8 key instead of the CTRL key. Next, enter the menu choice number for Safe Mode and press ENTER. When using Windows XP, restart the computer and press the F8 key. When the Windows Advanced Options menu appears, select an option and press ENTER. When the Boot menu appears again with the words Safe Mode displayed at the bottom, select the installation that you want to start and press ENTER. Once in Safe Mode, you can change computer settings or remove the software that caused the problem. If the problem does not reappear after starting in Safe Mode, you know the problem is not with the default settings or minimal device drivers.
If a new device or driver is causing a problem, start Windows in Safe Mode and reconfigure the settings or remove the device. Use Device Manager to check for any hardware conflicts. To use Device Manager, click Start, select Settings, click Control Panel, and double-click System. Next, click the Device Manager tab in the System Properties box. In WinXP, while in Safe Mode, choose the Last Known Good Configuration option. This option starts Windows using a previous good configuration. Safe Mode will not solve any problems caused by corrupted or missing drivers or files.
A menu of choices will appear on your screen after you are in Safe Mode. The most common Safe Mode options are:
Safe Mode: This starts Windows using basic files and drivers, including mouse, monitor, keyboard, storage, video, and default system services.
Safe Mode with Networking: This option starts Windows using basic files and drivers, as well as network connections.
Safe Mode with Command Prompt: Starts Windows using basic files and drivers. After logging on, the computer displays the command prompt instead of the Windows Desktop.
Enable VGA Mode: Starts Windows using a basic VGA (Video Graphics Array) driver. If you have installed a new driver for your video card and Windows is not starting properly, this is probably the most useful mode.
Last Known Good Configuration: Starts Windows using the Registry information that was saved the last time you shut down your system. If you choose this mode, you will lose any changes made since your last successful startup.
A useful and noteworthy aspect of hardware or software is called a feature. For example, a common feature of a word processing program might be that it performs spelling and grammar checks concurrent with the actual composition of a written document. A feature of a notebook computer might be that it runs for six hours on batteries. And an example of a feature of an OS (operating system) could be that it has a built-in Web browser.
Generally, a feature is an intended, documented, and advantageous facet of a computer system. On the other hand, an unintended, undocumented, and disadvantageous aspect of a computer product, such as a program, is called a bug.
An instance of where even good features can turn bad involves the inevitable computer trade-off between an abundance of useful features and a welter of confusing complexities. There reaches a point in program development where the accumulation of more and more features is no longer helpful. Instead, it is counterproductive, resulting in long hours of learning an application or avoiding the use of the complicated application altogether. This condition of an oversupply of features is termed featuritis or feature creep. Feature creep can occur across a series of developing versions of a system or application or in the course of the development of a single application at a particular time. Often the latter case of feature creep will happen because customers or the developers’ supervisors become increasingly and perhaps unconsciously ambitious about a product’s final capabilities and goals.
The name given to a custom icon used for a specific Web site. A Web site can create a 16 x 16 pixel icon that can be named favicon. When a user adds a Web page, Internet Explorer version 5.0 or newer checks for the presence of a favicon.ico file. If the file exists, the favicon is displayed next to the name of the Web page in a user's Favorites list.
Allows a computer to suffer some types of faults without losing data. Operating systems, such as Windows, have some of these capabilities built into their architecture. However, they do not always work.
A malfunction. Most often refers to glitches in a network system but also can refer to individual computers.
Also called bloatware, fatware is software that's inefficient because it takes up a great deal of hard drive space and/or system resources.
In a client/server environment, a fat client does most of its own processing, leaving little or no work for the server.
A version of software that consumes a lot of system resources. This is often the version that runs on the widest range of computers and operating systems; system-specific versions are much more efficient.
A modem protocol feature that lets two modems speed up when transmission improves; it comes into play after using a fall back to compensate for error-ridden transmission.
A method of determining the reliability of a device, typically a hard drive. For instance, a failure rate of 300,000 hours means one failure occured for every 300,000 hours of testing.
The window of time in which a system failure is expected.
A situation in which a computer cannot continue to perform as designed. Failures are caused by power fluctuations, misuse, poorly manufactured or designed hardware or software, and other calamities.
This term refers to the automatic activation of a backup system in case of a failure or the need to repair a server, database, network, or other computer system. The failover backup system is a redundant, or duplicate, system that picks up where the primary system leaves off. This means its deployment is transparent to users. The computing tasks are seamlessly offloaded to this secondary system, which is sometimes called a hot standby or a warm standby.
For a PC, a failover could be a second processor that takes over in case the first processor fails. In a network, a failover can exist for any number of components; for example, it is common for large network systems to employ redundant hard drive arrays. An uninterruptible power supply is another type of failover component.
Particularly vulnerable in networks are the connection paths—the communication lines connecting two points (nodes) on a network. If any one component along the path fails, all traffic along the path stops, disrupting the entire network. Modern networks can have failover connection paths, so if one route to the processor is down, the data can travel an alternate route.
Having a failover is especially important for mission-critical systems, such as credit card processing systems, which are accessed constantly. Computer systems with built-in failover are said to have a very high fault tolerance and are quite expensive.
A computer system designed to shut down nonessential components in the event of a failure but keep alive important functions, such as protecting against a loss of data, as long as possible or until the problem is repaired. Also soft fail system.
Face recognition is the biometric technique of identifying individuals by facial features. Face recognition is a type of biometric analysis, which aims to identify people by using biological or anatomical human characteristics, such as fingerprints and handprints, iris patterns, voice patterns, and facial structure.
More specifically, face recognition employs digital video cameras and software to capture an image, isolate a human face, and extract specific features of the face that do not change. Such features may be upper sections of the eye sockets, the area around the cheekbones, and the sides of the mouth. The individual’s features are then compared to other feature-sets in a database of photographs.
Face-recognition technology works with off-the-shelf PCs and video cameras, making this identification technology relatively inexpensive to install and operate. High-resolution images provide even better matches.
There are four basic methods employed in face-recognition software: eigenface, feature analysis, neural network, and automatic face processing. Eigenface, which means “one’s own face,” employs 2-D grayscale images that represent distinctive features. MIT (Massachusetts Institute of Technology) patented this technology. Feature analysis is similar to Eigenface, but can better accommodate changes in facial movements, such as smiles and frowns. Neural network technology uses both the newly scanned face and the stored face to determine if there is a match. An algorithm looks at the similarity of unique features. Lastly, automatic face processing uses distances and distance ratios between obvious features such as eyes, the end of the nose, and corners of the mouth.
Although it is an ideal application for security, the use of face recognition for public security is a controversial one. One of the initial deployments of facial-recognition technology in the United States was at the 2001 Super Bowl where police in Tampa, Fla., used it to scan faces in the crowd to search for known terrorist suspects. This sparked a major debate about governmental police powers and citizen privacy.
In the private sector, companies use face recognition to limit employee access to sensitive data. An example is hospitals that limit access to their patient records to physicians. As for governmental use, some states are using the face-recognition technology to prevent identity theft. In these states, the DMV (Department of Motor Vehicles) is scanning an applicant’s old driver’s license and comparing it with his new photo.
Face-recognition technology advocates say it is an excellent biometric solution for airport security because it can identify individuals without interaction. Enthusiasts also tout the technology as a way to authenticate ATM (automated teller machine) interactions or voting procedures, and to screen potential government and school employees.
But civil rights advocates, such as the ACLU (American Civil Liberties Union), worry that out-of-date photos and bad lighting could result in numerous misidentifications, or false-positives, when individuals are incorrectly matched with photos of other people. Indeed, one of the privacy advocates’ arguments is that face-recognition software doesn’t work as advertised, and it is easily fooled by changes in hairstyle, facial hair, aging, weight gain or loss, or simple disguises. Of course, the privacy advocates are highly concerned that “face prints” collected by the government will be misused.
Whether face-recognition technology will be widely implemented in public places in the United States depends a great deal on how face-recognition applications balance public security with personal privacy. The nation’s courts will ultimately decide the issue.
Fab refers to a manufacturing plant where various types of semiconductor chips, or microprocessors, are fabricated for production or part of product development. Fab facilities are highly specialized and notoriously very expensive to build, costing several billion dollars.
A key element of any chip fabrication plant is the clean room, the factory floor where chips are made. A clean room is more sterile than a hospital operating room and must be as dust-free as possible. Even the tiniest speck of dust can wreak havoc on a chip, much like a boulder crashing onto a freeway interchange, ruining many or most of the millions of microscopic transistors on the microprocessor. The air in a clean room is completely replaced several times per minute. The most sterile, or class one, clean room has no more than one particle of dust per square foot. Fab clean room workers must wear super-clean antistatic outfits called bunny suits to protect the chips they work on from skin flakes, hair, and other human particles.
In a fab clean room, microprocessors are built by creating very thin layers of silicon dioxide and polysilicon on a base wafer of silicon. This is achieved by exposing the wafer to various chemicals, gases, heat, and light. One common chip-building technique is called masking; a substance called photo resist, which functions like a stencil, protects areas of the chip, while the exposed areas are etched with patterns by acids. These etched areas of the chip may be bombarded with ions to alter electrical conduction and then layered with metal atoms, which serve as the electrical connections in the chip.
It takes about 20 connected layers and more than 250 steps to complete the process, depending on the design of the microprocessor. The chip layers are about 10 nanometers thick and must be positioned accurately within one-tenth of a micron. It may take as long as 12 weeks to complete a whole set of chips on a wafer of silicon, as it travels throughout the fab on an assembly line, where it’s treated, layer by layer, at various stations.
Each wafer contains hundreds of identical microprocessors. The microscopic circuits in each chip are individually tested, and the wafer is sliced into separate chips with a diamond saw. At last, the chips are packaged for connection in all kinds of devices, many of them everyday items, such as toys, calculators, and fire alarms.
A sub fab is an annex of the chip fabrication plant that supports all the machinery required to build the chips. It contains generators; the plumbing, filtering, and vacuum systems; tanks of etching acid; as well as the equipment that monitors clean room particulates. The sub fab is also an ultra-clean environment.
Large companies, such as Intel, build and operate fabs around the world. Some chip manufacturers sell the use of their manufacturing facilities; some build chips exclusively for other companies.
A fabless microprocessor company is one that does not have a manufacturing plant. Such vendors may design and test chips, but they must rely on another company with fab facilities to actually build their chips.
The area of a cable company that houses the satellite dishes and antennae that receive the video programming for the cable network. The head end of an online service is the company's computer system and the databases.
When an electronic device (such as a microprocessor) emits energy (heat) and a cooling device (such as a heat sink or fan) is in place to cool the electronic device, a heat leak is the amount of heat that escapes despite the cooling device's efforts. A heat leak is measured in energy lost from the cooling device, and in heat gained by the area surrounding the cooling device.
Monitoring devices connected to hardware circuits to oversee how the hardware works with the system or to indicate when a problem occurs.
Hardware keys act as security devices. Some computer systems, and some expensive software or peripherals, require users to insert a key before the hardware will run. If there is no key, there is no operation. Some computers have a key that plugs in the front or back of the system, while some programs or peripherals will install a special key box in the port. The peripheral or software will not work if the key is not inserted in this box because the box contains a required code or password for the device.
An easy-to-access table on a Web page that contains a series of hyperlinks that lets a user quickly and easily obtain information. The "View terms starting with..." option for this dictionary is an example of a hash table. By clicking a specific letter, a user is able to view dictionary terms beginning with that letter without having to navigate through the entire dictionary.
A location in a software's application where programming that invokes a certain function is inserted.
In statistics, a histogram is a kind of bar graph that shows how data is distributed. It comes from the Greek word histos, meaning “pole” or “mast,” and gram, meaning “chart” or “graph,” and it is sometimes also known as a pole chart. The horizontal axis, or y-axis, shows units, and the vertical axis, or x-axis, shows how often something occurs. You can switch this format, but it is not usual. The bars show measurements and frequencies of whatever is being measured. High bars would indicate a higher value and low bars indicate a lower value. This arrangement is helpful for showing not only the largest and smallest categories of data but also how they are distributed.
Histograms are used frequently in computing. Graphics programs, for example, use histograms to show how pixels are distributed in an image and therefore reveal the amount of detail in different areas of the image. In practical terms, this helps a graphic artist determine if she needs to clean up an area in shadows or if the highlights are too prominent in order to make a balanced image. This is sometimes called histogram equalization.
Histograms are also used in science and data gathering to represent grades and scores or weather patterns. Hardware and software performance is sometimes displayed in histograms.
A process used when bitmapping digital fonts. Hinting blurs the corners and curves of individual characters in a font so they appear as smooth as possible when displayed or printed in low resolution.
Refers to programs or software plug-ins that redirect you from one Web site to another. A plug-in from Gator.com is notorious for being hijackware, which is sometimes known as scumware.
A large area filled with many disk drives.
On a network, a remote disk drive accessible by some or all members of the network. Data can be written to and read from a disk server by members of the network.
The type of inkjet technology used in most computer inkjet printers today. Drop-on-demand describes exactly the process used: the printer’s driver software demands the printer fire a drop of ink onto the correct spot on the page, eventually forming text and images. Thermal inkjets and piezo-electric inkjets are both drop-on-demand printers.
A character that represents a frequently occurring number or value.
A data format is a way of organizing information in a computer file so specific computer programs and applications can access the data. Microsoft Word and Microsoft Excel, for example, store documents and worksheets in different formats due to the nature of the information these files typically contain.
The file name extension, the portion of the name following the period, found on a PC is often used to designate the data format. For example, Excel files usually have an .XLS extension, whereas Word files have a .DOC extension. The standardization of these file extensions lets the OS (operating system) know which application to launch when a user accesses a certain data file. For example, double-clicking somefile.xls, (where somefile is the file name), opens your file in Excel. If the file had been named somefile.doc, it would be opened in Word. It is up to the user or the application creating the file to assign the appropriate extension. Simply renaming a file created with Excel from somefile.xls to somefile.doc does not automatically convert it into a format readable by Word.
In addition to the file extensions mentioned above, other common file extensions and their data formats include: .CSV (comma separated variables), .DAT (binary data files), .EXE (executable file), .GIF (Graphics Interchange Format), .MDB (Microsoft Access), .PPT (Microsoft PowerPoint), .RTF (Rich Text Format), and .TXT (ASCII text files).
Many computer programs contain built-in filters that can read and/or write files stored in formats different from their native formats. It is common for vendors to include filters that let users read or import files from competitive products to encourage users to switch vendors.
The area of a hard drive or diskette that can store data and programs. When a disk is formatted, a boot record, partition table, root directory, and file-allocation table (FAT) are established first on a small portion of the disk. The larger remaining portion of the disk is considered the data area.
The horizontal wire that stabilizes and limits the vibration of the aperture grille on an aperture grille display. Its faint shadows may be visible on the screen. Larger monitors have two parallel damper wires, while smaller monitors have only one.
To make a window larger when using graphical interfaces. In many applications, a zoom box lets the user maximize a window, making it fill the entire screen. When the zoom box is selected again, the window returns to its original size. Also refers to magnifying a portion of a document on-screen in order to view it more closely.
Located inside a LAN (local-area network), zones are subsets of the larger network.
A Web server that is "hijacked" by a computer cracker to launch a DoS (denial of service) attack on another Web site. The cracker secretly places malicious code on the zombie Web server, and the zombie is instructed to launch the DoS attack at a later time.
To remove zeros from a number without affecting its value. The number 000.444, for example, could be written as .444.
A font composed of printers' symbols from the International Typeface Corp. that includes arrows, geometric shapes, stars, and circled numbers. It is a built-in font in PostScript laser printers and can be purchased in Type 1 or TrueType format for other printer types. The font's formal name is ITC Zapf Dingbats.
To set a variable or series of bits at zero.
Emulates the Unix Talk program, which allows users at different terminals to communicate with one another. YTalk, however, is capable of multiple simultaneous connections.
The largest measurement of computer storage, representing 1,208,925,819,614,629,174,706,176 bytes, or about 10 to the 24th power. Currently, the largest hard drives have storage up to one terabyte, which is about one trillion bytes.
This has also been known to as the Year 2000 Problem and the Millennium Bug. Headlines on national tabloids foretold the end of the world. Predictions of bank failure and global economic collapse were uttered. Advertisements sprouted for portable generators and survival supplies in anticipation of power generators everywhere grinding to a halt. Nuclear plants were set to melt down. And worst of all, your PC might not boot.
These predictions of catastrophe, almost enough to make biblical authors blush with humility, dominated public consciousness in 1998 and especially 1999. Reports emerged about how public utilities and world governments weren’t acting fast enough, and come 12 a.m. on Jan. 1, 2000—which, for the mathematically curious, was one year before the start of the third millennium A.D.—computers of all types and sizes the world over would fail because of one little problem.
The problem has its origins back in the early 1900s when data had to be stored on punch cards. The “19” digits in date fields seemed extraneous when those two characters spread over thousands of cards translated into a lot of extra work. By the 1960s and 1970s, a similar problem existed with programming mainframe computers, often using the COBOL (Common Business-Oriented Language) language. Each kilobyte of memory cost a considerable amount of money, the turn of the century was a long way off, and again year fields were chopped to two digits. This tradition of expediency was carried over all the way into the 1990s, permeating systems from supercomputers to the tiny chips built into traffic lights and elevators.
The problem was one of arithmetic. Boeing, which sometimes forecasts purchases as far as seven years in advance, first became aware of the issue in 1994. Imagine trying to plan orders for 1997, 1998, 1999, 1900, 1901. . . . With only two digits to go on, the system didn’t know that it was trying to plan operations for dates starting with “20.” The digits “19” were assumed as prefixes for all year fields. The system only knew that it was trying to compute a future event on a date that had mathematically already happened. In some cases, this conflict might be resolved by deleting the database record. (This might be a serious problem if the record in question is your Social Security account.) When credit cards started using year 2000 expiration dates, some stores reported that their entire card processing systems crashed.
To solve the problem, a global army of programmers set to work. Retired COBOL engineers were summoned back into action to fix antique code. Manufacturers devised plug-in cards for PCs that would trick motherboards into using the proper time. Operating systems needed patches. Spreadsheet programs in particular had to be methodically combed for two-digit year entries. In reality, though, most of the potential hazard for desktop PCs vanished if the user merely turned his machine off on New Year’s Eve, booted up the next morning, was careful to manually enter the BIOS (Basic Input/Output System) and change the year to 2000, then reboot.
Of course, there was no global catastrophe and the media were hard pressed to find examples of actual January 2000 Y2K glitches. There were a few, but nothing dramatic. In the end, the biggest problem for most people on New Year’s morning of 2000 was a mild hangover or a pile of dirty dishes in the sink.
A single cable that meanders into two sections and thus forms a Y shape, allowing you to hook up two devices, such as two joysticks, to be used simultaneously.
A listing of Web sites that often appear as links on a blog and are used to express connections between blogs. The list of links is used to relate the site owner's interest in or affiliation with other known bloggers. These lists can be made dynamic through services such as BlogRolling.
An encryption algorithm used in private-key (symmetric) encryption. A block cipher breaks a message into pieces and then encrypts each piece. Compare to stream cipher.
Refers to the process of copying a large array of bits from one part of the computer’s memory to another part, most often when the memory determines what’s showing on your screen.
Slang for a session or meeting in which a group of people try to assign blame for a recent failure.
To have text or graphics printed off the edge of a page. Bleeds often are used on purpose with graphics, but text bleeds can be a sign of a problem with a printer or the software's print setup.
A transmission of data in binary, or digital, form.
A portion of a hard drive or diskette that cannot be accessed for storage purposes. Both hard drives and diskettes use a round platter to store data on. Upon formatting, this platter is divided into sectors (extremely thin, pie-shaped wedges) and tracks (concentric circles, like rings on a tree). The sector and track location is recorded when data is stored on a drive or diskette. This enables the computer to reassemble the data when requested by the user. When a sector is not usable (data cannot be stored there), it is referred to as a bad sector. New drives and diskettes should be free of bad sectors, but media degrade over time, and a few bad sectors are not uncommon on older equipment. Several DOS and Windows utilities, including Check Disk and ScanDisk scan for, and either repair or mark, bad sectors. In addition, format utilities identify and mark bad sectors as unusable. A previously good sector can go bad through a failure of some sort. If this occurs, any data stored on that sector may be irretrievable. (Specialized software and/or retrieval services may be able to access it.) A drive which has numerous bad sectors, or on which the number of bad sectors is increasing, is a likely candidate for total failure.
Software that facilitates the creation and editing of a Web page by translating the HTML (Hypertext Markup Language). Also refers to a person who is in charge of maintaining a Web site.
The person who manipulates the look and feel of a Web site to make it more functional and intuitive. This person is responsible for most of the graphical elements on a page and also dictates where text-based content is placed.
A slang term for tiny images imbedded in some Web pages and HTML email that let organizations, such as advertising firms, track your movements on the Web. By establishing behavioral patterns such firms hope to better target their pitches and sell more products. The insidious nature of Web bugs has prompted legal inquiries.
Software that gives access to and navigation of the World Wide Web. Using a graphical interface that lets users click buttons, icons, and menu options to access commands, browsers show Web pages as graphical or text-based documents. Browsers let users download pages at different sites either by clicking hyperlinks (graphics or text presented in a different color than the rest of a document, which contains programming code that connects to another page) or by entering a Web page's address, called a URL (universal resource locator). Netscape Navigator and Microsoft Explorer are both popular browsers.
Web analytics refers to a group of statistics Web site maintainers can use to determine what parts of a site are most popular. Such statistics may include the amount of time spent on individual pages, where the visitors originated from, and where they went after viewing the site.
A cleaning blade (sometimes made of felt) that continually wipes a laser printer’s fuser roller. The fuser wand ensures stray toner particles and excess fuser oil do not build up on the fuser.
A war dialer is a software tool used by someone looking to gain illegal entry into a computer system. The program dials from a list of telephone numbers looking for any numbers answered by a modem. When it finds a modem, the number is logged for future reference.
To improve performance. In computing, there are many ways to optimize the performance of your system. For example, you can optimize a hard drive by running a defragmentation program.
A data transfer rating for SONET (Synchronous Optical Network) fiber-optic networks. OC-1 has a transfer rate of 51.84Mbps (megabits per second), about 6.48MBps (megabytes per second), so OC-x describes a fiber that can carry x times 51.84Mbps.
In the strictest sense, to “opt out” means to choose not to participate in something. In the computing world, this term often refers to a user’s decision to not receive emails, marketing materials, or other data from a company that offers that information. These materials are usually associated with some service or product that the end user may want to use or buy. The company will gather some personal data from the user in the course of selling or setting up the product or server and will automatically send the user emails, newsletters, or other marketing data unless the user specifically chooses not to accept that data. Sometimes the user may not be aware that, by providing his personal information, he is giving the company permission to send him materials. Also, the means by which one can “opt out” of receiving such data may not be readily apparent. Some companies will seek a user’s permission before sending the user emails and marketing data. In this case, the user would “opt-in”, or choose, to receive the information.
The order of precedence of operators in an expression. Normally, associativity is left-to-right. Associativity will affect the outcome of the expression. For example, in the expression 9-6+2, where addition and subtraction have equal precedence, with left-to-right associativity, you would first subtract 6 from 9, with a sum of 3, and then add 2, for a final answer of 5. If associativity were right-to-left, you would first add 6 and 2, to get a sum of 8, and then subtract that answer from 9, to get a sum of 1 as a final answer.
The part of a machine language instruction that tells a computer what to do.
An ODS provides short-term storage of operational data. Data stored in an ODS is simple and less complex than data stored in large data wharehouses. As a result, data can be found and retrieved faster from an ODS. Additionally, historical data is not kept in an ODS.
One of two modes, either Standard or 386-Enhanced, that adjusts the way Windows runs, letting it perform its best based on your system's components and software.
The focus of an operation. In mathematics, the operands are numbers or variables, such as 2 or X. In computing instructions, operands are where data is stored, such as Track 1, Sector 7. Also, in programming languages, the part of an instruction that is needed for the instruction to be carried out.
A standard that lets multiple programs work on a single document. The standard is similar to Microsoft's OLE (object linking and embedding) and was developed by several companies, including Apple, IBM, and Lotus.
Source code that is freely available to programmers for use in developing new software. The source is usually in the form of a standard--a sound format such as MP3, for example. It can also refer to an entire program (such as Netscape Communicator) or an operating system, such as Linux. Proponents of open source argue that by letting as many developers as possible work on a program, the software evolves. Developers will fix bugs, add new features, and adapt it for new uses or operating systems. See Open Source Initiative (OSI).
A mathematically intensive graphics language used to create complex, detailed three-dimensional objects, including screen savers.
Additional memory physically located on a CPU (central processing unit). Because of its proximity, the on-chip cache can deliver data to the CPU much more quickly than cache that is off the CPU.
This is an antivirus program that searches a PC's files and programs for hidden viruses. The scanner searches the files when the user opens the file. On-access scanners usually operate in the background, so users normally don't notice them.
Describes the absence of a modem. For example, two computers joined directly by a cable is a null modem setup because neither requires a modem.
To delete the contents of an entire directory or storage volume on purpose. This term is slang, but to be precise, it is never used to describe accidental deletion.
A relatively new breed of trackballs that are portable and the ideal size for notebook computer users. Generally, these trackballs do not consume valuable desktop space; instead, they are handheld.
A simple ASCII (American Standard Code for Information Interchange) text processor included with Microsoft’s Windows family of operating systems. It received an update with Windows 95 but has remained fairly unchanged for years. It reads and saves files with the .TXT file extension. Notepad is often used to get rid of unwanted text formatting by pasting a selection into it and then cutting it out.
A business or group that does not have a Web site.
A software application that converts music entered into a computer using a MIDI (Musical Instrument Digital Interface) device, such as a synthesizer, into traditional musical notation.
When pertaining to information technology, a term describing items contained in industry standards that should be conformed to by professionals or manufacturers.
A term used to describe the method of refining information in a database by placing items into tables with the purpose of ensuring clear, precise results when a user accesses that data.
A term used to describe a virus that activates when the user opens an infected program, wreaks its havoc, and resides in RAM (random-access memory) only long enough to perform the intended operation before turning off. Unlike resident programs and viruses, nonresident infectors do not use TSR (terminate-and-stay-resident) programs to remain active in a computer’s memory and have a much shorter activation time. This fact can make nonresident viruses harder for the user and some antiviral utilities to detect, because the computer’s available memory is only reduced for a short time.
Nonrepudiation simply means that something can not be reputed. In terms of computers, nonrepudiation refers to ensuring that a message is from the party it claims to be from and a way to ensure the message is received by the correct party. This eliminates the ability of the sender or receiver to repute having sent or received an email.
Special command instructions sent with printable data on to the printer. Nonprinting codes regulate the printing format but are not printed themselves.
A way an image is produced and refreshed on a computer screen. In a typical computer monitor, an image is produced by a series of horizontal lines that run from the top of the screen to the bottom. This is known as a raster display. An image is produced or refreshed in a noninterlaced manner when every pixel of every line is updated during every cycle; conversely, an image is produced or refreshed in an interlaced manner when every odd-numbered line is updated during the odd-numbered cycles, and every even-numbered line is updated on the even-numbered cycles. However, this interlaced every-other-line method can cause the screen image to flicker, making it hard on a user's eyes. Therefore, a noninterlaced monitor is preferable.
A method of storing data in which the information is not stored in contiguous, or adjoining, sectors of memory.
A DOS application not designed for operation in a Windows operating system. Non-Windows applications will operate in Windows but will run less efficiently and slower than in DOS.
Any material that transmits electrical currents poorly.
Four bits or half a byte.
A connection point at which information is transmitted between software applications and IBM operating systems (OS/2, DOS, and AIX) on a network.
The condition that can occur when a great deal of Internet traffic or a bad connection slows the retrieval of information from an Internet server.
This term refers to print quality almost good enough for use in business correspondence, therefore suitable for casual use. Near-letter quality was used primarily when dot matrix printers were the most common consumer printer, prior to inkjets.
NHR allows computers to read both cursive and hand-printed text. Unlike ICR, NHR doesn’t place any constraints on where information needs to be written. NHR operates by matching descriptions of an entire word to a list of descriptions in a database known as a lexicon. NHR systems do not look for an exact match because it’s highly unlikely that someone will write a word exactly the same twice. Rather, it matches general descriptions of a word by matching features specific to each word.
A computer application that converts one language (usually a high-end programming language such as BASIC, COBOL, or C++) into binary machine code that a computer can understand. Programs must be compiled (or in the case of assembly language, "assembled"), to function. Compilers are included as a matter of course with programming development kits.
The amount of uncompressed data a tape cartridge or reel can hold.
Describes a transmission channel in communications that has a slow data transfer rate and a smaller bandwidth, particularly any channel with a maximum throughput of 2400bps (bits per second).
A science that showcases the process of building in terms of an object's smallest elements, such as the molecular or atomic makeup of an item.
A unit of time representing one-billionth of a second.
A unit of length representing one-billionth of a meter.
A carbon nanotube with one closed end. The special electrical and mechanical properties of microscopic nanohorns and buckytubes (nanotubes) could usher in advancements in computing and other technologies. In particular, NEC wants to manufacture nanohorns for fuel cells powering mobile devices.
A prefix designating one-billionth of a unit of measurement.
The NAND logic gate is a combination of the AND and NOT logic gates. This gate will first use the AND operator, producing a “true” output when both inputs are “true” and a “false” output in all other situations. The NOT aspect of the gate then reverses this output into the opposite value. For example, an AND logic gate output of “false” will then be changed to “true” by the NOT operator. See logic gate. See AND logic gate. See NOT logic gate.
A type of nonvolatile memory in which the cells are linked serially to each other and the grid of interconnects. NAND is best suited for sequential data reads and writes, as in MP3 players and digital cameras. See NOR flash memory. See nonvolatile memory.
In XML (Extensible Markup Language), a term used to describe a document containing the “rules” and other element data (such as data field names) necessary for sharing information with others on the Web. The namespace’s Web address is usually included in the beginning of an XML document, so that a compatible browser will know how to display the information.
A way for computer processes inside a computer to communicate by sending data through a pipe with a specific name. Any message sent through this pipe can be accessed by any process authorized to do so.
Used in TCP/IP (Transmission Control Protocol/Internet Protocol) connections. Users send requests to the name server asking for help finding a specific computer or piece of information. The name server responds, translating the name of the site on the Web into a computer-comprehendable IP (Internet Protocol) address.
A document that is split into several subdocuments but can still be manipulated in its entirety. Authors of long documents such as novels or theses often use word processing software such as Microsoft Word and WordPerfect to create master documents. For example, an author might set up a technical manual as a master document, with a subdocument for each chapter.
To convert a file into another form. The term can also refer to one of the many different ways files or data are processed, or it may refer to the editing of image or text files.
A filter that holds back certain data and allows other data to pass. For example, when defining numeric fields for a spreadsheet, parameters can be set to disallow certain values that are too high or too low.
Used when adding one or more sheets of paper at a time to a printer rather than using the paper tray. This comes in handy when a different stock or color of paper is required for a single print job.
Software intentionally designed for a malicious purpose, such as to erase a computer’s memory or gain unauthorized access to a system. Trojan horses and purposefully system-damaging viruses are some examples of malware.
In an open source environment, a maintainer is the equivalent to a project leader in the commercial software world. The project maintainer makes all major decisions, resolves important disputes, and ensures that everyone receives the credit they deserve for their contributions.
A mail relay is an email server that delivers messages to their proper destination. A mail relay typically serves a specific local domain that might include an office or a university campus.
A unique set of data that identifies a particular event or transaction between two programs that work together to accomplish a task.
Reading online messages or chat room conversations without taking part in the discussion. Users new to online newsgroups, mailing lists, or chat rooms are encouraged to lurk for a while until they know what the discussion is about. This prevents the same questions from being asked over and over as new users discover the area. In addition to lurking, new users are encouraged to read FAQs.
The brightness of a computer screen, controlled by part of a composite video signal. Also used to describe part of the signal that defines the brightness.
A computer screen or printed page that appears rough, with very little fine detail. Low resolution on a display is the result of too few pixels; low resolution on the printed page is the result of too few dots per inch.
A programming mistake, often caused by the programmer's inability to anticipate every situation that might occur.
Email that is sent to “keep you in the loop.” These messages are often forwarded or CC'ed messages that may or may not have much relevance to your work day and, when sent in large quantities, are often considered counterproductive.
An abbreviation for the phrase "Laughing out loud" that is commonly used in email messages.
A problem in a program that causes it to operate incorrectly, but not to fail. Because a logic error will not cause the program to stop working, it can produce incorrect data that may not be immediately recognizable.
A circuit that performs a processing or controlling function in a computer, in contrast to memory circuits which merely store data.
An error in the logic of a program routine that results in the destruction of data. Unlike a virus, logic bombs do their damage immediately, then stop. Also, logic bombs are unintentional and can be the result of a simple corrupt file.
Starting a computing session or connecting to a computer network. You usually log in to a computer or network by entering a username and password.
A computer file that cannot be altered. Normal users of such files cannot alter the information they contain, change their location, or alter their names.
A change in a program made so it will work better for a specific group or function. For example, localization might include changes that take into account a different language, such as Japanese. One such change might be translating commands in menus from English to Japanese.
More commonly referred to as WLAN. This is a network that uses wireless means to transmit data from one point to another, rather than by using a more traditional wired LAN configuration.
Memory located on the same bus or card as a given processor in a system with more than one processor. Memory that is local to one processor generally is inaccessible to another.
The area on a magnetic tape where information storage begins.
Slang used to describe a person who uses a computer. A computer is the hardware, programs are the software, and the user is the liveware.
Livelock is a condition in which two or more processes constantly attempt to update themselves in response to one another or another process. As a result, neither process completes. This is the opposite of two processes that are deadlocked.
A number or instruction that remains constant and unchanged, even when translated into the machine language used by computers.
In Web design, a “flowing” layout that readjusts to fit any size browser window. Unlike jello and ice fixed-width designs, the liquid layout has no excess margins. However, extremely large or small browser windows can make the site appear sloppy and deteriorate the visual relationship among a page’s elements.
This term refers to links on Web pages that have become outdated as the Web pages the links refer to are moved or taken down. Clicking on such a link usually results in a "This page cannot be found" message.
When ranking a Web site, many search engines, such as Google, factor in the number of sites to which it is linked. Link farming involves exchanging links with other Web sites in an attempt to get a better search engine ranking. Most search engines, however, penalize sites that take part in link farming.
As a noun, refers to a connection between two objects. In data management, a link allows information sharing between a source document and a destination document. Information a user changes at the source also changes at the destination in linked documents. In communications, a link is the line through which data is transmitted. In programming, a link is a connection to another program. On the Web, a link (short for hypertext link or hyperlink) is a connection that takes users to another page. As a verb, refers to the act of connecting two devices or programs.
A graphic created entirely of distinct lines, with no shading.
A single process that slows the larger operation of which it is a part. For example, a slow spell checker can slow down an entire word processing program.
A light-sensitive pointing device that allows users to select objects displayed on-screen by simply pointing to them.
A highlighted item on a computer screen that will appear with a different color to make it stand out from the rest of the screen.
A piece of equipment that transmits light from one point to another. Fiber-optic cables are light guides.
A combination character used with some fonts when two regular characters appear next to each other and bump against each other. For example, a publisher may replace the letters ff with a ligature that connects the short line in the middle of the characters.
Refers to the length of time a key can be expected to be kept in use and still provide adequate security. A key is a special piece of code comprised of a string of bits to encrypt and decrypt data or information for security purposes.
In relation to computers, the words and definitions that make up a programming language.
An alphabetical listing of items. Numbers appear in a lexicographic sort according to their spelling.
This is an email that contains a program or other data that can damage a user's computer. When the letterbomb "goes off," the data may lock up the user's computer or carry out some other undesirable action.
In computer graphics, graphics layering involves working on several layers of a document at a time and then combining the layers to achieve a finished product.
A tool found in many image-editing programs that allows the user to select a specific portion of an image by freehand.
"When logging into a Web site you usually start by submitting your username and password. The server then checks to see if an account matching this information exists and if so, replies back to you with a 'cookie,' which is used by your browser for all subsequent requests."
Most Web sites protect your username and password with a secure HTTPS connection. Unfortunately, many immediately drop back into insecure HTTP once a visitor is signed in — and the site sends its cookie back over a now-insecure connection. Anybody snooping on your conversation can make a copy of the cookie and use it to interact with the Web site in precisely the same way you do.
Unlike Web-crawlers or spiders, which use general criteria to collect data for many users to search through, a knowbot employs an individual’s settings to scour the Internet and present the information for viewing. These programs are also easier to adjust for a specific user and use a more advanced technology than spiders or crawlers. An example of a knowbot would be an application that searches through White Page sites and services for a specific name or a newsbot that collects information from news sites for downloading to a personalized news page.
Industry jargon for a computer application that suddenly becomes so wildly popular that it drives other sectors of the industry. Examples are VisiCalc, the original spreadsheet program, and the Web browser, which changed computing by putting a graphical face on the Internet and making it simpler to use.
Some Web sites determine the relevancy of a Web site to a given search based on the number of times the search terms appear on the page. In order to appear more relevant and gain more visitors, some Web sites stuff keywords into the Web pages. The keywords can be hidden in html (Hypertext Markup Language) so they don’t appear on the Web page. Other sites create text the same color as the background so the text appears invisible to the user. Some search engines may penalize a Web site if it determines it’s using keyword stuffing.
A device used to record a keyboard's keystrokes to track the use of a PC. Parents and some companies use keystroke loggers to keep track of how kids or employees are using their computers. Some Trojan horses are also keystroke loggers, but the purpose of a Trojan horse keystroke logger is generally to collect usernames, passwords, and credit card numbers.
The act of pressing a key on a keyboard to enter data into a computer.
The range of possible variations an encryption key can produce. The keyspace will vary according to the length of the key in bits. A 40-bit key, for example, will have fewer possible keys, and thus a smaller keyspace, than a 128-bit key. The larger the keyspace, the more difficult it is to crack theit encryption.
A small keyboard holding only numbers and arithmetic keys used for data entry. Numeric keypads occupy less space than full-size keyboards, so they are valuable on small desks when only numeric input is needed.
A paper or plastic form placed on top of a keyboard to tell users which keys perform which functions in a program.
A function of most computers that lets users depress and hold a key and, after a short pause, cause the computer to react as though the user was repeatedly pressing the key. Keyboard repeat is handy if a user wants to type an entire line of a certain character, such as a dash.
The dirt, gunk, sticky goop from spilled soda, and other debris that tends to build up on computer keyboards.
A small microprocessor built into a keyboard that passes keystroke data to the main computer.
The length of a key in bits. Also called bit strength.
The act of expanding a key from it original size to create a longer key. A key in this sense refers to a string of bits used to encrypt or decrypt data or information for security purposes. Generally, the longer the key, the harder the key code is to break.
The exchange of keys by two or more parties. In terms of technology, keys are pieces of mathematical code used to encrypt and decrypt data or information for security purposes.
When editing video, jogging changes the position in the video clip by a single frame or a small number of frames.
A unit of work as a computer processes a task.
A computer operation that consists of numerous jobs with different tasks that are processed at the same time.
A plastic case used to protect a CD-ROM or DVD while being transported or stored.
The overload of a user's email program or a network's email server with email messages. Severe cases of overload, caused by such things as spam or viruses, can shut down a server.
An application that provides access to electronic mail (email).
The button pressed to eject a diskette, CD (compact disc), DVD (digital versatile disc), or other removable media from a diskette, CD-ROM, CD-RW, or DVD-ROM drive or other such device.
Software, generally for children, that blurs the line between education and entertainment. These programs combine learning with entertaining activities, such as games.
The edu top-level domain is used to identify educational institutions. For example, colleges and universities use "edu" in their URLs, such as www.hastings.edu. It is not intended for general commercial use.
A switch point at which two networks meet. This is often the point where a smaller network connects to a larger network.
Printing on both sides of a sheet of paper so, when bound, the corresponding pages face each other, as in a book.
Downloading multiple files from the Internet simultaneously and accidentally crashing your computer. You can drownload your system if you download multiple audio files or large image files, and the computer can’t keep up. Your system might stop downloading, freeze, or crash. You can prevent drownloading by downloading only one or two files at a time.
An effect used in graphic design to create the illusion that an image is floating.
The first letter of a text document that has been enlarged so it encompasses vertical space on lines above or below it. Drop caps are used to incorporate graphical elements where there would otherwise be only text.
A program downloaded and installed into a user’s computer without the user’s permission or knowledge. The user receives no warning pop-up or other instruction informing him that a program is being downloaded.
Metal brackets used to mount a hard drive (or other drive) in a computer, in such a way as to allow the drive to be removed easily by sliding it forward. Generally, the rails mount on the sides of the drive and include spring tabs to secure the drive in the computer chassis. This system does away with the need to bolt the drive to the chassis itself.
Any device used in conjunction with a drawing program that allows the cursor to be used as a pen to create and manipulate an image or shape.
The amount of voltage an instrument has consumed from its power source.
In a GUI (graphical user interface), the act of moving an object, or icon, into another object to initiate a process.
An unsuccessful Web-based venture.
An impurity added to silicon during the manufacturing of a computer chip to control how well the silicon conducts electricity.
A textual or graphical compilation of data that is dependent upon an application program for its creation but is treated independently from the application's files for storage purposes.
Application GUIs (graphical user interfaces), or portions of the GUIs, are dockable if they can be dragged and docked (placed at the edge of the screen). For example, you can drag the Taskbar to either side, the top, or the bottom of your screen.
A term used to describe the process of preparing a file for output at one location, then electronically sending it to various locations for actual printing. This allows for a publication to quickly cover a much wider geographic area than would be possible using only one print location.
A system of computer stations in which processing, data storage, and accessibility to databases are shared among individual nodes.
A key that has been divided and then distributed or shared among many users. A key is a special piece of code comprised of a string of bits that is used to encrypt or decrypt data or information to provide security.
A hyphen, automatically inserted by many word document programs, at the end of a line when a word breaks.
A hardware device considered a separate and distinct entity.
The transfer of data to an output component, such as a printer, as a desperate attempt to at least partially recover information that has fallen victim to a disk error or failure.
To turn off a function or prevent an event from occurring. In hardware, disable usually means to unplug or remove a component.
Unlike early jukeboxes, which contain vinyl record albums or audio CDs and play back the audio content based on user specifications, digital jukeboxes store content on a hard drive. Digital jukeboxes are commonly associated with music playback, but digital jukebox content is not limited to audio; it can also include video or any other form of data.
The creation of audio in digital format. In other words, sound represented by the 0s and 1s of the binary system. Special audio software is needed to read audio files.
In a GUI (graphical user interface), an on-screen text box that provides users with information and explains possible options. For example, a dialog box for a wizard in a word processing program might provide choices between creating a fax cover sheet or a business letter. After the user clicks an option, the dialog box would present another set of options, such as a list of formatting styles. Dialog boxes filled with options would continue to appear until the document is created.
A device driver is a program that allows a hardware peripheral, known as a device, to communicate with a computer. Device drivers typically come with the device, and updated drivers can be obtained through the manufacturer's Web site.
A general name for a group of devices. For example, all keyboards are input devices.
An external hardware apparatus that attaches to a computer to allow it to send or receive a specific type of data. A printer and a modem are two examples.
The site to which data are directed. A site can be any hard drive, disc, file, directory, or document within the computer or online.
A filter found in some photo editing programs that removes small, unsightly speckles, or bits of grain, from an image to improve its quality.
Refers to a Windows Desktop, the first screen you see when the OS (operating system) is opened. The Desktop always includes several items including the Recycle Bin, the Start button, and the Taskbar.
A method of arranging data in reverse alphabetic, numeric, or date order. Examples include a numerical sort from 10 to one and an alphabetical sort from Z to A.
A character that relies upon a previous operation to determine its value.
A symbol, such as a comma, that programmers use to separate data in code.
The keyboard key used to erase individual characters to the right of the cursor or highlighted strings of characters. This key can also delete files selected by a user.
Using tools found in an image-editing program to alter, or deform, the data that makes up a digital image.
A method of preventing future defects by maintaining a database of prior defects.
The standard setting, predetermined by your computer, that is engaged when the user fails to denote a specific alternative. Defaults generally are the most often used settings for a particular program.
Hackers who break into a Web site often vandalize or deface the site by replacing the site's content with their own. The content can sometimes be humorous or political in nature.
The nature of the web allows the creators of one Web site to link to content within another Web site regardless of where the information might be. A deep link is any link to information on another page or Web site that is not the site’s homepage.
A device that serves only one purpose.
The process of translating encrypted data back into their original language.
When you deboss a logo or other design, you create a depression into the surface of the paper. This is the opposite of embossing, which creates raised edges.
An error that occurs when two programs are each waiting for a signal from the other to proceed. Also called deadly embrace.
A key that has no function when pressed by itself but produces an effect when pressed in conjunction with another key or keys. One example is the SHIFT key.
Any mechanism that directs data to various locations. For example, a data switch allows a single computer to send data to multiple peripherals, or it allows multiple computers to share a single peripheral.
The part of a cache that holds actual lines (cache lines) of data.
The electronic form of paper shredding. Letting a computer user destroy a file to render it unusable.
The mutual use of a single file on more than one computer or by more than one person or organization.
The part of storage or memory that retains data required by a program.
In a database management system, the act of recalling data from a database.
Within a computer system, the precautions taken to maintain data integrity and minimize errors.
Multiple pieces of data that have been joined together and treated as a single item when passed between network sites.
A diagram used to illustrate how data travels through a system, such as where data is stored or processed, and the path that the data follows as it travels through the system.
The movement of information through a computer system.
In a database management system, an area within a data record reserved for a small specific piece of data such as a date.
The path data follows when traveling between two peripherals.
The accumulation of information in a form that can be used by the computer. For instance, data capture occurs when an analog-to-digital converter translates normal audio into digital signals the computer can process and manipulate.
A small, high-memory storage area designed to speed up access to stored video files. The video cache, which is much smaller than a hard drive, takes considerably less time to load and retrieve files.
A programming term that refers to a pointer whose target has either been moved or erased.
The amount of time between one RAM access and the next.
Combining the words "cyber" and "librarian," a cybrarian is a professional who is adept at using the Internet for research purposes.
To modify or set up hardware and software according to an individual's preferences.
A marker on-screen that shows where current input or output is going to happen. It may appear as a blinking vertical line, a solid or blinking box, an underline, or a caret.
A downloadable file found on the Internet that is falsely named. These files are created by people as a practical joke and are commonly found at Web sites that offer free music downloads. For example, you might think you are downloading an MP3 of “American Pie” by Madonna, when the file is actually “Easter Parade” by Perry Como. Also an MP3 file that has been altered to render it useless. For example, the first few seconds of a song may be followed by four minutes of white noise. The idea was conceived by those running the Cuckoo’s Egg Project to slow the spread of copyrighted material through services such as Napster. No harm is intended; this tactic simply wastes the time of the person who downloaded the file in an effort to discourage them from trying again. Oddly enough, cuckoo eggs themselves are illegal because they contain a snippet of a copyrighted song.
A key on a computer keyboard that, when used in conjunction with other keys, gives a key a function other than its labeled one. For example, in Microsoft Word, pressing the CTRL key with ALT and the minus sign (-) on the numeric keypad produces a long dash (--). The CTRL key generally is on each of the lower corners of the main section on a keyboard.
The study of encryption and code breaking.
To process information. A number cruncher is a device or routine designed for rapid processing of numbers.
Slang for two bits, or two binary digits.
A set of crossed lines that takes the place of the cursor in some programs. An operation will take place at the point of the intersection.
To trim an image to refine it for use in a document. Backgrounds, individuals, or objects may be cropped out of pictures. Cropping may result in a less-cluttered or more powerful image, but it also can create a misleading picture.
Often associated with freeware or shareware. Some companies offer free or trial versions of their software to entice users to buy a full version. The trial versions do not have all of the features and functionality of the full versions, thus they are crippled versions of the program.
Spyware and other malware designed for criminal purposes such as fraud, identity theft, and theft of funds. The term crimeware may also cover other types of software if used for illegal purposes, such as antiforensics.
A CPU (central processing unit) shim is a thin piece of non-conductive material, copper, or other material that is completely flat and is installed between a CPU and a heat sink. If used correctly, CPU shims prevent damaging the CPU when installing the heat sink. CPU shims are sometimes called CPU spacers.
Educational or training software used in schools or other training facilities to teach about a specific topic.
A program routine that is repeated a specified number of times. A counter variable is increased by one each time the routine is performed. When the variable reaches a certain number, the routine ends.
The damage or alteration of data or programs because of hardware malfunction, software failure, viruses, power failure, human error, or deliberate sabotage.
To alter or partially erase information in memory or a file, rendering it unusable by the computer. Hardware or software failure can corrupt a file by rearranging the bits of data. Corrupted information no longer is readable.
Diagnosing and fixing computer problems instead of preventing them.
A visually busy Web page or ad that incorporates so many colors, graphics, fonts, and other visual devices that it becomes confusing or unattractive.
Describes two or more programs that reside in memory at the same time. This term can be used to describe two or more things in the same place (such as a computer or a network).
Hardware or software that protects programs from being copied without authorization. Copying commercial software for reasons other than personal use is a violation of software licensing agreements and is illegal.
An operation mode in which multiple computers work on different parts of the same program or on the same data.
Hardware or software that changes information or electrical signals from one format into another for use by a system or device requiring a format other than the original.
An interactive mode of operation in which a computer is interacting with the user in an exchange of commands and system responses. PCs operate in this mode.
A standard, whether formal or informal, that is applied fairly universally in a given situation. For example, programming languages rely upon conventions that define the meanings of certain symbols and abbreviations.
A measure of how much darker a monitor’s darkest black is compared to the monitor’s lightest white. For example, a monitor with a contrast ratio of 250:1 has black dots 250 times darker than its whitest dots.
Representing the quality of an object's surface in computer graphics. Shows whether an object is rough or smooth.
Processing transactions as they are entered into a system, as opposed to batch processing, in which transactions are processed in groups (or batches).
A set of information stored in consecutive memory locations.
Side by side. Two or more items are contiguous if they are touching each other. For example, contiguous sectors on a disk are physically next to each other.
In data processing, a group of data fields that may be processed one after another, in sequence.
A help menu that refers to the choice or area of a program currently selected. This type of help is useful because the help refers to the item in its current context.
A kind of multitasking in which the computer moves from one task to another as necessary, instead of giving time to each task in its turn.
The menu that appears next to the on-screen pointer after a user right-clicks. For example, if a user right-clicks the Windows 7 Desktop, a context menu will appear with options such as Screen Resolution, Gadgets, and Personalize.
Materials used in the process of performing a task. For example, ink, paper, and toner are considered consumable items for printing tasks.
The amount of time a user spends connected to a remote computer, particularly referring to how long someone is on the Internet with an online service or Internet service provider. Connect charges often are based on connect time although some have a flat monthly fee for unlimited connect time.
An overload of data on a communications path. Congestion caused by a high volume of traffic on the Internet, for example, sometimes results in network slowdowns.
A type of software that translates and passes data between a desktop computer and a handheld device.
The status of an expression or variable. Examples are true, false, equal, and not equal. In some programs, instructions take place based upon whether a certain condition is true.
A font style that reduces the width of each character and places the characters closer together, allowing more characters to fit on each line.
An operation in which two or more programs have access to the microprocessor and are carried nearly simultaneously. Although the operations are not truly taking place at the same time, the difference between how a computer manages time and how people perceive it makes it appear simultaneous.
The use of a computer system, program, database, or other resource by more than one user at a time.
A device that combines communications signals from several sources, such as computers on a network, into fewer signals before transmitting them to the destination. Also can refer to a hardware device that connects several peripherals to a computer with only one line between the concentrator and the computer.
The ability of computers to accept visual input; or, components that let computers accept visual input. CV hardware and software developers form a large group with diverse interests. For example, some CV developers are interested in industrial applications (such as monitoring factory lines for product control), while other CV developers pursue highly technical endeavors (such as using CV to aid nanotechnology to give "sight" to tiny robots, or for artificial intelligence applications).
html (Hypertext Markup Language) tags that have open and close code.
A document that contains data from two or more applications. For example, a word processing document that contains a chart from a spreadsheet program is a compound document.
In image editing, this is the process of combining several images or specific portions of images into one overall image.
A measure of how well two or more devices (hardware or software) work together. For example, two programs are compatible if a file created in one can be read in the other. Compatibility also can refer to how compliant a device or program is with a standard.
The line on which the user types commands to be carried out by a program. This is a feature of a text-based interface such as MS-DOS, as opposed to a GUI (graphical user interface) such as Windows.
An image on transparent film that produces a normal, positive picture when light is shone through it. A photographic slide, for instance, is a color transparency. Photographic negatives are the opposite of transparencies.
Literally, the degree of "color" in a color. Higher saturation means a higher degree of color.
Refers the multiple passes a scanner must make before a duplicate image achieves the same color quality as the original.
A technique that lets remote users take control of your computer as if they were using your keyboard and mouse. It’s sometimes used by companies to help customers troubleshoot problems they are having on a Web site or on their computer.
A section of code that contains specific operations or instructions for a software program.
Refers to the garbled-looking characters in a computer security code system. What looks meaningless actually contains plaintext elements that refer to words, phrases, or numbers.
A collection of programming code. Code libraries simplify programming by providing access to frequently used routines and functions.
Code forking refers to branching a program in multiple directions. This often happens when a considerable number of people want to add new features to a program but the developer does not. Code forking most often occurs in programs that are in the public domain or are open source.
A cluster is made up of a group of sectors found on a diskette or hard drive. Each cluster is assigned a number by the operating system. When you access a file, the operating system retrieves the file by accessing the clusters the file uses.
The smallest unit of time recognized by the CPU. Also called CPU cycle.
The act of hiding your name and email address in an email. Individuals who distribute bulk unsolicited email often cloak their real identities and email addresses to avoid retribution from those angry over being "spammed."
Mass-produced artwork available for authorized users to incorporate into their own publications.
In the days before publications were assembled by computers, publishers and graphic art companies often subscribed to clip-art services that sent an assortment of artwork each month, printed in booklets or on loose pages. Rather than creating all artwork from scratch, publishers had the more budget-conscious option of clipping an illustration off a sheet and pasting it into one of their own pages for reproduction. Hence the name, clip art.
Although printed clip art is still available, most of it now comes in electronic form. Desktop publishing software usually comes with clip-art collections, and a variety of clip art is available for the professional and casual user alike. Clip-art services still provide electronic or printed artwork by subscription, and there are clip-art packages available for individual sale, as well. In addition, there is a a great deal of artwork available online for downloading, either for free or at a modest cost.
Clip art is subject to the same copyright law as any other published material. Those who buy clip-art packages, or software that includes a package, are purchasing the rights to use that artwork. Rights, however, are not always unlimited. Many packages have stipulations on the way the art may be used.
A term that refers to a user who is clicking a mouse button very quickly.
A compilation of all of the links a visitor clicks during a visit to a Web site. The information is used by marketers to determine visitor preferences.
A closed-in area containing sensitive equipment. The air is filtered to keep out dust and other particles, and people wear protective clothing to avoid inadvertently contaminating the equipment. The computer facilities of many companies, particularly those with important data such as customer accounts, are set up as clean rooms, as are areas where highly sensitive equipment such as microprocessors are made.
A blog that is not open to the public. Often blocked by a firewall.
A series of references in which the last reference points back to a previous reference in the same series. Alternately, a circular reference can mean a data entry mistake, usually in a spreadsheet, in which a formula is told to act upon itself or an element of itself. For example, setting a formula that multiplies two cells and then asking that the result be placed in one of those two cells is a circular reference and probably was a typing error.
In printing, cibachrome is a color printing process that produces high resolution prints directly from color slides, transparency film, or digital film.
The purity, or quality, of color. Chromaticity is defined by wavelength and saturation.
A line that connects the two endpoints of an arc. When referring to mice, a chord is a simultaneous click of the left and right mouse buttons.
A program that uses artificial intelligence software to interact and hold conversations with human users. Examples are the Eliza and Alice programs.
A calculated value transmitted with data to check for errors in the transmission. There are several ways to calculate a checksum. In a simple example, the number of bits of information is added, and that number is sent with the transmission. The number of bits in the message is recalculated at the receiving end, and if it matches the original checksum, the information is considered error-free. (The procedure is the same regardless of which mathematical operation is used to find a checksum.)
A transaction file in which changes to a database are logged. The change file is then used to update a master file. Also called a transaction log.
Linking two or more things together so that they depend upon each other; one program causes another to execute. Within a program, statements are considered chained if all but the first statement depends upon the previous statement. Segments of data storage are considered chained if, for example, a single file occupies several sectors, each of which points to the next section of the file and its location in memory.
The byte in a date field that indicates the century. For example, the 20 in 2002.
A derogatory term used to describe Internet filtering software by those who oppose such software. Internet filtering software blocks access to sites deemed inappropriate and is used to keep children away from adult or other inappropriate material on the Internet. Censorware opponents claim that such software does a poor job of filtering content correctly, allowing viewing of some inappropriate sites and banning some legitimate sites.
A silicon junction in a memory module’s grid of rows and columns. Volatile memory, such as RAM, and non-volatile memory, such as flash, both store bits in cells as electrical charges.
Prior to LCD (liquid-crystal display), the display screen commonly used in televisions and standard computer monitors. An electron beam moves across the back of the screen, lighting up phosphor dots inside the glass tube, which causes an image to be displayed.
In images, the cast is the emphasis of one hue or tint that overpowers any other hue or tint.
The housing for the computer. Also refers to the format of a letter, as in whether a letter is uppercase (capitalized) or lowercase (not capitalized). Uppercase letters are A, B, C, and so on; lowercase letters are a, b, c, and so on. The term comes from the early days of printing, when individual letters were stored in trays or cases, with the capital letters in the "upper case," and the non-capitalized letters in the "lower case."
The symbol usually found on the number 6 key at the top of the main part of a computer keyboard. Some programming languages use the caret as an exponential operator. For example, the phrase 4^2 means the number four to the second power, or four squared. In computer instructions, the caret often is used to represent the CTRL key on the keyboard.
To move received data into a file for storage or later use. Sometimes this refers specifically to saving all the information that appears on your screen during a communications session so there is a record of the online "conversation." The term also can refer to a screen capture (also called a screen dump), in which the image on the monitor is captured as a graphics file.
A button in almost any dialog box in a GUI (graphical user interface) that lets a user exit the dialog box without making any specified changes. It returns any settings to their status before the box was opened.
Fonts that simulate the flowery calligraphy. Sometimes called script fonts.
To open a program, file, or document. This makes it appear on-screen and ready for using or editing.
If your young son receives an invitation to a party that’s BYOC, don’t be worried. BYOC stands for bring your own computer. BYOC is a common phrase used by gamers when hosting a LAN (local-area network) party. At LAN parties, a group of people get together to play computer games and compete against one another using a common local network. Because each player needs his own computer, guests are asked to bring their own.
A condition in which a bright unchanging light on some types of computer displays can, over time, permanently burn an image into the phosphor coating inside the display tube. Burn in can be prevented by turning off an unused monitor or using a screen saver, which continually changes the image to prevent one picture from appearing on-screen for too long. Burn in is not much of a problem with newer computer monitors.
A small graphical element used to set off items in a list. Classic bullets are small filled-in circles, but bullets also can be squares or other shapes. Bullets often are used in word processing and desktop publishing applications.
A device that uses electromagnetic energy to erase data from a magnetic storage medium such as diskettes or hard disks.
A flaw in an application or piece of hardware that causes a persistent malfunction or undesired result. Software bugs can be corrected by rewriting the software code. Hardware bugs are corrected by redesigning the hardware. The first computer bug is said to be a moth found in ENIAC, one of the first digital computers, in 1945. The moth caused a malfunction after being crushed between two electrical contacts. The term itself is older, however, and some sources trace it back to the 1800s.
When a buffer receives all the data it can hold, it will stop accepting data. If it continues to accept data, the overflow will cause a loss of data and can crash the system.
A colloquial term for storage. A hard drive or other mass storage medium can be referred to as a bucket for your information.
A self-replicating worm that emerged in 1999 with the power to spread via email to Microsoft Outlook and Outlook Express. Unlike previous email borne viruses and worms, BubbleBoy could infect a computer even if the user didn’t open any attachments. Merely opening an infected email in Outlook or even viewing the message in Outlook Express’s preview pane was enough to activate the worm. Once activated, BubbleBoy would attach itself to the user's address book and send itself to everyone on the list. Although BubbleBoy itself wasn’t harmful, and although it wasn’t initially found “in the wild” (that is, at large on the Internet), it was considered to be an ill omen of malicious viruses to come.
The small bubble or text box that appears when a user hovers a mouse cursor over an item in a graphical interface. This information is typically timed to disappear after a few seconds.
The process a Web site employs to detect which version of a browser a visitor is using. This tells the site if a visitor’s computer can handle more complicated multimedia presentations or just a simpler version of the site.
To view data, usually in such a way that you can page through screens or windows quickly. Today the verb is associated with looking at sites on the World Wide Web.
A temporary, partial loss of power, ordinarily because of a dip in the power supply level. This is different from a blackout, which is a temporary but complete loss of power.
An especially bad or embarrassing bug found in a computer program. The bug is so egregious that it may make the programmer want to put a paper bag over his head.
Traditional "brick and mortar" companies that have ventured into the world of e-commerce. Bricks and clicks have both a physical presence, such as a department store in a mall, and an online presence through which they sells goods or services.
Used on a Web site to let you know where you are and how to get back where you were. For instance, the Open Directory Project (dmoz.org) lists the section and subsections of the directory you’re exploring as you navigate the site. A bread crumb trial might look something like: Computers: Software: Operating Systems: Linux: Distributions: Debian.
To test every possible action a program might perform.
A graphical area that appears on-screen, usually with information or a request for user input, in a GUI (graphical user interface). Boxes are different from windows in that they usually cannot be resized or otherwise manipulated. Boxes are part of an application, whereas windows usually contain an entire application. In some instances, a box might also be a synonym for "computer," for example, a Macintosh box.
A method of writing that moves from left to right on the first line, but from right to left on the second line, and so on. Some printers, especially older ones, would follow this pattern when printing text.
Computer software has traditionally handled on-screen objects (such as clip art images) by putting a bounding box around such objects. When you click a graphic in a program such as Word, you’ll see the bounding box.
In program design, a process in which the simpler programming is designed first and the more complex programming is designed afterward.
An illegally reproduced copy of a piece of software. Many manufacturers attempt to foil bootleggers by incorporating anti-copy measures into their products, but nearly every useful program is copied by someone eventually. Software developers consider bootleg copies produced in large quantities by rogue manufacturers in the United States and other countries a significant problem.
The boot sequence defines where the system looks for the OS (operating system). The computer’s BIOS (Basic Input/Output System) can be set to look for the OS on drives in a specific order. For instance, the BIOS may be set to look for an OS on a floppy drive, then check the CD-ROM drive, and finally check the hard drive for an OS. The boot sequence is generally configurable.
The primary hard drive on a user’s computer; the drive that contains all the startup information. If the boot drive isn’t working, you won’t be able to start your PC normally. Most PCs designate the C: drive as the boot drive.
The part of a disk that contains the software that enables a system to start. The boot block typically includes an operating system.
(Pronounced BOO-lee-un.) An adjective describing an expression that results in a value of either TRUE or FALSE. Named for mathematician George Boole, the word describes a common system of logic using mathematical expressions. It uses a defined set of operators such as AND, OR, NOR, and NOT. Any expression that contains relational operators such as the more than (>) sign are considered Boolean, because of the result being either TRUE or FALSE. Boolean expressions are used extensively in search engines on the World Wide Web. For example, if users are searching the Web for information on singer Tina Turner, they might type "Tina AND Turner" into the search box. This is a Boolean expression that will retrieve only documents containing both the words Tina and Turner. If the user does not want to read about Turner's Australian tour, the Boolean expression to be entered might be "Tina AND Turner NOT Australia." Documents that meet these criteria would be "true" and all others would be "false."
User-definable lists that allow a person to display easily a certain location within a document or a page on the World Wide Web. Clicking a bookmark usually calls up the location it references. Bookmarks often are used in connection with Web browsing programs such as Internet Explorer. The lists let users point and click on names of locations instead of typing addresses or paging through screens of text.
An unusable or obsolete piece of hardware.
A case mod (modification) whereby a cooling fan is installed in the side panel or top of a desktop system's case. Sometimes the blowhole is positioned near the CPU to help keep the CPU cool. A blowhole positioned in the top of a case is called a chimney fan.
To check data, either through software or manually, to see if it adheres to certain standards. A diskette could be checked for corrupted information, or information could be checked to make sure it adheres to the standards for a program, such as numbers falling within a designated range.
A data feed produced by a blog. It is designated by a URL, and is usually in an XML-variant format like RSS. Blog hosting software produces a machine-readable version of the blog that can be further used on the Web.
A group of data with a beginning and an end, usually occurring within a larger amount of data. Many users with word processors manipulate text blocks consisting of words, sentences, or paragraphs by highlighting them with the cursor and then cutting, copying, and pasting them. Spreadsheet users might highlight blocks of cells, columns, or rows to perform similar operations. Data also are saved in memory in blocks.
A slang reference to software that requires a lot of hard drive space and random-access memory (RAM) for features that may be seen to have dubious value. Bloatware is a consequence of Parkinson's law, which says resource requirements grow as the available resources grow. In other words, as soon as you add a faster processor, more RAM, and a bigger hard drive, software makers will find a way to use it all. The major Internet browsers and office suites often are tagged with this epithet. There is a reaction to this phenomenon primarily by smaller software makers, who deliberately produce applications with tightly focused functionality and moderate to low hardware requirements.
An abbreviation of blind carbon copy, a feature found in many e-mail client programs. Recipients addressed under Bcc: will get the message, but other recipients under To:, Cc:, and Bcc: will not be aware of this. Bcc is a tool for sending someone a copy of an e-mail message without anyone else knowing about it.
Can be used in a variety of contexts, but it may refer to a list of abusive users who are banned from a Web site, newsgroup, etc. It may also refer to a list of blocked email addresses.
A hacker who intrudes into a system with intent to cause harm. Black hat hackers may simply steal data or they may deliberately destroy files.
The number of bits transferred in a certain amount of time. The most common unit of measurement for data transfer is bits per second.
In the field of computer security, biometrics is an authentication technology in which computer identification of physical characteristics replaces passwords. For example, biometric scanning devices can identify users by their retinas or fingerprints. Biometric devices and techniques are expected to be applied increasingly in the area of e-commerce to boost the security of online transactions.
The name of a number system made up of only two digits, usually 0 and 1. Any number can be represented in the binary system, although larger numbers are much longer than when expressed in the more familiar decimal system, which uses 10 digits (0 to 9). Computers use the binary system extensively to store, receive, and transmit data. The number "1" in binary is written as 1. The number "2" is written as 10, where the one is in the "twos" position and a zero is in the "ones" position. The numbers one to 10 in binary would be: 1, 10, 11, 100, 101, 110, 111, 1000, 1001, 1010. If a set of letters is numbered, letters also can be stored in binary format.
An image that only has black and white pixels.
Slang for a software design that attempts to integrate features from two distinct products into a single release.
An effect used in graphic design to make an image appear three-dimensional.
Slang terminology used to describe a situation in which a technology or standard, usually of superior quality, becomes obsolescent because a competing technology or standard becomes more widely adopted.
Errors or flaws discovered in a software program during its prerelease period, often called the beta.
A slang term that refers to freeware, which is software that developers give away. With beggarware, however, the programmer practically begs for donations in exchange for the program.
An audio result of the POST (power-on self test) that a PC completes as it starts up. The number of beeps indicates a particular problem. Typically, a single beep means the computer is functional.
A term used to describe the area toward the front of a computer typically where the disk drives and CD-ROM drives are housed. Bays usually are stacked on top of each other. The word comes from the telephone industry, where equipment was mounted on racks in similar bays.
A computer task that requires no input or other type of interaction with the user. Often, batch programs involve sorting or printing items in large databases. Batch programs sometimes run as background processes at predefined times.
An imaginary line with which typed letters are aligned. The bottom of a letter usually touches the baseline. Descenders, such as the bottom of a "j," drop below the baseline.
A term used to describe a monitor screen distortion where both sides of the display appear to bulge at the sides and/or along the top and bottom.
A standardized system of representing data in the form of parallel lines of different widths and spacings. With the correct equipment, a computer can read bar codes, which often are used to identify objects for inventory and to track shipments. One everyday use of bar codes is at the grocery store, where nearly every package includes a bar code that computerized cash registers use to find price information and to update inventories.
Slang for a Web site that stores pirated files. The site promises access to the files if you click through a number of banner ads, a process that’s usually unsuccessful.
A script included in Web pages that automatically changes the banner ad that a user sees at a particular Web site. The banner ad rotator will show a new ad to the user whenever he visits the site or refreshes the Web page.
A flaw in a printed document characterized by noticeable vertical or horizontal lines running the length of the page.
The process of sending data through a network on a less-than-direct route. The idea is to avoid network congestion and perhaps save time and money.
In reference to text, alignment is the arrangement of characters according to a particular point of reference, such as the left or right margin.
An alternate name assigned to a computer, file, object, or group on a network. Aliases are handy when they replace a long name or a list of names. Many email programs let users assign an alias to lengthy and cryptic email addresses. For example, a user could send an email message to "Joe and Sally" rather than email@example.com, and the message would be sent to the complete address. Macintosh and Windows systems let you assign aliases to files, so you can have icons for the same file in different folders. Unix also supports aliases.
In a GUI (graphical user interface), a box that displays a message to warn the user about a potential or real system error.
An additional layer of security in a computer network, in which some LANs (local-area networks) that are part of a larger network are not connected to each other or to the Internet. This helps keep some parts of the network secure if other parts are compromised, but to some degree, it limits the communcation among the LANs.
A collection of data objects in a programming language.
A slang term used to describe free, sponsored software that often, but not always, contains cookies and Registry keys that are loaded onto your computer when you install the main program. This data is then used to track your Web movements and/or target ads to suit your tastes and needs. Sometimes, uninstalling the original software will not remove the cookies and Registry keys from your system and will still let advertisers track you. However, you can use programs, such as Lavasoft’s Ad-aware, to remove these sticky components for you.
A cursor that may be directed immediately to any location on the computer screen. Normally this is accomplished using a multiple key combination. For example, using the CTRL-HOME key combination will position the cursor at the top of most word processing documents.
The maximum number of pixels a monitor can display. The more pixels there are on a screen, the closer together they are, and the more precise the picture looks. Also known as resolution.
A portion of a computer's memory reserved for keeping track of the location of data in memory.
The practice of changing your email address when you post it somewhere on the Internet, such as on a forum, Web log, or online form. A human wishing to reply to you will understand that the extra characters you type after the @ sign in your email address, such as the “NOSPAM” in yourname@hotNOSPAMmail.com, are extraneous and will leave them out of your address in a message to you. However, an automatic email address retrieval bot or spider may not be able to make the distinction, especially if you use a more unusual munging phrase than “NOSPAM.” Some Web administrators caution that munging may protect your inbox, but it does nothing to deter the spammer and actually just creates more undeliverable messages administrators must deal with.
An automated program that scans newsgroups and Web sites for email addresses. In many cases these addresses are used to send unsolicited junk email.
A feature of most email programs that lets users maintain and store multiple email addresses. The address book enables users to easily send an email message to multiple recipients. It lets users click the addresses they want and then their email program automatically adds each selected address to the header or the To: field.
In data transmission, adaptive compression selects a compression algorithm that best suits the characteristics of the data, choosing the one that offers the fastest transmission speed and optimal compression.
A bridge in a network that is programmed to “remember” destination addresses, which significantly speeds up subsequent transmissions.
A small piece of computer code, usually written in html (Hypertext Markup Language), that advertisers give to the Web publisher that hosts their advertisement. When a user comes to a Web page and clicks the ad, the ad tag directs the user’s browser to the advertiser’s server to retrieve the body of the advertisement.
The ratio of active records to the total number of records in a file, useful in determining the load on a database.
Any data file that currently is open and able to receive or transmit data.
A connection or line of data that is currently in use. This term often refers to channels that are streaming data over a network.
Describes an application or file that currently is operational.
Any distinct and executable command that initiates an action for the computer. The command might consist of a single word or a series of words and might perform one action or a number of related actions. An example is the clear command, which in many computer languages clears the screen. An action statement differs from an expression, which designates a value instead of performing an action.
Acronyms are abbreviations of terms or phrases that are pronounced as words rather than individual letters. Two common acronyms are WYSIWYG (What You See Is What You Get) and RAM (random-access memory).
The length of time that is required for a computer system to process a data request and then retrieve the data from memory, a storage device, or the Internet. This access time can range from a few nanoseconds when accessing a file in the computer's memory, to hours when retrieving a large amount of data from the Internet.
The rights a user or computer has to open up a communications pathway with a particular computer, component, or application. Limiting access rights keeps specific people, machines, or groups from using a certain network, machine, or files. Access rights usually are controlled through the use of passwords and codes.
In an 802.11 wireless LAN (local-area network), the hub through which different devices using the network communicate.
Different permissions associated with files to determine how they can be used. Such permissions include write, execute, and read. Some users may not have all the permissions associated with a specific file available to them.
A device or software driver that allows one component or application to communicate with another. For example, an access arm positions a read/write head for communication with a hard disk; a device driver allows a software application to communicate with the computer system.
The ACL is a list noting which users have access rights to network resources. Specific users, for instance, may have access to company payroll information while other users are restricted from accessing such information. Different users may have different rights to a specific resource. Some users, for instance, may only be able to read a file while other users may be able to read and write to a file.
The ability to allocate computing resources based on a user's identity. A simple example is the setting of a password on your computer that keeps it from working until the password is entered. Administrators also can use special software on a network to customize access according to user identity. Such software usually allows levels of access to be set.
Also known as TOS (terms of service). Many ISPs (Internet service providers) have an acceptable use policy that their customers agree to abide by. The AUP defines specific activities that a user cannot use his Internet connection for, such as hacking Web sites or using the ISP for illegal purposes.
Software developers use abstraction to identify similar features and processes in software code in the hopes that the instructions can be combined. The idea is to make the software more efficient and effective.
A comment you would type into the subject line of an e-mail message to tell the recipient that you won't be online for a while, due to network problems or because you're moving or sick or some other reason, generally beyond your control.
A term borrowed from print media that indicates the portion of the screen the user sees first. On Web sites, important information should go in this space, but it’s also expensive advertising real estate. In order to be above the fold, the information should be visible without having to scroll vertically or horizontally. Since users can have various screen resolutions that affect whether something is positioned above the fold or not, it is important to know the resolution used by most visitors to the site.
A DOS error message that appears when a nonfunctioning drive has been accessed. Some form of this message most often appears when a user attempts to access an empty diskette drive.
Extremely common words that a search tool sometimes omits, including “and” and “the,” among others. Placing the words in quotation marks sometimes forces the engine to find them.
Sharing of licensed content among Web sites. Supplying material for reuse and integrating it to fit the desired content.
Symbolic links are also known as shortcuts. Symbolic links shortcut to other files. For example, the icon on your shortcut that opens your My Documents folder is a symbolic link.
Allows users to send short (160 character) messages from an enabled electronic device to a mobile user. When a message is sent to a mobile user, it first travels to the Short Message Service Center (SMSC), which then contacts the home location register to find the status of the mobile user. If he or she is not using the device, the home location register will let the SMSC know the user is not active and the SMSC will hold onto the message until the user accesses his or her device. At that time, the home location register lets the SMSC know the user is active and the message is delivered.
In both negative and print format, this is the luminance difference between the lightest and darkest areas.
The highest amount of electrical current a conductor can support. Also, a measure in desktop publishing of how much hue is in a color. For example, if a mixed color is 90% red, it has a red saturation of 90%.
An intelligent hub serves as a central connecting point for a network. It is “intelligent” in that it’s capable of more complex functioning, including switching, routing, bridging, and even LAN emulation, among other possibilities.
A general term for money in a monetary transaction that takes place using the Internet. Also called cybercash and e-money.
A name, label, or title given to a function or variable.
Storage not currently accessible to the computer, such as files on a diskette that is not in the diskette drive.
Software for which businesses buy licenses but don't use.
A device that expands the number of peripheral units a user can connect to a single port, usually on a portable computer. An expander makes it possible to connect additional devices, but only one of those devices can operate at a time.
As an operating system writes to and deletes data from the paged pool in RAM, gaps appear between blocks of data that are still current. New data larger than the existing gaps is often written piecemeal, as space allows, leading to the condition of pool fragmentation.
Files are transferred through the Web using packets, which are reassembled, piece by piece, at the destination computer. If a packet is delayed, the final document can’t be reconstructed, causing a packet jam. Clicking Reload or Refresh requests that the file be sent again, which should fix the jamming problem.
An access point onto a LAN (local-area network).
An electrical impulse used to send data to and from various devices in a PC, or across cable or wires. One example is the analog signal sent by modems over phone lines to establish a connection with an ISP (Internet service provider).
A set amount of stored information in memory. In word processing and graphics programs, a page is the amount of information on-screen that would take up one printed page. On the Internet, a page refers to a single World Wide Web page.
As a verb, to move the beginning of a line of text inward from the margin. As a noun, the space created by such a move between the margin and the beginning of text. A typical indent is five spaces. In many programs, users can press the TAB key to create an indent.
Describes two electronic devices that have the same type of connector pins, with the same input and output abilities. These two devices can replace each other and can be plugged into the same socket.
A block of data transmitted from one computer to another on a network or on the Internet. A packet contains three parts: the data to be transmitted, the data needed to guide the packet to its destination, and the data that corrects errors that occur along the way. Several packets make up a typical transmission. The computer splits up the transmission at the transmission point and reassembles it at the destination.
A switch or dial connected to a PC fan. This switch lets you control fan speed, and thus, noise levels and temperature inside the PC case.
An air circulating device inside a computer case that cools heat-generating components. Usually, these fans are built into the power supply of a computer. Modern CPUs run at very high temperatures and often require two or three fans to cool the components.
A storage area for paper in a copier, printer, or multifunction device. It can usually hold 100 or more sheets of paper and includes a sensor to determine when the paper runs out.
Papers are classified into different grades by the materials used to make them. Papers are also graded differently depending on the intended purpose.
A state of low-power inactivity. PCs and peripherals with sleep capability can be set to enter an energy-saving mode in which all but vital functions are shut down until the user "awakens" the machine. For instance, a monitor might go blank when in sleep mode. Often pressing any key on the keyboard will end a computer's sleep.
An ad view occurs whenever a user downloads an ad. The idea behind ad views assumes the user sees the ad, but there is no reliable way to know whether they have fully downloaded it. Most Web sites prefer to sell ad views to advertisers.
In a spreadsheet, the cell (the point at which a row and column intersect) currently open for data manipulation. The active cell, which can hold text, a numerical value, or a formula, ordinarily is highlighted.
A peripheral (such as a printer or modem) that is not necessary for the operation of a computer but often is useful. Also called accessory.
Refers to a paper’s ability to absorb and keep ink in one place. Papers with very high absorbency may hold ink better, but may lack the vibrant colors produced by papers with lower absorbency.
An expansion board placed in a PC that acts as a TV tuner. The tuner card receives signals from an antenna or cable like any regular TV set. Additional software then lets users change the channels or settings as if operating a television.
A data file is a logical collection of related information stored on a computer's hard drive, tape drive, or other mass storage device. Data files usually contain a specific kind of information, such as a personal music catalog or a contact list. For the purposes of retrieving and processing the information, data files are generally subdivided into data records, which are then subdivided into data fields. Data files are given a meaningful name for the convenience of their human users. This name is stored in a directory, which resides on the same storage device as the file. The directory also stores the disk location of the first part of the file, as well as information, including the date the file was originally created and the date it was last modified. Logically, a data file is a consistent, contiguous collection of information. Physically, however, it is nothing more than one or more blocks of binary data stored on the recording surface of a computer device. On hard drives or other random-access devices, these blocks may be randomly distributed over the surface of the disk and linked together by the FAT (file allocation table) for that device. On sequential devices, such as magnetic tape drives, a data file's blocks must be stored together and in the proper order on the tape due to the slower speed of these devices. Data files may contain fixed- or variable-length records. In either case, the records within a data file each contain similar types of information about different objects. For example, in a personal music catalog, each record would contain similar types of information about a different CD or cassette tape. Each record is subdivided into fields that contain the individual pieces of information for a specific object, such as the title, artist, or genre of a CD. Data files can stand alone or be part of a larger logical scheme called a database. In either case, certain fields within each record are designated as key fields. These key fields are associated with an index file that lets users locate desired records within the data file quickly and easily. For example, the use of an index file would produce a list of all titles belonging to the classical genre much faster than sequentially reading each individual record in the file and discarding those where the genre field is not equal to classical. See database.
The spreading of a signal. In the case of fiber optics, propagation describes the spreading of light rays through an optical fiber.
An MMORPG (such as EverQuest, Asheron’s Call, World of Warcraft, or Ultima Online) lets hundreds of thousands of players worldwide role-play in PSWs (persistent state worlds). Players pay monthly subscription fees to keep the neverending games running on managed servers. As in traditional RPGs, players can develop their characters over time, and gameplay is very open-ended.
A game in which players take on another identity and play the game in an imagined reality. Dungeon & Dragons games are some of the best examples of role-playing games.
When using a search function, a keyword is the word the user wants to find in a document or documents. For example, to find all documents about dogs in a folder, a good keyword might be "dog." Some word processing and database programs let the user attach certain keywords to specific documents to make searching faster; rather than searching the entire file, the search program might only look at lists of user-defined keywords for each file.
A picture-taking mode many digital cameras have that lets users take images that have an overall brownish or bluish tint or impression. Sepia modes are specifically used to give images an antique or aged feel.
A section of the boot drive that contains the computer’s startup files.
A reserved portion of drive or memory that functions as a separate unit; when used as a verb, partition refers to the process of dividing up the space on a drive into smaller units. A partition acts as a separate space, but physically it is still part of the whole drive. A user could, for example, partition a hard drive into several separate drives (such as E:, F:, and G:), while maintaining the physical structure of only one drive. This is a way to make the hard drive more efficient. Hard drives partitioned into multiple sections often work faster because the computer only needs to search a specific section for information rather than the entire drive.
In computer graphics, cropping the part of the image that lies outside a boundary set by the user. Programs that allow screen shots (graphics showing the appearance of the computer screen at the time you take the shot) often let a user clip the image to show only an active window or part of the screen. Depending upon the program, clipping can be done either through a dialog box or by drawing a line around part of the image. Also called scissoring.
A communication method that only allows one participant to transmit at a time. One side sends a message, the line switches from send to receive, and the other side sends a reply.
The disk drive that is automatically employed by an operating system, unless denoted otherwise, when a computer is booted.
A self-contained device, usually in a protective plastic shell. There are several kinds, including ink cartridges, disk cartridges, memory cartridges, and toner cartridges. Also called cart.
A Web site that has remained inactive or has not been updated in a long period of time.
Cooling computer devices with components other than a fan. For example, a heat sink is a passive cooling device. However, many newer processors generate enough heat to require a fan on the heat sink.
A tool found in many image-editing programs that lets the user select a specific portion of an image to manipulate (copy, color, move, enlarge, rotate, etc.) based on a similar color pattern.
A device that routes data between one or more local area networks and an asynchronous transfer mode network. Sometimes called a boundary router.
A secondary menu that appears next to the original menu when an option with a menu of its own is selected. This arrangement is common when a menu item has many related commands. Some cascading menu items have their own cascading menus in turn. This multilayer menu system is where the term cascading came from, as each menu flows from the one before it.
Googlewhacking is the art of trying to find only one Google result on a search with only two words.
A nickname given to software that’s has not yet been released. Beta ware is often distributed to many users before the official release to let them search for any malfunctions.
A type of shareware that interrupts the user while they're using the program and asks the user to register or pay for the software. This usually takes the form of some sort of pop-up box. Usually the user has to click a button before the program will resume.
An angry state of mind in which a computer user may resort to flaming (a personal attack via email) another user. Like road rage, it’s an impulsive action that likely has regrettable consequences.
An email that returns to the sender because the recipient’s address is incorrect or belongs to a recipient the server no longer recognizes. A bounce email usually appears in the form of a message from a system administrator or mail server in the original sender’s inbox with the email in question attached.
An e-mail message that has been directed to the recipient through a third party server and does not identify the sender.
Email that circulates among many Internet users, detailing the latest “scare,” from rumors of terrorist attacks to giant vampire bats. Most turn out to be urban legends.
The opposite of client pull. The server automatically sends data to the clients (usually desktop computers) connected to the server.
Occurs when a desktop computer (the client) initiates a request for some kind of data from another computer. The client computer "pulls" the information it needs from the computer storing the information, usually from a server.
Encoding a file to prevent others from accessing its contents. An encrypted file appears as a string of gibberish. Users must decrypt the file to read or use it. Files are usually encrypted using encryption programs.
A failure by either a computer or its source while in the process of inputting information into the computer.
A portion of memory that temporarily holds data until it can be permanently saved, usually when there is a decrease in a system's activity. This delay improves system performance over that which exists when there are frequent disk writes, because the computer is not constantly pulling data from or storing data to disk. Also called write-behind cache or write cache.
To record a song from an audio CD and encode it into the MP3 format. MP3 files are significantly smaller than audio CD files, therefore ripping them can save quite a bit of space on your hard drive. There are several software programs available that one can use to rip songs from a CD.
The electrical supply needed to operate a computer. Also, the device inside a computer that transforms the AC electrical currents available in a standard wall socket into the lower DC voltages used by a computer.
A designer of computer systems for specific tasks or environments. Systems analysts must consider how end users will use the system before they can design a new unit or add to an existing one. System analysts often can be likened to efficiency experts in that they examine a system to see how it is currently being used and how it is falling short of user needs, demands, and expectations. The analyst then takes this information and creates an effective system that will let end users complete their tasks quickly and efficiently and with fewer problems. After the system has been created, the analyst will supervise its implementation.
To press and quickly release the right button of a mouse or trackball.
To obtain an open channel of communication with a software application or computer component so the user can work with it. For instance, a computer must access an attached modem before it can be used.
The focal length at which the maximum amount of optical zoom is applied.
A prefix meaning one-millionth. Also can be used informally to indicate an object is tiny.
To eliminate unneeded information from a system. Users may purge old files from their computer for more storage space. For example, a student may decide to purge all the document files associated with a history class after the class has been completed.
Performed by a Web browser for quicker access to previously viewed Web pages. Once accessed, the html code along with image, video, and audio files are automatically stored in a temporary file within the browser. When the viewer returns to a page, the browser brings up the site using the downloaded information in the temporary folder. This form of caching also alleviates some of the stress put on Internet connections and servers from large numbers of surfers trying to access a given site.
Networking technologies are plentiful, and keeping them straight is no small task. One of the newer wireless standards is 802.11n. This new standard builds on the previous 802.11 technologies by adding MIMO (multiple input/multiple output) capabilities. The first 802.11n routers officially became available on April 14, 2006. Speeds for these routers can reach speeds in excess of 300Mbps, which is much faster than the currently popular 802.11g standard with 54Mbps speeds.
A word that is reserved for special use in programs and cannot be used for naming files, documents, or macros. Reserved words in certain applications might include operators such as IF, OR, and NOT.
A type of camera that is specifically used to take panoramic images. Panoramic images are those that have a very wide field of view, usually on a horizontal scope. Panoramic images can be just one image or several images stitched together to form a full 360 degrees or less.
A computer display that is sensitive to the touch of a human finger. Touchscreens let users interact with a computer by touching pictures or words on the screen instead of using alternative input methods such as a keyboard or mouse. You’ll often see touchscreens on information kiosks, tablet PCs, smartphones, and PDAs.
An arrangement of information in rows and columns that makes comparing and contrasting easier. For example, charts in newspapers and magazines often are presented in table format.
A way to increase and improve a printer's resolution. Typically, resolution enhancement is accomplished by altering the dpi (dots per square inch). This alters the number of dots that are printed in each square inch of the paper.
A user who is exceptionally knowledgeable and skilled in the use of computers and software.
A return to normal operating conditions after an error has occurred. Recovery may involve complex retrieval of information lost due to system errors.
The amount of computing ability, determined by speed and functionality, a computer has, or the actual electricity used to run a computer.
The ability of a machine to follow instructions and carry out user-dictated jobs. Computers are programmable.
A quality of hardiness; the ability to continue working properly in unusual or difficult situations. In computing, this may refer to hardware's physical durability or software's ability to handle unusual situations without crashing.
The memory controller chip on a specific motherboard and chipset architecture. The northbridge typically directs data traffic between a system’s CPU (central processing unit), graphics controller, and system memory; the bridge is connected to each by a high-speed data bus. A slower, PCI (Peripheral Component Interconnect) bus connects the northbridge to another chip called the southbridge that controls the system’s drives and devices installed to the computer’s expansion slots.
A slang phrase used to refer to a 404 error message. On the Internet, a 404 error means the Internet couldn’t find the Web site requested. Atlanta’s area code is 404.
A measurement for the distance between corresponding peaks or troughs on a transmitted wave signal.
To alter the size of an image. Scaling an image up enlarges it while scaling an image down makes the picture smaller.
Refers to an image taken with a digital camera that is framed vertically, or so the scene spreads out up and down. A landscape image differs in that the image is framed horizontally, or so the scene spreads out from side to side.
Keys that act as shortcuts for performing functions such as saving files or printing data. Function keys are usually lined along the top of the keyboard and labeled F1 through F12, although some keyboards have fewer and others have more. Function keys also might be on either side of the lettered keys along the right or left edge of the keyboard. Function keys change their function depending upon which software is running, although the F1 key, for instance, often brings up a help screen.
To damage an electronic component by letting too much electrical current pass through it.
A play on the term war dialing. War driving refers to the hobby or outright obsession of driving around a neighborhood in an attempt to locate wireless Internet access points.
A type of hard drive space that mimics actual memory (RAM). When actual memory space is limited, the use of virtual memory can let users work with larger documents and run more software at once. When a program needs information held in virtual memory addresses, the information is moved to actual memory addresses. This process of moving sets of virtual addresses (or pages) into actual memory is known as paging or swapping. When virtual memory is used, it appears to the user as if actual memory is in use. The process may be a bit slower, however, because of the time required to swap information between virtual and actual memory.
To temporarily place a function or application on hold without shutting it down. Users can then pick up the application where they left off.
A slight, slow, wandering movement of objects on-screen that are supposed to remain fixed.
An electrical component that provides resistance to a flow of electrons. Used in electrical circuitry for protection and to control a current.
A cable that’s enclosed by one or more layers of a conducting polymer, which redirects electrical noise away from the cable’s internal wire. The shielding prevents electromagnetic radiation from interfering with the signal passing through the cable.
A function available in some digital cameras where the user can identify specific images to be stitched together within the camera to form a single panoramic image. Panoramic images cover a very wide field of view, usually on a horizontal plain.
A data transmission mode in which information is sent one character at a time.
To begin a program or use a program.
In Windows, a restore point refers to the point at which a system was backed up. If a system change causes a problem, you can restore the system to the last working restore point.
To change the size of a graphical element. Often refers specifically to changing the size of a window in a graphical user interface.
The information about the activity level of an aspect of the computer system such as a device or a program. For example, the flashing light on a diskette drive indicates that the status of the drive is active.
The PC receiving data from software, another PC on the network, or a communications device.
To eliminate data from a storage medium, this leaves the medium available for future storage.
Artificial life models complex behaviors in software. Artificial life can learn new behaviors not defined in its software.
Computers or applications that work with data 32 bits at a time. A 32-bit computer might have a microprocessor capable of handling 32 bits of information at a time. More commonly, 32-bit also can describe the capability of the computer's bus to transport 32 bits of data at a time. Most computers based upon Intel's 80386 microprocessor are 32-bit machines. A 32-bit operating system such as OS/2 Warp and recent versions of Windows works with information in 32-bit groups.
A hard drive in a plastic or metal cartridge that can be used and removed in a manner similar to a diskette. A major benefit of this type of hard drive is that it can be moved from one computer to another if both machines have a bay to accommodate the removable hard drive. This lets large applications and documents be moved from one location to another.
A type of logic bomb (destructive programming code) that is triggered when the clock reaches a predetermined time. A time bomb can wreak havoc on a software system.
Technology without an interesting name.
(Pronounced “leeds”) The metal pins or legs of an integrated circuit chip (including microprocessors).
In graphics programs, when a user grabs one portion of a line or image and moves it while other parts stay anchored, causing the line or image to stretch.
A method of increasing or decreasing the playback speed of an audio recording without altering the pitch of the recording.
A fake computer virus warning, typically forwarded by someone using a distribution list. If you receive such a warning, you may want to investigate the claim by checking one of the numerous sites that keep current lists of active viruses and worms.
A keyword or character set used to arrange information into a desired order.
The trim feature of many software programs lets you cut out unneeded parts of an image. In many programs, this feature is called the crop tool.
A mode that prohibits the OS (operating system) from interfering with the direct flow of bits to or from an I/O (input/output).
Word-of-mouse is a term that describes the spread of information, accurate or otherwise, via email.
Slang for items that adorn a person’s computer monitor.
A feature of some applications that automatically records, at periodic intervals, changes made to a file. The changes are saved to a temporary file that can be retrieved. Autosave helps prevent accidental data loss.
A bit-mapped graphic that appears as a backdrop on the Windows desktop and other operating environments. In Windows 3.x, wallpaper is controlled from the Windows' Desktop icon in the Control Panel. Wallpaper images can be basic images (such as the Windows logo) or patterns (such as argyle or tartan) to more elaborate photographs, cartoons, or other images created by users or provided by third-party manufacturers. Also called backdrop.
A special chemical coating on a monitor’s glass that reduces static electricity and dust buildup on the display. Most monitors come with antistatic coating.
An add-on device made from polarized material that can be placed in front of a monitor's screen to reduce glare and prevent eyestrain.
Strategies used by some Web marketers and hosts as a way of keeping their services at the top of search engine results. Spamdexing includes submitting multiple, yet slightly altered, Web sites to a search engine, and "word stuffing," which places a word or keywords in a site numerous times, to ensure the search engine will bring up the site as one of the top keyword matches. Other techniques include "bait-and-switch" gimmicks, such as loading the site with frequently used keywords such as "free,""sex," "money," or "shareware," even though the words have nothing to do with actual site content.
The equivalent of unsolicited email that is sent to VoIP (Voice over Internet Protocol) voicemail boxes.
A spam message in your email account that contains predictions of high performance for a specific stock. The email scam relies on spam recipients to buy the stock and increase the stock price. Once the stock price increases, those who sent the spam will sell their stock for a profit, which they purchased for a low price before sending out the pump-and-dump spam.
Software that monitors a computer for viruses by looking for irregularities in a computer system and then comparing its findings to a database of virus information. Viruses not included in the antivirus program's database will go undetected, so it is important to periodically update antivirus programs with information about new viruses. Such updates usually can be purchased on a subscription basis from the company that produced the antivirus program. The regular use of an antivirus program often can eliminate a virus before any damage is caused. Antivirus applications should be used when foreign software is introduced into a computer.
The area of a printed page actually covered with toner. The industry assumes an average of 5% toner coverage per page to gauge the number of pages a toner cartridge can produce.
A device that takes commands from a computer and produces hard copies, usually on paper, of the text and graphics that appear on the monitor. Printers such as the daisywheel and dot matrix produce images by striking the paper. Inkjet, thermal, and laser printers use more complicated and precise methods to render characters and images. These printers generally produce a higher-quality image than daisywheel and dot matrix printers.
An intensely focused beam of light. Lasers have many uses, from reading stored optical data (such as on CD-ROMs) to high-quality printing (laser printers). Laser is an acronym for Light Amplification by Stimulated Emission of Radiation.
When printing a document or image on a laser printer, the paper is rolled between this extremely hot roller, which is kept warm with an internal halogen lamp, and a pressure roller to melt the toner and create the image. In color printers, two fuser rollers are used to melt the toner.
The hallucinatory, mesmerizing image displays that many music programs display as songs play on your PC. If you use Windows Media Player, you can download new visualizations from the Internet.
A single button on the keyboard. Letters, numbers, and symbols are all represented by keys on most keyboards, along with several special function keys (for examples, see the CTRL key and the ALT key). Pressing a key in many applications causes the character on the key to display on the monitor. Also refers to the code used to encrypt and decrypt data. There is also sometimes a physical key that can lock a system.
If something is static, it is unchanging. In computers, static is often opposed to dynamic. For instance, a static IP (Internet Protocol) address is a constant IP address often used for Internet servers while a dynamic IP address is an IP address that changes regularly.
The ads you see on most Web sites aren’t permanent. Instead, many sites have a list of different ads that they rotate onto the site.
Two depressions of the mouse button, performed rapidly and without moving the mouse. Double-clicking is one method of opening an application in graphical user interfaces (GUIs) and also can be used to activate commands.
A standard element of graphical user interfaces (GUIs) in which one option is presented along with a small button, usually represented by a downward-facing arrow. Clicking the arrow with the mouse causes a list of other options to appear below the first. The user then can select from the options by clicking one. The drop-down list then disappears, leaving the selected option displayed in the original box next to the arrow button.
The reliance of one program, operation, or device upon another for its function.
A more friendly variant of spam, bacon (also called bacn) is a term used to describe email you signed up to receive from a Web site you know and trust. These emails can be notices of software updates, new product notices, or information about podcast schedules. Not quite personal mail, these messages sometimes go unread.
To find a piece of data and bring it to an active application. Information can be retrieved from memory or a storage medium, such as a diskette.
A method of copying the contents of a computer's entire hard disk to a file. The file can then be placed onto the hard disk of another computer, creating a system with the identical software and settings as the first. This is a simple way to set up several systems with identical configurations.
A central repository for a user’s voice mail, e-mail, faxes, and other messages that the user can access either by phone or PC. UM is an example of CTI (computer-telephony integration). It has given way to the broader concept of UC (unified communications).
In every Windows OS (operating system) since Windows 95, the far right end of the Taskbar, in the bottom right of the screen. The System Tray displays the time as well as the status of various Windows functions. You can also change some system configurations via the System Tray, such as the volume. Various software programs, from virus scanners to RealPlayer, might place an icon in the System Tray that lets you conveniently launch the program and change the program's settings.
A computerized imitation of a real object or action.
Programming jargon for checking software code for blatant errors.
The menu that appears when a user clicks the Start button. The Start menu gives the user access to all programs on the computer, unless the user has instructed it otherwise.
A video card that contains a graphics coprocessor designed to handle graphical computations better than the computer's CPU (central processing unit). The coprocessor increases the speed of on-screen images and improves system performance by relieving the CPU of the graphical tasks, letting it handle other tasks. The amount of RAM (random-access memory, either DRAM [dynamic RAM] or VRAM [video RAM]) contained on the video accelerator, which has become standard equipment on most new PCs, determines how many colors and which resolutions are possible on the system. Also called a graphics accelerator.
A term used with industrial-strength items. For example, a Rackmount Chassis, Rackmount Keyboard or Rackmount Console. Describes how the piece of equipment is made; it comes ready to be attached or mounted to a rack or another piece of equipment.
The integration of hardware and software to create a machine, such as a computer, that can perform work. System can refer to a single computer or a system of multiple computers. Also can mean an operating system.
Sometimes called a “nibble” in the communications industry, a quadbit is a 4-bit combination used to carry encoded transmission signals. This allows for more efficient data transfer, because the signal doesn’t have to be carried one bit at a time, but in groups of four.
Recognizable and memorable domain names that include words or combinations of words that relate to the person or organization that owns the domain. Most domain names are vanity domains.
A request for data not found in cache memory. When this occurs, the computer must search the main memory to find the data.
To render a computer, application, or other resource inactive without removing the item from the system. In this way, technicians can reactivate the resource much more quickly than they could if they had to reinstall it.
The part of the printer that determines the resolution, speed, and overall quality of the printing. Most engines are replaceable self-contained units; printers from different manufacturers often use the same engine.
Repeating a word on a Web page in an attempt to increase its relevancy when people perform a Web search. This attempt is usually in vain, as search engines typically locate information using methods other than a simple word search.
The ability to update data, such as a number in a spreadsheet cell, when it is being displayed in a different application, such as a chart or a graph. This lets the user change the data in the originating application and see the results in other applications that use the same data.
Speed dial refers to the ability of a telephone or cell phone to store a given telephone number in its internal memory. With a speed dial-enabled phone, a user can assign frequently dialed numbers to a short button sequence or to dedicated speed dial buttons and then press these buttons to quickly call that number.
Physical topology is the placement of hardware on a LAN (local-area network). This is where the connections are set up and the location of cables, switches, etc.
A section of an overall network (either LAN [local-area network] or WAN [wide-area network]) specifically reserved for storing data. SANs consist almost entirely of storage hardware. Servers connected to the network are gateways to the SAN subnetwork, where information can be stored and accessed.
One of the main input devices used by computers, a PC's keyboard looks very similar to the keyboards of electric typewriters. Computer keyboards, however, usually include extra keys such as the function keys, cursor keys, and a number pad.
A menu item in most programs that provides electronic assistance. Textbook-like help is available for searching and may be context-sensitive, meaning the help may change according to the type of function or program users are working on when they select the help option. Although most help files are usually portions of the manual put on-screen, some help options also may include tutorials and tips on how to use the program.
An input device used with computer games, typically with flight simulation games, that allows the user to fly up or down, back or forward by pulling or pushing the steering wheel-like device.
Random-access memory gives a computer a fast storage area for the programs you run. Without enough RAM, the computer feels sluggish because it has to use the hard drive instead. A new system should have at least 2GB of RAM. If your computer runs Windows Vista, however, you should consider 3GB or even 4GB.
The information category that a sort process uses to organize the database information. For example, "last name" might be a sort field.
A term used to describe 100Mbps (megabits per second) Fast Ethernet network segments that use fiber optic cable rather than twisted-pair wire and support full duplex (the simultaneous sending and receiving of data) transmission. The IEEE (Institute of Electrical and Electronic Engineers) standard that includes 100Base-FX standards is 802.3u.
A play on the word “tradition” that means the passing down of technology-related information, through word of mouth, in digital documents, and by other means.
A blinking horizontal or vertical line or a square that denotes where new characters or changes will appear in a text field.
A list of image quality adjustments on the screen accessible by controls on a monitor's bezel.
An email that a user receives by requesting information that comes on a regular basis from a Web site. Newsletters and notification of changes to a Web site are examples of opt-in emails.
The set of standards that let users of the Web exchange information found in Web pages. You can use a Web browser, such as Microsoft Internet Explorer or Netscape Navigator, to read documents formatted and delivered according to HTTP. The beginning of every Web address, "http://," tells the browser the address' document is HTTP-compatible.
A menu in a graphical user interface that is opened by placing the screen cursor over the title and clicking a mouse button. A list appears below the title, and the user can select options from that list.
A malicious or nuisance program embedded within an html (Hypertext Markup Language) file, email attachment, or push technology data. Vandals often arrive in applets or ActiveX controls and, unlike viruses, do not self-replicate. They can, however, breach security restrictions within a computer to access passwords or cause loss of service for users within a network.
A high-capacity optical storage format similar to DVD. Blu-ray was developed by the Blu-ray Disc Association, a group of developers that includes Sony, Philips, Apple, Dell, Samsung, and Mitsubishi, as well as many others. Blu-ray takes its name from the blue-violet color of the laser used in a Blu-ray player or PC drive. CD and DVD players and drives use red lasers. A Blu-ray player’s laser beam is thinner and more tightly focuses than the laser of a DVD player, so manufacturers can store more bits of data much more closely together on a Blu-ray disc than they can on a DVD. Blu-ray is designed to use high-definition video and audio and may replace video DVDs. Blu-ray video players can play video at resolutions up to 1080p, a higher-quality resolution than DVD players can produce. PC users can also record large volumes of data to a recordable Blu-ray disc, assuming a user has a Blu-ray recordable drive. A single-sided, single-layer DVD can store about 4GB of data, but a single-layer Blu-ray disc can store 25GB of data. A double-layered Blu-ray disc can store 50GB of data. Blu-ray supports the MPEG-2, MPEG-4 AVC, and SMPTE VC-1 video formats. It also supports several audio formats, such as linear PCM, Dolby Digital, Dolby Digital Surround, Dolby Digital Plus, Dolby TrueHD, and DTS Digital Surround.
A program that has a tendency to stack its dialog boxes on top of one another, which may make it difficult to use the program properly.
A portable computer battery that keeps its system up-to-date about its power status. Also called an intelligent battery.
A one-time pad is a cryptography term used to describe a process in which a message is encrypted using a randomly generated key. A unique key is randomly generated for each encrypted message. To decrypt the message, a recipient must have the same key. Theoretically, one-time pad encryption is impossible to break because each key is unrelated to other keys. However, working on a secure method to transmit the secret key to the receiver is a problem. Generally, one-time pad encrpytion takes place when both the sender and receiver begin at the same physical location and then separate. This technique was commonly used in WWII.
A notebook less than four pounds. In many cases, mininotebooks come in a smaller package, meaning you have a smaller display. Power is an issue because there’s not as much room to add a large power source to a mininotebook. Smaller displays help conserve power as do slower processors and graphics controls. Mininotebooks are typically one-spindle devices capable of supporting only a hard drive. You can add an optical drive and/or floppy drive by clipping additional hardware to the bottom of the notebook or attaching the drives with cables (to USB [Universal Serial Bus] ports, for instance).
Any component installed in or connected to a computer that expands the capabilities of the entire system. Modems and printers are two examples.
A popular solid-state flash memory module used in MP3 players, digital cameras, and other gadgets. SmartMedia cards are very thin at 0.03 inches and are 1.46 inches wide by 1.77 inches long, with a notch on one corner. This format also is known as the SSFDC (Solid State Floppy Disk Card) because it can fit inside an adapter that slides into a PC’s diskette drive. Occasionally the term SM card is abbreviated as SMC (SmartMedia card).
A number indicating how far from a starting point an item is located, usually in bytes. For example, an offset might tell a processor how many bytes into a segment of memory it will find a specific piece of data. This is the computing equivalent of giving directions to a house by saying it is the second one from the corner; it gives a reference point and counts from that point to the desired item.
To take a document, break it down into separate pages, and number the individual pages for printing.
A reference to fiber optic cable that has been installed but is not yet in use. Companies sometimes install extra cable when setting up a fiber optic network in anticipation of future needs.
Internesia is a slang term that describes the inability to remember where you found a key piece of information. It’s obviously a combination of the words Internet and amnesia.
A measurement a Web publisher takes to count the number of times it delivered an ad. The server's log files, or records detailing its activity, count the number of times the server sent a Web page with a specific ad on it to a user. Impressions do not consider whether the Web surfer actually saw the advertisement, just whether the surfer had the opportunity to see it.
Text messages sent through a network to a specified individual or group. Received messages are stored in an Inbox and can be kept, deleted, replied to, or forwarded to another recipient, depending upon the email program. Besides a message, an email may have an attached file or graphic. Users can make sure a message was received by requesting a receipt. Although not all items can be sent electronically, email's big advantage over postal mail, nicknamed "snail mail," is speed. Email can be delivered within seconds or minutes across thousands of miles. May also be spelled e-mail or E-mail.
Computers or applications that work with data 64 bits at a time. A 64-bit computer might have a microprocessor capable of handling 64 bits of information at a time. More commonly, 64-bit also can describe the capability of the computer's bus to transport 64 bits of data at a time.
Video playback in which individual frames are changed at a rate of at least 30 frames per second (fps). On a computer, video can play at various frame speeds depending upon system resources. At slower than 30fps, the image begins to appear choppy and not fluid to the human eye.
A device, such as a hard drive or sound card, that may have been intended for inclusion in a system package but for whatever reason has been repackaged to be sold separately. White box refers to the cardboard packaging the device comes in, although the packaging is often not a white box at all. The devices themselves are often referred to as white box devices.
Huge, vertically-oriented banner ads along one side of a Web site.
A term used to describe the method of scanning the odd numbered horizontal lines making up a picture on a CRT (cathode-ray tube) monitor before then scanning the even numbered lines. This method is sometimes used when a monitor’s resolution setting is above 800 x 600 pixels per inch in order to help reduce screen flicker.
A twist in an image that makes it look tilted to one side or another. Some image-editing programs have a skew feature to help users warp their images.
An uplink is a connection from a ground-based transmitter to a satellite. The satellite can then relay the signal to a ground-based receiver over the downlink connection.
An air card is a small card that connects to your laptop or mobile phone and gives you wireless Internet access. It does not replace the Wi-Fi capabilities of your mobile devices; rather, it augments the availability of wireless Internet. Air cards connect to mobile devices through PCMCIA (Personal Computer Memory Card International Association), ExpressCard, or PC Card Type II slots, though some models use a USB connection. After you install the accompanying software, your card should be ready to use.
If you're the type of person who likes to work outside of the home or office, an air card may be just the thing you need to beef up your productivity. For example, if you'd rather spend an hour returning emails in the park instead of a coffee shop, you can just pop your air card into your laptop and have at it.
A special ability of some printers whereby the printer only needs the outline of a particular font to create it in any required size.
The approximate number of commands carried out in one second. Microprocessor power is sometimes measured in MIPS as a way of comparing chips. This practice is somewhat controversial, as some computers require a different number of instructions to complete the same task.
A graphical special effect that produces a 3D color look. A gradient fill uses a gradual blend from a light background to a solid foreground or from one color to another.
A circuit board that survives after power is applied is said to have passed the smoke test. A short circuit or some other problem may result in a smoking circuit board.
Phishing is the act of trying to trick users into giving up personal information by making them think they’re dealing with a legitimate business. A phisher sends unsolicited bulk emails to a large number of users. The email claims to be from a legitimate company, such as AOL or eBay, and claims the user’s account will be suspended unless they click on the provided URL and supply the requested information (often passwords, credit card numbers, and other personal information). The URL is on a server controlled by the phisher, but its appearance is similar to that of the real site.
A noncommercial, often personal page that updates its content once a day or more and typically focuses on a specific subject, topic, or theme. Web logs usually feature updated content from the site creator, viewers, and/or other Web sites as well as moderated discussions about a variety of subjects.
The unit for measuring electrical current; current measures the amount of electric charge flowing through a conductor at a given time. An ampere is the charge of one coulomb (a unit of electric charge equal to 6.25 X 10 to the 18th electrons) passing a point in one second.
The bar located along the top of a window or dialog box that displays the application's name. In Windows 3.x, the Control menu box, minimize button, and maximize button are located on either side of the title bar. In Windows 95 and subsequent Windows OSes, the title bar includes the minimize button, the maximize button, and the close button.
To organize data. For example, the information in a database can be sorted alphabetically, numerically, by keywords, and in other ways.
One occurrence of a repeating event.
The image or text viewed on a monitor. More recently, display has become synonymous with the monitor itself, particularly when referring to flat panel displays.
Short for pseudonym, a word used to describe the name given to or created by a computer user for the purpose of keeping that user’s real identity hidden. Nyms are used to conceal identities when sending and receiving email and browsing the Internet. When you pick or are assigned a nym from a privacy company, all your incoming and outgoing email and Internet browsing requests go through the company’s servers and are processed under your nym. Anyone looking for your identity, then, will only be able to know you by that chosen or assigned name.
The specific light-sensitive area on an image sensor used to capture a digital image. Most image sensors used in digital cameras are CCDs (charge-coupled devices) or CMOS (complementary metal-oxide semiconductorsS). Other portions of an image sensor are used for other purposes.
The file format used by Intuit software to store financial data. A .QIF file can be imported into programs such as Intuit Quicken or Microsoft Money.
The most basic computer language used by the computer's processor to communicate with the rest of the system when no other language has been introduced to the computer. In most cases, the native language is the binary code inherent to the processor before the OS (operating system) has been introduced.
A do over; in documents, this means to reword or edit sentences, paragraphs, and pages. In data storage, rewrite means to save over a file with the same file.
Advanced cellular phones that can also receive text and data via the Internet.
When looking at specifications for new software, be aware that manufacturers will often list minimum system requirements as well as recommended ones. Though the software may work with the minimum requirements, it's probably a good idea to make sure that your system has the recommended ones because the programs you install will generally run a lot smoother and crash less if your system doesn't have to use every bit of its resources just to load them.
A list of information about files or storage space. File details might include name, length, type, and location. In a database, catalog refers to the data dictionary.
A cache made of high-speed SRAM (static RAM) linked directly to the CPU. RAM caches are used for keeping a copy of the most recently and most frequently accessed data in memory so the information is more quickly accessible. Also called a memory cache or processor cache.
An antenna or other device used to connect one network to another network over distances without cables or wires. A wireless bridge, for instance, could connect networks in multiple buildings on a college or company campus. In other circumstances, a wireless bridge could connect an office network in one part of the city to an office network in another part of the city. In order for a wireless bridge to work, both nodes must have a clear line of sight path to one another. Wireless bridges can be omnidirectional, meaning they radiate a signal in all directions, or directional. Directional wireless bridges must be pointed directly at one another.
The various definitions of a PC's ability to display colors and resolution. A PC supports a certain video standard only if both the monitor and the video adapter support the standard. The numbers specified for a standard often are minimums; many manufacturers claiming to meet that standard actually exceed the minimum numbers.
A peripheral that is limited by the boundaries of an on-screen application window as it manipulates the movement of a cursor.
A method of ordering data that accounts for alphabetic order, punctuation, and numerals. It often organizes data in the following order: punctuation marks, numbers, capital alphabetic characters, lowercase alphabetic characters, and any remaining characters.
Computer hardware or software that works with older versions or standards. Backward compatibility is popular because it lets users upgrade systems and software gradually, rather than starting over from scratch each time a new version or standard is released.
In Windows-based applications, an option that, when activated, identifies the registered user of the program, the version number, and the program's creator. The About command usually is located in the Help menu.
A plate found on a scanner or copier that the document is placed on to be scanned or copied. The glass allows light to illuminate the print on the document so that it can be processed.
To record information on top of previously recorded information, replacing the old with the new.
A type of rack-mounted server that can accept additional motherboards, called server blades, each of which has its own CPU, RAM, and associated circuitry. The blades share a common power supply, operating system, and management mechanism. The blade-style server's modular approach to adding processing power reduces the overall cost, heat output, size, and management difficulty of a group of servers, especially compared to a traditional server farm of similar power.
Used to describe times when network activity is at a minimum. Off-peak hours typically include evenings and weekends. Mobile phone companies often provide a greater amount of free off-peak minutes than peak minutes and may charge less for additional off-peak minutes compared to peak minutes. Off-peak can also describe the hours at which Internet traffic is at a minimum.
GUI is a program interface that incorporates the computer’s graphic capabilities into the application, which makes it easier to use. A good example of a GUI is any Windows operating system. The user interacts with Windows through icons, windows, menus, and pointers as opposed to typing in DOS commands.
A land is the smooth part of the underside of a CD-ROM, as opposed to a pit, which is an indentation on the underside of a CD-ROM. When the laser from a CD drive passes over a land, more light is reflected back to the photo cell than when the laser passes over a pit. This is how a CD drive distinguishes between pits and lands. The pits and lands equal the ones and zeros that make up the binary language of computing.
A clear window in a computer's tower case, usually in the case's removable side panel. Case windows are most often found in high performance desktop systems and are intended to show off the components inside. Case windows are typically made of scratch-resistant acrylic.
Located on a circuit board; sometimes meaning specifically on the motherboard. For example, memory chips on the motherboard are referred to as onboard memory.
The insertion of tiny blank spaces between words, performed by a word processing application when justifying text.
A technique used to create more realistic looking objects in three-dimensional (3-D) applications by giving them a detailed texture. Tree bark, for example, would be very detailed to give the tree a rough appearance.
Audio compression software uses two types of compression, lossless and lossy, to create smaller digital music files. Lossless compression retains the quality of the original audio recording. All of the 1s and 0s in the audio track are accounted for, and all of them are re-created perfectly when the compressed music is decoded. That means there is absolutely no quality loss compared to the original audio file, but lossless compression is extremely inefficient. It generally crunches files down to half their original size, meaning that with lossless compression, a 74-minute CD will consume about 325MB of space on your hard drive. Lossy compression gives up some quality to achieve much smaller file sizes than lossless compression. Lossy formats use different algorithms to strip some of the frequencies and other data out of a song that don't necessarily make any difference to our ears. A track compressed using a lossy algorithm may not have the dynamic range of the original track and may not sound quite as crisp, but it's possible to create perfectly acceptable music using a bit rate as low as 128Kbps for most types of audio. Audio that doesn't have a lot of dynamic range, such as audio books, can be recorded at bit rates as low as 64Kbps and remain virtually indistinguishable from the original audio CD. Using lossless compression, you could fit more than two hours worth of perfect audio on a single CD. Not bad, but using a bit rate of 128Kbps, you can squeeze more than 10 hours' worth of music on a CD or 20 hours' worth of audio books recorded at 64Kbps.
A computer model of a 3-D object, using wires to define the outside edges of the object. The wireframe provides the skeleton of objects rendered in 3-D for programs such as games.
A separate browser window that “pops up” when a user enters a certain Web site. Interstitials are usually advertisements, and they often include animated content or other graphics. The user can then click these ads or graphics to link to Web pages with more information. Some interstitials go away after a few seconds, but most must be closed by clicking the close buttons in the upper-left corner of the window. Also called pop-up ads.
A tool included in many photo-editing programs that simulates a spray paint pattern on a photo. Typically the user can define the color and size of the spray. Airbrushing is also a term often used by people who make a hobby of modifying their PCs. These users pay artists to airbrush complex (and expensive) artwork onto the side of their PC cases.
The organization responsible for writing the official definition of open source. It exists to promote the use of open-source software and to convince businesses to open-source their projects. While the OSI is actively involved in open-source advocacy, it is not opposed to proprietary software.
An amount of time in which a process runs without interruption. Also known as a time slice.
Usually used in reference to video services or video downloads. On-demand refers to a user’s ability to access, download, or view content at the time of his choosing, rather than at a predetermined time, as with a television show. Many cable services are now offering on-demand video services, and some online media portals, such as iTunes, are now offering video downloads and streaming video of television programs. Some hardware products, such as Tivo and other DVRs (digital video recorders) are also providing a sort of on-demand service in that they record TV shows and movies for the user so she can watch them at her convenience. Other devices, such as the Slingbox, let users view their local television programming from anywhere in the world, so long as they have access to the Internet.
An individual or company that creates or delivers content, usually through the Internet, although it can also refer to those who provide content for cell phone users. "Content" may be in the form of text, audio, video, or images.
The printed circuit board that is the foundation of a computer. This board contains a computer's CPU (central processing unit), RAM (random-access memory) chips, and expansion slots. The motherboard is where all of the computer's components meet. Also called system board or mainboard.
The size of a device, in physical terms rather than capacity. It can be used to describe media sizes (such as 3.5-inch and 5.25-inch diskette drives), but is more often used to describe the size and layout of devices' cases. A form factor for a computer case or motherboard describes its dimensions as well as its layout, such as the location of hard drives, CD-ROM and diskette drives, slots, and ports. Form factors for computer cases and motherboards can have descriptive names, such as the Baby AT form factor for motherboards.
A drive that sits within the computer’s case.
A biometric technique that compares the size, shape, and features of the human hand for purposes of verification. Although the human hand is not unique enough to be used for identification on its own, it can be used to verify a person’s identity in concert with a PIN number, fingerprint, or some other means of identification. When users place a hand on a hand geometry device, a computer captures an image of the hand and compares overall size, width, and length and curvature of the fingers to previously captured information.
Certain versions of Microsoft’s Office affix a GUID to all documents it creates. The GUID can be used to trace a document back to a specific computer (and therefore, a specific user). A number of privacy concerns involving the GUID have been raised by individuals who fear GUIDs could be used to track down individuals who want to speak anonymously.
A character, such as a period, that isn't valid or can't be used in certain commands because the character is used for some other reason within the operating system.
An ICE (in-circuit emulator) is a computer chip used in the design of embedded systems. An ICE emulates the embedded processor used to run the system and allows developers to design and debug software.
A temporary storage area in a computer's memory, usually RAM, that holds recent changes to files and other information to be written later to the hard drive. Because hard drives are relatively slow compared to RAM, buffers speed up performance. However, buffers generally are wiped clean by power outages; saving a file moves the information to the hard drive. Print buffers allow printing in the background while the user moves to another application or document. Buffers also are used by some transmission protocols. Incoming data might be stored in a buffer until they are verified.
If your external storage device shows up in My Computer, but you can't access or write to the drive, the drive may be incorrectly formatted for Windows or have a corrupt partition. Windows 2000 and XP feature a utility called Disk Management that analyzes your external drive and assigns it an Online, Healthy, or Unreadable status. Open the utility by right-clicking the My Computer icon and selecting Manage. Under the Storage heading, double-click Disk Management to view your external storage drive's status. If it has an Unreadable status, you need to format the drive to remove the corrupt partition or incompatible Windows file format. Before you do, attempt to transfer the drive's data onto another computer because formatting completely erases the files on the drive. To format, simply right-click the external hard drive and click Format.
A slow-moving mail server designed to trap and punish address harvesters. A spammer's mailer gets stuck when she tries to send spam to email addresses gained from a teergrube host.
A peripheral device that captures photos, graphics, or text, and converts that data into a digital format for editing on and output from a computer. Some scanners, coupled with an OCR (optical character recognition) program, can scan blocks of text into a word processor for editing, while others are designed specifically for photos, slides, or film. Scanners come in many shapes and sizes. Some of the most popular types of scanners include flatbed, sheetfed, handheld, and film.
A program that "crawls" across the World Wide Web, automatically collecting Web pages. Most spiders will follow every link on a page, cataloging each page, until it comes to a dead end. Then it will start over on a new page. Spiders are used primarily by Web search engines to gather data for the search engine's database. Search engines don't actually search the entire Internet when a user enters a search term. Instead, they look at the database of Web pages collected by their spider. Spiders are also known as crawlers and bots.
In terms of fiber optics, the jacket is the outermost layer of a fiber optic cable made of hard plastic. Its purpose is to protect the cable from moisture, scratches, and other elements. The jacket is one of several protective layers that make up an optical cable.
If you don't have one already, consider investing in a UPS (Uninterruptable Power Supply). A UPS protects your computer by providing battery power after a power outage or electrical surge. This enables you to save your work and shut down your system safely. Suitable for home use, a standby UPS uses utility power under normal circumstances, but when that power is interrupted, it will use a backup battery. A continuous UPS will run off constant battery power. Depending on how many devices you have connected to the UPS, battery power can last approximately 15 minutes or longer. There are UPS's built to sustain power for longer amounts of time.
Equal to exactly 1,024 bits. Used to measure data storage or transmission in terms of bits, as in kilobits per second (Kbps).
Hotspots are locations that provide wireless Internet service via a wireless access point. Hotspots are usually in populated public areas, such as a town square or downtown area, as well as at hotels and airports. In some instances, users may have to pay for access whereas other hotspots provide free access.
Podcasts are downloadable episodes of programs that are similar to radio broadcasts. These files are saved in a compressed audio format, such as MP3. Users can download individual episodes of favorite programs, or they can subscribe to podcasts. Typically, podcasts are delivered to subscribers through RSS (Really Simple Syndication) feeds. Podcasting is a method of publishing files to the Internet, allowing users to subscribe to a feed and receive new files automatically by subscription.
A function on many printers that allows the characters to be formed with as few dots or as little ink or toner as possible. Despite its substandard quality, draft mode is used for rough drafts because it is quicker and more economical than the normal printing mode.
Reducing a window to a small button or icon, while keeping the application running inside it open. In the newest Windows operating systems, the minimize button is in the upper right of the application and has a short horizontal line at the bottom. When you minimize an application, it appears in the Taskbar as a button that, if clicked, maximizes the application.
A term used by programmers to describe the amount of memory a program needs in order for it to work. Heap memory has been set aside for a program to request as needed to operate. A set amount of heap memory is hard to determine before a program is started because the amount changes as a program runs.
One of two kinds of clocks in most computers. The first is a real-time clock, which keeps track of time just like a wall clock or wristwatch and often includes the date. This clock usually is battery-operated, so it continues working when the computer is turned off. The second kind is the system clock, which actually is a circuit that generates a series of pulses that pace the electronic system within the computer, synchronizing the circuits and operations.
A detailed list of a system's or application's activities. A log can be useful for keeping track of computer use and emergency recovery of data.
The act of manually creating a page break in a document. Word processors typically mark page breaks automatically, but you have the option of creating a page break at any point in a document. The text following the hard page break will appear on the next page.
Any surface on which a mouse is used. Normally, this would be a mouse pad. However, because optical mice function on most surfaces, common mousing surfaces today also include desktops, stacks of paper, and even pant legs.
Full-motion video represented by the 0’s and 1’s of the binary system. Digital video is a bandwidth-intensive function, meaning you need a capable multimedia PC to handle its demands.
Bluetooth is a wireless standard that takes advantage of short ranges and slow data transfer speeds. You'll find Bluetooth-capable PDAs, game controllers, wireless headphones, printers, and digital cameras.
Bluetooth is extremely secure due to its multiple layers of data encryption. Typically, Bluetooth-compatible devices will require a PIN and Bluetooth address to identify other Bluetooth devices. A low-powered Bluetooth device can transmit up to 30 feet and a high-powered device up to 300 feet.
USB (Universal Serial Bus) flash drives are high-speed, high-capacity memory devices designed for long-term data storage and easy transport among PCs. The host PC treats the device just like a drive, so you can transfer files of all types to and from the device. Because the device emulates a drive, it supports any type of file, including audio files (such as MP3s) and graphics files (such as JPEGs [Joint Photographic Experts Group] and BMPs [bit map]). In addition, USB flash drives can easily support applications, CAD (computer-aided design) drawings, and a wealth of personal information you’d rather not leave on any particular PC. Most USB flash drives are smaller than a pack of gum and can easily fit onto a key ring. A flash drive is also called a thumb drive or travel drive.
As a verb, integrate refers to the action of two or more hardware or software components working together as a system. As an adjective, it means something is a single, conglomerated unit.
A dual-core processor has two execution cores on a single chip. Each core independently accesses the frontside (system) bus, which connects the CPU to the system's RAM.
A dual-core processor is ideal for multitasking—for instance, watching streaming video while listening to MP3s with other applications open, as well—or playing graphics-intensive games.
A printed circuit board connected to the motherboard at an expansion slot. An adapter card enables a computer to communicate with a peripheral. For example, a joystick requires an adapter card to communicate with the computer system. Also called controller card.
An automated program, generally in the context of the Internet. These programs either gather information or perform a task for you without your intervention. An example would be services that check to see if specified Web pages have been updated. Agents include "bots," which can, for example, be set to gather news items of interest.
For power-hungry laptops and portable DVD players, an external rechargeable battery is the only type of portable power that stores enough energy to provide the extra hours of battery life you need on a long plane ride. The additional usage time you'll receive from an external rechargeable battery will differ depending on the watts stored in the battery and the power consumption of your device. Generally, you can expect most laptops to run another two to three hours off an external battery that stores around 60W, and a battery with a capacity of around 120W should power your notebook computer for another five to six hours. External batteries typically connect to the DC input jack of your portable device (the same hookup you use for the AC power adapter) through an included cord that may feature adaptable connectors. We should note that DC input jacks vary in size, and you'll want to make certain the external power source includes connector tips that fit your portable device's DC input jack. Contact the external battery's manufacturer or visit its Web site to ensure a connector tip is provided for your device.
A program utility that moves a program from storage into memory, where it can begin operation.
(Pronounced bye-ose) A special piece of software built into most computers. BIOS routines control the startup process of the machines and other basic functions such as the keyboard, display, and disk drives. On older computers, the BIOS is stored in read-only memory, which is not erased when the power to the computer is shut off. Newer computers store BIOS on flash ROM, which can be erased and rewritten if the user needs to update the BIOS program.
To delete or remove data or a file.
To swing back and forth, such as the waving arm of a metronome. The electrical meaning is a complete cycle of alteration.
The act of touching a metal surface to discharge static electricity. It's always wise to ground oneself before working inside a PC because the static electricity can damage electronic circuits inside the PC's case.
A measure of printer resolution that indicates how many ink dots the printer can place in one square inch. The larger the pi, the sharper the printed image. A text printer should have at least 600dpi; a graphics printer should have at least 1200 x 600 or 1200 x 1200 dpi.
A data-file copy stored somewhere other than the location of the file from which the copy was made. An archive copy helps ensure against permanent data loss, which may occur in cases of system failure or natural catastrophe. Backing up files to a diskette or a tape drive is one method of archiving data. Extremely valuable archives often are stored in fireproof vaults, underground bunkers, or at sites hundreds of miles from the original data source.
A measure of the brightness consistency on a computer screen. A screen with areas of darkness has poor uniformity. You can easily spot a monitor with poor uniformity when looking at a plain white background on its screen.
If you can access the Internet when you connect directly to your broadband modem, but not when you put a router between the modem and your PC, one solution is to reset your network devices. This gives them the chance to reassign IP (Internet Protocol) addresses and connect to each other without conflicts. To completely reset your network devices, power off your PC and then unplug your broadband modem and router. Leave the units unplugged for a few minutes. Consult your device manuals to determine whether you need to perform any additional tasks to reset the devices (some units have Reset buttons, for example). Finally, plug in and power on your devices, starting with the broadband modem, then your router, and then your PC.
Pronounced “wares,” a term for copyrighted software made available illegally for downloading from the Internet. Also, any method used by software pirates to acquire applications without paying for them.
An html (Hypertext Markup Language) code used to index pages. The tag includes such things as keywords and page descriptions for a Web site.
Describes any new user of computer or Internet technology.
The exploration of a network to determine topologies, IP (Internet Protocol) addresses, database information, etc.
Copyrighted software distributed on a free-will donation basis either via the Internet or by being passed along by satisfied customers.
Most PDAs have a Reset button. If your PDA freezes, or if your software installation requires it, you may need to perform a soft reset by pressing the Reset button.
Slang for traditional paper mail sent by a postal service, taken from its relative slowness to arrive compared to electronic mail.
An instrument that increases a signal's strength so it can be transmitted and received over a greater distance without a loss in quality.
Advanced technology used for page layout formatting of text. Rich text can include fonts, borders, underlining, italicizing, and other formatting. Rich text requires more storage space than plain text.
Email that a person can access from any computer that has Internet access and a Web browser. Examples of these accounts are Hotmail or Yahoo mail.
Refers to a digital image that is too dark or wasn't exposed to enough light.
The system unit space reserved for the installation of any type of drive. These slots are usually located on the front panel of a computer. Empty drive bays may be protected by a plastic cover. To install many types of add-on components, an empty drive bay is required.
Different cell phones support different types of ringtones. A polyphonic ringtone uses your phone's ability to emulate instrument sounds and play multiple tones at once. Phones that are polyphonic-capable can play up to 40 notes at once, but are unable to play lyrics. In comparison to monophonic ringtones that can only play a tone-based version of a song, polyphonic ringtones sound more like the original song. Conversely, because polyphonic ringtones can't include lyrics, they're apt to sound less like the original song than a full music ringtone that includes lyrics and sounds nearly identical to the full version of an original song.
Multiple cores (the central brain of the chip) contained on one chip. Having dual or multiple cores allows a chip to divide computing tasks efficiently, which allows more computing work to be finished in a shorter amount of time than a single-core chip would have used to do the same work.
The set of available colors in a given computer graphics program or computer system. Palette also can refer to the collection of tools in paint programs used for creating and altering images.
To transmit a message or article for publication on an Internet newsgroup or bulletin board.
The ease with which software can be moved from one computer or operating system to another. Portability can be defined as either high or low. High portability implies the software is easily moved to other systems; low portability means it can be moved with great effort, similar to the effort put into writing the original program.
A technique used by some search engines, with the most popular Web site listed first. The number of sites that link to the ranked site determines popularity.
A group of hardware components used to secure monitors, network hubs, and other hardware items to walls or desks.
Correcting the brightness, contrast, or color of computer graphics on a printer, monitor, or scanner so graphics are uniform on a monitor or hard copy.
This top-level domain name is reserved for Web sites affiliated with the U.S. government. It is used in URLs (uniform resource locators) to identify a site as a government Web site. For example, www.whitehouse.gov or www.firstgov.gov.
The number of bytes, or characters, a disk can hold; the maximum storage volume of a disk. Capacities are usually stated in kilobytes (KB or K), megabytes (MB), or gigabytes (GB).
In terms of data encryption or decryption, key length is a measurement of how secure the encryption key is. In general, the longer the key length, the more secure the encryption is.
>computer science To start running a computer program from the very beginning, without being able to continue the processing that was occurring previously when the system was interrupted.
In computers, to bootstrap or "to boot is to load a program into a computer using a much smaller initial program to load in the desired program which is usually an operating system.
A core dump is the recorded state of the working memory of a computer program at a specific time, generally when the program has terminated abnormally, crashed.
Input is the term denoting either an entrance or changes which are inserted into a system and which activate/modify a process. It is an abstract concept, used in the modeling, system (s) design and system(s) exploitation. It is usually connected with other terms, e.g., input field, input variable, input parameter, input value, input signal, input device and input file.
Input/output, or I/O, refers to the communication between an information processing system such as a computer, and the outside world – possibly a human, or another information processing system. Inputs are the signals or data received by the system, and outputs are the signals or data sent from it. The term can also be used as part of an action; to "perform I/O" is to perform an input or output operation. I/O devices are used by a person or other system to communicate with a computer. For instance, keyboards and mice are considered input devices of a computer, while monitors and printers are considered output devices of a computer. Devices for communication between computers, such as modems and network cards, typically serve for both input and output. Note that the designation of a device as either input or output depends on the perspective. Mice and keyboards take as input physical movement that the human user outputs and convert it into signals that a computer can understand. The output from these devices is input for the computer. Similarly, printers and monitors take as input signals that a computer outputs. They then convert these signals into representations that human users can see or read. For a human user the process of reading or seeing these representations is receiving input.
Debugging is a methodical process of finding and reducing the number of bugs, or defects, in a computer program or a piece of electronic hardware thus making it behave as expected. Debugging tends to be harder when various subsystems are tightly coupled, as changes in one may cause bugs to emerge in another.
If Windows displays an error message that a keyboard isn't present or characters you type aren't displaying on-screen, check the connection to the computer. Shut your system down and then look at its back to make sure the connector is securely plugged into the proper PS/2 or USB port. PS/2 keyboard ports are typically colored purple, and the connector will only fit one way. Check also that the connector's pins aren't bent or broken. It's possible to gently bend a pin back in place, but if it's broken, replacing the keyboard is your only option./p>
If the pins are fine but you suspect the board isn't receiving power, plug another keyboard into the computer. If it works, your keyboard's circuitry may be damaged, and you'll likely need a replacement. If the substitute also fails, the PS/2 or USB port or a motherboard controller may be bad, and it's possible you'll have to replace the motherboard. Finally, if the keyboard is plugged into a USB hub, the hub may not be capable of supplying sufficient power to the keyboard. Try connecting the keyboard directly to a dedicated USB port.
Memory-related error messages that appear when your computer first begins booting usually point to a bad memory module. The computer performs basic tests on all hardware when it's first switched on. If the information it writes to memory is not the same as the information it reads from memory, the computer stops booting and displays an error message.
In most cases you'll need to replace the bad module. If you have recently installed new memory, however, the problem could be a compatibility issue. Try removing the new memory and see if it solves the problem.
If you have multiple memory modules, try booting your PC with just one module installed at a time. This will help you isolate the bad memory module.
Also known as smileys and short for emotion icons, these punctuation combinations form small pictures, often best viewed sideways. Emoticons are most often seen in electronic mail (email) and Internet messages.
Operations such as printing that are being held, usually in the order received, before the computer executes them. Also refers to lining up these operations. When referring to programming, it means to remove data elements in the order they were entered.
Software that allows two otherwise incompatible programs to communicate with each other. The middleware converts data from one program to the other, and vice versa. Middleware is most often used to connect databases.
A term used to describe the gap that exists between people who have the capability, access, and knowledge to use modern technology and those who do not.
An authorized access level that each network user is assigned, either as a user, an administrator, or as a guest. This determines what information he or she can and cannot have access to.
Speakers used in a surround-sound configuration. The satellite speakers are used as the front speakers, usually placed to the left and right of the sound system, facing out.
A type of software designed to let users on a network use the same software and work on the same projects at the same time. A popular groupware product is Lotus Notes, which is software that, among other applications, lets users work on the same documents and exchange email.
The person who uses hardware or software programmed or designed by another person.
To put two sets of data together while keeping the integrity of each intact.
Off-the-shelf software available in stores, as opposed to custom software created for a specific company or individual.
A removable container that holds toner for a laser printer and which can be thrown away when empty. Some toner cartridges contain only the toner, while others include the photosensitive drum, making it less likely that someone will touch the drum and damage or mark up its surface.
Back-hack refers to the art of tracking a hacker who has broken into your system.
The result of a successful ping, or test of a network connection’s performance. If the site or device you ping is operating properly it sends a return transmission called a pong.
How much activity is taking place on a communications system. Too many users on a network will lead to more traffic than the system was designed to carry, or a kind of traffic jam. Overloaded networks will sometimes malfunction, so network administrators work to control traffic.
A measurement used to describe the height of a printed character. A single point is 1/72 of an inch.
A place on a text line where the cursor goes when the TAB key is pressed. In word processing documents, tab stops usually are placed at regular intervals across the line but can be set wherever the user wants them.
The ability of a machine to recognize patterns and improve future performance based on this experience.
The way an application fundamentally arranges and presents data. One example of a native file format is the way Microsoft Word inherently arranges and presents text in a file with a .DOC extension. The native file format may be associated with one program, or it may be universally accepted.
Refers to the actual act of creating a key, which is a string of bits used to encrypt or decrypt data or information for security purposes.
The integrated circuit, known as the CPU (central processing unit), that controls the computer. Microprocessors cram more than 1 million transistors into 1 square inch of space. Microprocessors are responsible for interpreting instructions gathered from input devices and transmitting the results to output devices. Though there are many types of microprocessors, the two main families used in PCs are made by Intel and AMD.
An abbreviation for robot. Bot usually refers to software that executes some function automatically. Search engines typically use bots to seek out Web sites and record information about the sites for future search purposes.
Information that comes out of a computer after processing. Output can be displayed on a screen, sent to another computer, or stored on a variety of storage media.
A device that boosts the strength of a signal before sending it down a line. A line driver increases the transmission distance, which helps to ensure the signal reaches its destination.
To stabilize a PC after an error has occurred. If used in conjunction with a program, to recover means the program stabilizes itself and returns to use without user intervention. Often "recover" is used to describe getting files back after a hard drive error. In this case, a recovery program searches for whatever information remains in storage. Whatever is found is "recovered."
A highly sensitive device that converts light into an electrical signal. Solar-powered devices use photosensors.
A computer designed for use by a single user, with everything a user could need for basic computing, including the ability to process and store information. IBM introduced its first single-user computer as the IBM PC in 1981, and in the last 15 years, the term has come to represent any computer based on the IBM standard. The other standard in the personal computer market is the Apple Macintosh. Software and peripherals specify whether they work on IBM-compatible PCs or Apple Macintosh platforms. In addition to standard abilities such as word processing, PCs have brought a wide variety of new possibilities to home users. Today a PC can be used to play high-tech video games, access huge amounts of information, and contact people around the world. The growth of the Internet and the World Wide Web has opened up a vast new world of opportunities for PC users.
The ability of some word processing applications to automatically insert a list of addresses and other information into form letters. The user sets up a document laced with special codes indicating where addresses and names will be inserted. This document is then combined with a list of names and addresses. The results can be printed or stored as separate files. Mail merge saves the user the hassle of repeatedly typing the same text. Also called print merge.
Any device connected to the computer that performs a specific function. Printers, keyboards, diskette and tape drives, and monitors are among the most common types of peripheral devices.
A term used in jest by users to describe the fictional place where information or data lost in transmission on the Internet winds up.
A computer that exists on the same level as another with similar access privileges on a network.
The plural term for computer storage material such as diskettes, hard disks, and tapes.
A word, term, or expression recently invented or given a new meaning. One example is wallpaper, which, before computers became widespread, meant the material you cover a room’s walls with. The rate of neologisms has increased with the introduction of new technology, most notably, the Internet, which has spawned such terms as intranet, extranet, emoticon, and netiquette.
A camera lens that can be attached to some cameras to produce a very specific effect. A fisheye lens is a very wide angle lens that takes straight lines of an image and displays them as curves. Typically, a fisheye lens focuses more intensely on the center of an image, while at the same time focusing less on the outer edges of the image.
A method of keeping email messages safe from encryptions while they transmit. Chaffing adds false packages to a message when it is sent and removes those packages when it is received, making it impossible for anyone but the intended recipient to understand the message.
To improve a scanned photo image using the tools available in a photo manipulation program. Improvements can include everything from more refined colors to improved clarity.
A measurement or degree of an image's on-screen clarity. The smaller the dots that make up an image and the more dots used, the clearer the image. Bigger dots make the image appear grainy. Granularity also refers to the degree of difficulty in searching a database and manipulating data. If a search's features are not specific enough, a database might be considered quite granular.
A type of texture mapping that accounts for depth while rendering images. By doing this, objects that are supposed to be closer are larger, and those that are farther away appear smaller.
The pattern of a signal, such as that generated by sound and light, that changes at regular intervals.
A communication or program error that results when a response is not given in a specified length of time. For example, you can be disconnected (sometimes called "kicked off") from an online service if you do nothing for a certain period of time. Some programs let you choose the length of time after which the program times out, so if you walk away and accidentally leave the program open, it won't keep running indefinitely.
An item, either hardware or software, that is available for a computer to access during an operation. A resource can be accessed by a single computer or through a network and includes items such as a system's hard drive or a shared printer.
A function built into a system's hardware, rather than software, to perform a task. The capability to perform a task can be built in through an extra microchip, instead of programming the task into software. For example, some computers might include MPEG (Motion Picture Experts Group) video as hardware instead of relying on software to do the job. However, the term occasionally is used when referring to software. It might also be said that a feature is hardwired into software if that feature cannot be manipulated or changed by the user.
To place in between. In computing, it means to place something between data, information, or any other pieces of a document. For example, you can insert words anywhere in a word processing document.
A "signature," such as a nonfunctioning symbol or picture, that microchip designers often add to their chips to add a personal touch to their handiwork.
Transmitting data from point A to point B, whether the points are on a communications link or between components on a computer system.
This database feature locks an object before the object is updated. That way, the user will be sure no one else accesses the object during the update and ensures that the update will be made.
A blank section of videotape. Video black is often used to separate different portions of a program on the tape and at the very beginning and end of a tape.
Pixels that are improperly displayed after the mouse pointer moves across a PC screen. This happens frequently if a mouse driver doesn’t work with the current graphics mode.
A key or combination of keys, such as CTRL and an alphanumeric character, that activate a pop-up program or cause some other predetermined action to occur. For instance, SHIFT and F7 are hotkeys used to print in DOS versions of WordPerfect.
The range of frequencies from 3KHz to 300GHz on the electromagnetic spectrum between light and sound. These frequencies are used by devices such as AM and FM radios and baby monitors, or for communications between satellites.
The ALT (Alternate) key on a computer is used in conjunction with other keys to give a key an additional function other than the one indicated by its label. The ALT key is similar to the CTRL (Control) key. For instance, employing the ALT-F key combination in most Windows applications will open the File menu. When using the ALT key, it is best to press the ALT key and, before releasing it, press the other key desired.
These kinds of viruses try to avoid detection by antivirus programs by changing their code. The structure or code of the virus will appear to be different on different systems, which may confuse the antivirus software.
An action that happens when you begin clicking the mouse before the software is prepared to accept new input. This happens most often with programs you’re so familiar with that you know when and where you need to click before the program is done loading.
A computer that shares information with other computers, or the act of sharing information with or providing services for other computers. Examples of host computers include a file server, which shares files and programs with other computers on the network; a Web server, which shares content with the rest of the Internet; and a mail server, which accepts email messages and sends them to the intended recipients.
A hypothetical disease describing the breakdown or decay over time of the underlining binary instructions that make up a program or a data file. Bit rot can be brought about by physical processes. Computers contain error correction codes to compensate for bit rot, but large amounts of bit rot may result in a program that’s so rotted it will no longer run.
A video device that captures images from video and then changes them into a digital form the computer can understand. A grabber can refer to the hardware card that captures the video frame or the software that grabs the image and stores it as a file.
Hardware devices, such as servers or monitors, designed to be installed on a metal frame. Also describes devices already installed on a metal frame.
In software development, a group of people who volunteer or are paid to test new applications with the goal of determining the code’s security weaknesses.
An annoying impasse where two pieces of equipment, such as modems, PCs, networks, and fax machines, that are attempting to communicate with each other are both sitting idle, waiting for the other to begin the transmission. While the name is amusing, and bears some nostalgia for those awkward junior high days, the equipment deadlock is anything but funny, especially when you're waiting for a data transfer.
The momentary lingering of previous images on a changing computer display.
From kilo binary byte, a unit of measurement that is equal to precisely 1024 bytes. Similar to the more common kilobyte. Kibibyte came about because the prefix “kilo” may refer to 1000 units or 1024 units, whereas Kibibyte strictly refers to 1024 units.
Short for micrometer, the unit of measurement used to measure the core of a fiber-optic cable, or more commonly, the elements that create the transistors on a CPU (central processing unit). A micron is one-millionth of a meter, 1/25,000 of an inch, or 1/50 of the width of a human hair. The first 486 processor measured 1 micron and the first Pentium measured 0.8 microns. The smaller the chip, the cooler and faster it can run.
The smallest part of an image that a computer printer or display can control. An image on a computer monitor consists of hundreds of thousands of pixels, arranged in such a manner that they appear to each be connected. Each pixel on a color monitor comprises three colored (blue, red, and green) dots. The term comes from the words picture element, and also is abbreviated PEL (pronounced pell).
Any indication that a text block or an object has been selected with a mouse-click or the arrow keys on the keyboard. The highlight may appear as a change in the color of text or as a border around an object. A highlighted object is usually ready for some type of operation, such as deletion.
A book or a computer program that contains a set of instructions about how to use a piece of software or hardware. Most computer products are sold with some sort of users manual included in the package; manuals written by third parties can be obtained from retailers of books and computer products. In many cases, the third-party manual can contain more tutorial and troubleshooting information than the manual that was provided by the manufacturer.
Distinct pieces of information, which can exist in various forms such as numbers, text, bit, bytes, or memory. This information can be processed and translated by a computer, and as a result, text, pictures, or sound appear on-screen.
One or more keys that, when pressed together, equal a menu function or other function in an application usually reached through a mouse-click. Keyboard shortcuts usually are not as intuitive as point-and-click mouse commands, but the frequent user of a program can save time by learning them. One shortcut in many programs is CTRL-X, which equals the Cut option found in many Edit menus.
An organized directory of pages on a Web site.
A technology that lets a user view a smaller window within a larger display. For example, with a PIP display, a person can channel surf in a corner of a television screen while watching another channel. In addition to television, PIP is often used in video conferencing.
A process that allows one person at a time full access to files contained in a network database. Locking prevents two people from trying to make changes on the same file at the same time. In most situations, a second user may view the file, but only the first one can make content changes.
A personalized list of contacts with whom to communicate online. Coined by AOL, a buddy list informs the user when a contact is logged into the network so the two acquaintances can converse online.
A printer far from the user. It could be a shared printer in a secluded area of a building or, with the advent of printing over a network or the Internet using IPP (Internet Printing Protocol), a printer thousands of miles away.
A term used in programming to denote a reusable section of code. Object-oriented programming methods use objects as the basic building blocks of programs. Objects are generally standardized so they can be used in many different types of programs without having to be rewritten each time. In graphics, the term is used to describe a distinct element, such as a block.
Information from a Web site sent to a browser and stored on a user's hard drive so the Web site can retrieve it later. A Web server using the technology looks for a cookie when a user visits. Cookies generally are used to identify visitors. A cookie can contain information about the user's login name, password, and preferences. For subscription sites, the cookie can make it unnecessary to log in each time. Users have the option to configure their browsers to either accept or reject cookies.
redundant array of independent disks
Any component, bus, or interface that slows down an otherwise faster system or network. For example, an external hard drive and its host computer will likely be constrained by a slow parallel port connection between them. Likewise, a 56Kbps (kilobits per second) dial-up modem connection can be considered a bottleneck between a fast Web or cache server and your PC.
Storage space that houses huge, outdated mainframe computers.
A term used when a system only contains one hard drive inside the computer's case.
A term used to describe someone who seems to have become only accessible through electronic means, such as email or video talk, and is no longer accessible by phone or in person.
Parts located in a printer that stretch across the width of a page and pull the paper through during the printing process.
Any computing device worn on the body. Some wearable computers are portable multifunctional devices such as a PDA (portable digital assistant), mobile phone, and MP3 player designed to be worn for easy access. Some wearable computers even include a head-mounted LCD (liquid-crystal display) screen. Prototypes for future wearable computers include specially-designed power-generating clothing such as a shirt with solar cells.
Refers to an Internet site that hosts text-chatting functionality. The term is most popular among users from the United Kingdom.
Areas of light around bright objects that appear on a computer monitor when they shouldn't. The halo effect is a sign of an inferior monitor.
A particularly small footprint. Manufacturers use the term footprint to indicate how much desktop space a product consumes.
To switch between settings, such as on and off. Also can mean the actual switch that controls these settings. For example, in Microsoft Word, the buttons controlling the switches for bold, italic, and underlined text are toggle switches, because each of those text characteristics is either on or off when the buttons are clicked.
Used to represent 1 billion, or 10 to the ninth power. In computer terminology, however, the prefix giga means 2 to the 20th power, or 1,073,741,824.
A measure of how easy it is to upgrade a particular hardware or software product. For example, on a small network hub, how easy is it to add more ports to the network? Or, if a company bought a powerful computer for a Web server, can they significantly upgrade the hard drive and RAM (random-access memory)? Software scalability indicates that a product can handle heavier usage if it's given more computing power or memory. Programs that aren't scalable will crash under heavier usage conditions even if there is plenty of memory or computing power available. Scalability is a very important feature for hardware and software to have. If you're making a significant investment in a product, you should be confident that you can add to it and use it for years to come.
A separation process that divides and arranges digital information.
An email that is returned undelivered before being accepted by the recipient's server. A common cause is a misspelling of the domain name or the second part of the e-mail address. For example,if the sender enters firstname.lastname@example.org instead of email@example.com, a hard bounce will occur.
A file at the bottom of a hierarchical file system that can have nothing below it. Using a tree structure analogy, the leaves connect to the branches, which connect to the roots.
A specific location in a computer's memory where keystrokes from the keyboard are stored until the computer acts upon them. This allows fast typists to continue typing even if the computer is unable to immediately display the letters.
Slang term for Internet congestion. Large amounts of data are clogging a network, slowing down network performance, not unlike traffic during rush hour.
Memory buffers your computer uses like sticky notes to decide which piece of hardware is next in line to work.
Similar to pen pals, key pals are two users who communicate frequently by email instead of written correspondence.
The processing of information. The retrieval, sorting, modifying, filtering, and querying of data are a few of the primary methods of data manipulation. Essentially, data already must be present within a file or database for data manipulation to occur; it does not involve entering new data. The creation or deletion of files, however, is considered part of data manipulation.
A generic term used to refer to electronic paper. E-paper exhibits some of the same properties as paper. It’s thin, flexible, and inexpensive. Using special devices, however, you can create an electric image on the paper. Unlike paper, e-paper is completely reusable.
A circuit board in a computer that controls display factors such as resolution, colors displayed, and speed of images displayed. A video card cannot bring an older monitor up to its standard. Both the monitor and the video card must support a resolution, such as 800 x 600, for that resolution to be possible on the system. Today's video cards typically contain some memory so that the PC's RAM (random-access memory) isn't bogged down with handling displays. Some cards, often called video accelerators or graphics accelerators, contain a graphics coprocessor that handles graphical computations. Also called a video adapter, video board, or video controller.
A pause in a microprocessor's clock cycles that allows for differences in speed between one component and others in a computer (such as input/output devices or RAM). Wait states are common in systems where the microprocessor has a much higher clock speed than other components, requiring the latter to "play catch up." During a wait state, the microprocessor idles for one or more cycles while data comes in from RAM or other components. Although unnoticeable to users, this idling can affect a system's performance because it involves the microprocessor's clock speed; if clock speed is reduced, system performance will slow. Wait states also are not uncommon between buses and expansion cards, where the expansion cards run slower than their buses.
The insulation that surrounds the core of a fiber optic cable. The cable jacket is placed on top of the cladding.
A conflict when more than one computer, or more than one program in a single computer, tries to access the same resource at the same time. Different systems and networks respond in different ways; some require all parties to access the information again, while others operate on a first-come, first-served basis.
A capability of a modem protocol that lets two modems lower their speeds to compensate for transmission problems.
Action or characteristic related to the entity as a whole. For example, an action that affects an entire file, directory, program, or project.
In multitasking environments such as Microsoft Windows, several applications can run simultaneously. One runs in the foreground while the others run in the background. The application or window in the foreground is active and can accept user input with a mouse, keyboard, or other device. Applications in the background cannot accept user input, but they still can run internal processes such as printing, reading and writing data to the hard drive, or performing calculations. In Windows, users can move background applications to the foreground by pressing the ALT-TAB key combination or by clicking a background window. Background also can refer to the color of the screen in DOS or Windows environments. Background colors can be selected according to the user's preference.
A technique that stifles the response of a circuit or device so it does not exceed certain limits. Damping is used to pace the flow of electricity or information within the computer.
The part of a network that carries the majority of the data traffic. Backbones connect smaller networks, or nodes, together to create larger networks. Backbones usually transmit data at higher speeds than the rest of the network. On large networks, such as the Internet, there may be more than one backbone, all of which span long distances. On smaller networks, the backbone sometimes is called the bus.
Gesture recognition refers to the ability of a computer to read and accept human gestures as input. Instead of moving a mouse or keyboard, for instance, a simple pointing gesture might do the trick. Gesture recognition has a number of applications ranging from helping disabled individuals to video games. Gesture recognition usually involves the use of some sort of camera connected to a PC.
An object used to absorb and eliminate heat to prevent overheating and breaking down. Some computer components generate heat as they operate because they run so quickly. Computer manufacturers often install these small metal devices on powerful microprocessors.
A help system featured in many applications that uses small pop-up "balloons" of text that appear when the cursor is moved over certain spots in an application's interface. The balloons usually describe the function of a button on a toolbar. Similar to tool tips, which are rectangular pop-up help words that appear in many Windows-compatible programs.
In a network system, a data frame is a packet of information transmitted as a single unit. This data frame exists only as it moves along, encapsulated, on the connecting cables or line. The information takes another form before and after the transmission.
Any type of storage medium, such as tapes and diskettes, in which magnetic patterns represent stored values.
To test aspects of computer hardware or software against a known standard. When used as a noun, a benchmark usually is the result of such a test. Benchmarks are only useful if all computers or applications being tested are tested under the same conditions. When measuring the speed of computers, for instance, a benchmark utility program should attempt to perform the same operations with each machine. It also is necessary to know exactly what a benchmark is designed to test. A machine that is speedy at one type of mathematical operation could be slow at other tasks.
The slot or opening at the top of a diskette that provides access to the magnetic diskette inside. The read/write head in a disk drive must directly access the magnetic diskette to store and retrieve information. To get to the magnetic diskette through the head slot on a 3.5-inch diskette, the drive moves a metal cover off to the side. It's simpler for a disk drive to get to the magnetic diskette inside a 5.25-inch diskette because the head slot is always uncovered.
When an object or icon dragged across the screen leaves a trace behind it.
To synchronize the movement of an on-screen pointer or cursor with that of an input device such as a mouse. Also, the spacing between letters and words.
A term used in multiplayer console, PC, and Internet gaming that refers to a player who directs his or her game character to stay in roughly the same spot for the duration of the game. Sometimes campers stake out a spawn point (a location where others players returning or entering the game appear) to get an unfair kill. Other times a camper stands near a valuable item spawn point to horde that item. Campers are generally not considered to be breaking the rules, but the activities they engage in are frowned upon by most gamers.
The destination file or device where source data is moved, copied, or stored, whether transferred internally or over communication lines. For example, if a user wishes to download a file from the A: drive into the C: drive, the A: drive is the source, and the C: drive is the destination and therefore the target. The target can also be the audience for whom a certain product is designed.
Each individual request made in a Web server's log. The number of hits a Web page receives equals the number of times a part of that page has been accessed. One Web page could receive as many hits as it has files to download. Typically a page will include an html (Hypertext Markup Language) text file and several other files including graphics, sound, video, and/or text. Thus a page made up of one html file and nine graphics files that receives 1,000 hits has been viewed 100 times. This information can be useful, but many advertisers are more interested in page impressions, which count the actual number of visits to a page.
To input information into a computer using a keyboard or numeric pad. Often used to describe the inputting of large amounts of data into a database.
Perpendicular lines on the edge of an on-screen image. Jaggies are caused by a monitor resolution setting lower than the one the application requires or by a font or graphic with poor scalability. Also called jags.
An executable program capable of performing a specialized function other than system maintenance (which is performed by utilities). Games, educational programs, and communications software are all examples as are word processors, spreadsheets, and databases. Also called software.
These devices, also known as Web cams (or Webcams) and desktop digital video cameras, are small, focus on one object (such as a person sitting at a computer), and usually sit on top of a PC monitor. Web cams capture still images and video motion, and then transmit this data for such purposes as video conferencing, video email, and enhancing Web pages.
In computing, the process of using software to manipulate images and sounds within a video media file. This can involve adding sound effects or music, shortening or rearranging segments, or adding transitions or other visual effects.
Any method of condensing information so it can be stored in less space or transmitted in less time. Many large graphics and sound files are compressed so they can be downloaded faster. Although data compression can be done in many ways, a compression program generally looks for redundancies in a file, then compresses the identical pieces of data into one representative token. Also called data compaction.
A length of cable running between different PC components or between devices on a network. A segment can consist of a single cable or multiple cables connected to each other.
The identifying title given to a system of computers, usually including the top domain and all of its subdomains. For example, a domain name, such as socrates.nd.edu, indicates that the Socrates network is found at the University of Notre Dame (nd), which is an educational institution (edu).
Stored data that can be accessed but not altered. Usually, this term refers to information that can't be physically altered. For example, traditional CD-ROMs are created by a method of creating pits in the storage medium. Users usually can read, but not change, the information stored in this way. Read-only also may refer to the status of a file. For example, files can be placed in read-only status for security purposes. This status is used for documents such as newsletters that are available to all users on a corporate network.
The area in the computer where cards are installed. The area usually has protective metal and mounting brackets. The term comes from an external, cage-like box where cards were on older computers.
In the computing world, there are typically two kinds of skins, one refers to images or themes that change the appearance of a user interface, and the other refers to the ability to change the look of a character in a video game. You can change the look for Web browsers such as Microsoft Internet Explorer and MP3 players such as WinAmp by adding a skin to it. Skins are usually based on a specific theme such as a movie or type of product. Video game skins are options that players can use to enhance the look of characters in a game by giving the character different clothes, for example, or by changing the character's gender or species. In both cases, end users can create their own skins and incorporate them into the programs.
In communications, a registered or billed connection with a network, an online service, or an ISP (Internet service provider). Online accounts are used to keep track of connect time and monthly service costs. In multiuser networks and operating systems, accounts primarily are used for identification purposes.
A small (usually about one inch square) sticker or metal plate applied to a computer case depicting the logo or image associated with the computer's manufacturer.
A device that locks hardware or software to prevent unauthorized use. Often a small metal key that secures the hardware contained within a computer case. The dongle can prevent a computer from being booted.
A file designed to store information while a user is working with that file. Temporary files are retrieved from storage by an application and manipulated by the user, leaving the original file intact until the user saves it under the original file name. Temp files are created automatically by applications and usually are deleted automatically when they are no longer needed. The user can delete them, however, to recover disk space. Also called a temp file.
Any device or circuit that allows electrical currents to travel in one direction only.
A term used to describe a monitor screen distortion that displays defocused images and reduced detail and sharpness in bright objects. Also refers to a problem with some digital camera sensors. Blooming occurs when camera sensors become overcharged, resulting in blurred details.
A row of boxes, often at the top of an application window, which control various functions of the software. The boxes often contain images that correspond with the function they control. In Microsoft Word, for example, the box that controls the print function contains an icon of a printer inside it. In most programs, toolbars can be turned on and off and often can be personalized with controls specific to an individual user's needs.
Technology that lets a computer “speak” in a human-sounding voice. A current application for voice synthesis is called text-to-speech. UC (unified communications) applications let a user retrieve her email messages over the phone, among other things. Using text-to-speech, the message server will “read” the user’s email to her.
Often blogs will have links that lead to other blogs. Blog hopping involves following links from one blog to another while also visiting related sites, forums, and articles.
Data inserted into copyrighted work that contains vital information, such as the author and copyright dates. Such watermarks can be viewed only with the correct software and are designed to be invisible to ordinary users.
To intentionally and prematurely terminate an active computer command.
The popular design for portable computers, with a shallow case hinged at the back so the screen folds up from the keyboard.
A specified operation completed by the system. A job can be as simple as saving a document or as complex as organizing data into a report.
To end prematurely, hang without allowing user input, or otherwise fail. Applications are said to bomb, while entire systems usually are said to crash. However, the terms can be used interchangeably. In Windows, the CTRL-ALT-DELETE key combination sometimes can regain control of or end an application that has bombed.
An intermediate Web page that can prelude a Web site’s home page. When users click an advertisement, the ad tag sends them to a special site the advertiser has created to continue the ad. Jump pages often include rich media. Also called a splash page.
The collection of icons, graphics, and text displayed on-screen at a given time.
A biometric technology that measures the characteristics of a user’s voice against templates created during initial use. Users speak into a microphone, and the computer measures variables such as cadence, pitch, tone, and the shape of the speaker’s larynx to verify identities. Since users can easily change some of the variables involved at will, voice verification is not considered as accurate as other biometric techniques such as retinal scans or fingerprint verification. However, it is generally cheaper to implement than such methods because it doesn’t require special or costly hardware.
The process of converting linear pictorial images into digital data for storage. For example, a scanner converts a non-digital image, such as a portrait or photograph, into a digital format of positively (1) and negatively (0) charged signals so the image can be stored on a hard drive. Likewise, a sound card can digitize a sound by translating it from analog (its actual sound) to digital (a form that can be read by a computer).
A packet of legal paperwork that allows users to purchase the use of a software company's product. It does not transfer ownership. Most license agreements appear on a software's package, and when the package is opened, users agree to the terms listed.
The digital version of an image, photograph, or picture displayed on a monitor screen. The computer must change photographs or other images into the digital form of files for it to understand and work with them.
An electronic form used to gather information about a user. E-forms are used to provide feedback, make inquiries, order merchandise, sign up for services, and more.
The darkest black a computer monitor is capable of producing. The black level in a good monitor should be purely black.
A kind of printer feed used with continuous-feed paper that has holes along the left and right sides. The tractor feed is named for the sprocketed wheels, which look like tractor wheels, that fit into the holes in the paper and pull the paper through the printer. Also called tractor feed.
To execute a program one step at a time. Usually used to find the flaw or error that is causing a program to run improperly.
In a leapfrog attack, a malicious user "borrows" a user ID and password from any of a number of sources, such as a file containing IDs and passwords, and uses it to penetrate another system. A user can also use this tactic to make it difficult for other computers to trace him.
This number represents the number of times a software program has been downloaded from the Internet by users. It is often used to signify a program's popularity.
A pen-shaped instrument used with graphics tablet or touch screen input devices to write or draw on the computer screen as on a sheet of paper.
A computer that has two OSes (operating systems) installed, each in a separate partition. When the user starts the computer, a menu appears from which the user can choose the desired OS.
Refers to the way a gamer interacts with other elements in the game. Often found in game reviews, the term is also used as a means to rate the quality of the experience the player had while playing a particular game.
Refers to changing the resolution of a digital image. An image can be resampled up or down, meaning the resolution can be increased or decreased with the use of software.
A mickey is the unit of measurement used in determining the speed and movement direction of a computer mouse. The speed of the mouse is determined by the ratio of how many pixels the cursor moves on the screen to how many centimeters the mouse moves on the mouse pad. Directional movement is referred to in terms of a horizontal mickey count and a vertical mickey count. One mickey is roughly 1/200 of an inch.
A method of storage used by a router that keeps track of addresses and host names to provide quick access when future packets are sent.
A software-activated division of the screen in which different documents can be displayed. Each document can be manipulated individually. Also called split window.
The fear of being ignored or ostracized in the online community brought about by delays in Internet chat rooms, message boards, and Internet telephony communications due to a network lag. People communicating by such means may experience laganoia if responses to their messages are a long time coming. Sometimes, though, other users are responding, but responses take a long time because of poor bandwidth or problems with transmittal from one portion of the Internet to another.
A component of a network, typically a NIC (network interface card), that is operating incorrectly. A jabber will send a continuous stream of incorrect or meaningless data to the rest of the network, which could cause the entire network to stop working.
A section of a message, ordinarily at the beginning, that routes it to its destination and often identifies the sender. Another type of header is text such as numbers or chapter titles that appear at the top of each page in a document. In data storage, a header lists a file's name, size, and the time and date of its creation or revision. In a database, a header is a record identifying the fields and kinds of information in the following data records.
The unpredictable area of a network that data passes through. Clouds exist because data sent in packets can take various paths to reach the same end point.
A device conflict occurs when a device attempts to access a port that is in use by another device.
Early batteries often used some sort of liquid solution as an electrolyte. This liquid solution could spill or leak and was often harmful if not Handled properly. Dry cell batteries eventually replaced wet cell batteries because they were versatile and durable.
Slang for each of the smaller companies a breakup of Microsoft would create. When the Department of Justice declared Microsoft a monopoly, it proposed That Microsoft split into two companies, or Baby Bills, an applications-based company and an operating systems-based company.
A printing technique that produces a replica of each character in a lighter shade and slightly off center so it appears the letter has a shadow.
A term used to describe an increase or decrease in electrical power that can damage the circuitry of a computer. Dirty power can be in the form of spikes or surges.
A computer and a display screen that display information in public areas. Kiosks can display simple rotating graphics or html (Hypertext Markup Language)pages. More complicated, interactive kiosks allow a user to access the information they want. Kiosks are used to provide information about a specific location,to provide directions, or to provide countless other services to the public. An ATM is a good example of a kiosk.
The form in which information is transmitted within a computer or a network. Data signals usually are binary codes transmitted between devices. Data signals might consist of viewable information, such as documents or graphics, or internal computer information, such as virus checks or control characters.
A computer introduced as a result of a technological breakthrough. Hardware, such as microprocessors, also can be classified in generations. For instance,Intel's Pentium processor line makes up the generation following the company's 80486 CPU (central processing unit) line. Programmers may also refer togenerations of commands, implying a lineage of processes (one process that may give rise to other processes). When users store files in directories and subdirectories, this relation is sometimes expressed in generations (with a grandmother, mother, and daughter directory or file).
Slang term for logging in to a computer or network.
Like a notebook computer, a tablet computer is a portable PC that runs on batteries or AC (alternating current), is 1 or 2 inches thick, and is roughly the width and length of a writing tablet or notebook (8.5 x 11 inches). Although notebook computers typically have an LCD (liquid-crystal display) screen that's attached to the notebook via hinges, a tablet computer typically has a touch-sensitive LCD screen that is part of the main device.
A menu-driven, search-and-retrieval tool that helps Internet users locate information online through menus, which are itemized according to collections of information and stored databases. The menus also may lead to other menus, files, and search tools. Developed at the University of Minnesota in 1991 and named after the school's mascot, the Golden Gophers, Gopher lets users retrieve data over the Internet without using complicated commands and addresses.
A pixel in an LCD (liquid-crystal display) monitor that doesn't work correctly and is always turned on (or stuck as) a certain color, usually red, green, or blue.
A pop-up box that nags the user to update, register, or pay for the software. Nags can occur at random while using the software. Nags can also occur when you start or close the software. Usually, the user must perform some sort of action to close the pop-up box.
A flat disk of silicon crystal sliced from a larger piece. Used in semiconductor chip manufacturing, these disks are approximately 1/30th-inch to 1/50th-inch thick and 3 to 6 inches in diameter. Made to hold circuitry components, wafers are eventually enclosed in another substance, such as plastic or metal.
A virus that travels as a macro embedded in documents, especially Microsoft Word and Excel documents. Such viruses remain dormant until the infected file is opened. Then, if the virus is malicious, the virus may damage other files, perform a prank, or infect other files. Some macro viruses will delete all files in a directory or your entire hard drive. Others are more benign, simply attaching their code to documents. Once an infected file is opened, the virus will usually infect all files that are opened afterward until the virus is removed by software that disinfects the appropriate template file. Macro viruses are quickly spread through email messages or shared files. Antivirus scanning software should be used and updated so macro viruses can be caught before they infect a system.
A method used by some Web sites and marketing companies to track the surfing habits of visitors to their sites. Online profiling is common among shopping sites. It may include noting which products a visitor appears interested in or buys. This data is then used to target products and services to the person visiting the site. The data may be collected with or without the permission and knowledge of visitors to the Web site.
The act of defragmenting information stored in memory, thereby arranging data so the largest free space possible is created.
A tool to convert one language into another that more closely resembles machine code. Translators are also called language processors and include assemblers, compilers, interpreters, and preprocessors.
A key or key combination that executes a specific function or command within an application or operating system. For example, the F7 key in Microsoft Word 6.0 initiates the spelling checker while the F12 key initiates the Save As command. Also called an application shortcut key. A shortcut key can be specified with a specific software package, such as using the ALT key plus the first letter of a pull-down menu option, or it could be a user-created macro.
The act of modifying a piece of hardware or software to perform a function not intended or authorized by the original manufacturer. In gaming, changing a game's code to alter game play; for example, adding new content to existing games, or "total conversion" mods which change the game significantly.
A term for the expected customer feedback after a product's official release. Gamma testing is a play on the term "beta testing", which is the testing software or hardware undergoes before release. Some critics derisively use the term to chastise companies that knowingly release an undertested product, leaving customers to find and report bugs.
A slang expression for a PC that alternates between working and nonworking states. One minute a PC is up and working, the next minute it's down.
A rectangular, flat input device that controls an on-screen cursor by tracing a finger or a stylus across the surface of the tablet. A graphics tablet is used instead of a mouse or trackball when more intricate cursor control is needed, such as when using a drawing or graphics program. Also called a digitizer, digitizing tablet, or drawing tablet.
A circle that represents choices in a common option list form in graphical user interfaces. Only one item in a list with radio buttons can be selected at a time. To select an item in such a list, the user clicks the radio button in front of the desired option, and a dot appears in the circle of the radio button to show the option has been selected. The name radio button comes from the fact that these buttons are similar to those on a radio; choosing one automatically undoes the previous choice.
The term comes from scientific disciplines, where it is most often used as a measurement for the amount of time a radioactive substance takes to lose half of its atoms. In technology, it refers to the amount of time that it takes for a storage device to loose half of its effectiveness.
By altering the headers in an email message, someone with the proper know-how can make an email message appear as if it came from someone or somewhere else.
the protocol most often used to send email) doesn't include much security, making it possible for people to forge, or spoof, the origins of the email.
A section of memory that holds information before it is sent to the monitor. The video buffer also called a screen buffer or regeneration buffer is usually a part of the video card.
Smart Tags are a technology found in Microsoft Office XP. Smart Tags can be used to link portions of a document with other documents or information on the Internet or company intranet. Microsoft was playing with the idea of adding Smart Tags to the next version of Internet Explorer. The plan met with some resistance from Web designers and others who were afraid Microsoft would abuse the Smart Tag technology.
An entry way into a password-protected system that bypasses having to actually use a password. In some systems, designers usually deliberately leave a back door so technicians can enter a system later for maintenance or other purposes.
When one or more of the three-color beams inside a monitor do not align on the screen. This is often seen as a blurring of color onto parts of the monitor that should not have it. Also called convergence error.
A rotating ring usually just behind the focusing ring on a camera. This ring lets you control the amount of light you let into the camera. Only professional-level digital cameras currently have aperture rings.
Usually relating to monitors, the screen pixel resolution and refresh rate the manufacturer recommends for optimal, flicker-free performance.
Vulnerability scanning automatically examines a network for known security holes that could be exploited by outsiders to gain access to a network. The software contains a database of known vulnerabilities and examines a network for these vulnerabilities. Vulnerability scanning is typically employed by companies and corporations looking to close security holes before they're exploited.
The plug at either cable end. One end plugs into the computer, and the other plugs into the device being hooked up to the computer. Connectors are either male (containing pins) or female (containing sockets). The type of cable often determines the shape of the connectors. For example, most cable connectors for mice or keyboards are round, while printer cables have trapezoidal connectors.
When you encrypt a file, you translate the original contents into a code to keep the file secret. Data encryption software uses advanced algorithms to encode a file's contents so they can't be read by anyone who doesn't have the proper key to unscramble them. Encryption algorithms are mathematical, or they apply other rules to files, which systematically change the contents of those files. When children pass secret messages in class, they might use the alphabet replacement method where they write "a" for "b" and "b" for "c" and so on. The shifting of the letters is the algorithm, and nobody could crack the code without knowing which or how many letters were shifted. Encrypting data of any type involves processing a message through an algorithm to scramble it.
A control feature often found in computer or stereo speakers. The balance control adjusts the amount of sound you hear from the right or left speakers. Generally, the balance should be adjusted so that the sound level from both speakers is the same.
An indention at the beginning of a line to signify a new paragraph in a document. Usually about five spaces, tabs are primarily used to ensure equal spacing from line to line. There is also a tab called the write-protect tab on diskettes. When in a certain position, this tab prevents data on the diskette from being overwritten or erased. See 3.5-inch diskette. See 5.25-inch diskette.
To copy a file or files to an alternate location so a safe copy remains if the original is destroyed or damaged. A single file or an entire drive can be backed up if media of sufficient size are available. Because of their large capacity, magnetic tape drives often are used for backing up information. Backup programs often save files in a compressed format that occupies less space on the backup media. This means that to view the backed-up files, the program that backed them up must be used to restore them to their original form. See restore.
To replace a computer component while the computer is on. This ability is especially important for mainframe computers or servers in a client-server system that can't afford downtime. These computers generally have redundant parts, such as hard drives and power supplies, to ensure reliability, and these parts can be switched out if they fail. Storage systems on client-server networks also often use hot swap functions for the same reasons. For personal computers, the advent of the USB (Universal Serial Bus) standard lets users hot swap peripherals into USB ports; the computer automatically recognizes them without rebooting.
An environment on the Internet that prohibits users from accessing specific material or Web sites. Such an environment may not make it impossible to access this information, but it makes it more difficult. For example, in 1999, America Online's Kid's Channel in the United Kingdom created a walled garden to shield children from unsuitable material.
In laser printers, a doctor blade is a straight edge set a precise distance from the developer roller. It ensures that just the right amount of toner sticks to the roller. The doctor blade scrapes away any excess toner.
A printing process in which a printhead heats tiny sections of a colored ribbon to transfer ink to the paper. A dye sublimation printer may use three or four colored ribbons or perhaps a single ribbon with differently colored sections. See thermal transfer printer.
A printed circuit board or adapter that plugs into a computer to add a new function such as modem capabilities or hardware device support. The term also refers to the punched cards used for data storage and entry devices in early computing. See punched card.
A temporary file, document, program, process, or alphanumeric character that is used to hold a place for another file, document, program, process, or character. When the actual information is available, the dummy information is deleted. Dummy is often required as a place holder when a program cannot deal with blank spaces while waiting for data to arrive.
A program package that combines a number of other, seemingly distinct, programs into a single package. Also called integrated software.
A series of characters treated as text. Character strings can contain numbers and letters.
To break into a computer system, typically with the intent to steal or otherwise manipulate information, or to do damage to the system itself.
The ability of a computer to locate and retrieve data immediately from a storage device, without having to start at the beginning and read all the data.
A way of recording CD-ROM discs that adds data in blocks instead of recording the entire disc at once. For example, half of the disc could be written one day and the rest written a few weeks later. Some older CD-ROM drives can't read multisession discs. This type of recording is used by some CD-R (CD-recordable) drives and all CD-RW (CD-rewriteable) drives.
In an image-editing program, this is a technique used to displace colors in an image, giving it an impressionistic look.
A feature that provides step-by-step instructions to lead users through certain tasks in applications. Unlike online help menus, which often must be read before executing a task or printed out, wizards use dialog boxes that walk users through each step of a process. Also can describe an extraordinary programmer.
A term used by Microsoft Excel to describe a spreadsheet file. A workbook can contain numerous spreadsheets in a single file.
The command issued to immediately shut down a Linux system. This command is usually called by issuing the shutdown command.
A glass tube from which all gas has been removed, creating a vacuum. Such tubes containing electrodes for controlling electron flow were used in early computers (before semiconductors) as a switch or an amplifier. Vacuum tubes allowed digital computations at what was then considered a high speed.
Unlike a traditional switch that trips when it is switched, a rocker switch rocks between the on and off positions, hence its name. When one side of the switch is moved to a down position, the other side is always up. Switching on the up side will change the position of the two and trip the switch. You can find rocker switches on many kinds of computers and computer add-ons, including various power devices, surge protectors, monitors, and others.
To place a file that is infected with a virus or otherwise poses a threat in a directory where it cannot do any harm. Functions that divert threatening files to a quarantined directory are typically part of antivirus software.
A packet sent over a network by a system containing information such as the IP (Internet Protocol) address of the system, to indicate the system is ready to receive and transmit data.
A set of hardware normally composed of a keyboard and a monitor that lets users communicate with the internal CPU (central processing unit), which is the "brain" of the computer.
A conductor through which current flows. Batteries, for instance, have two electrodes, the positive electrode is also known as the anode and the negative electrode is known as the cathode.
The absolute minimum length of time required to completely execute a program without introducing new data or extraneous processing.
The process of smoothing, finishing or achieving an extremely close tolerance on the heat-absorbing side of the heatsink, with the idea that heat will transfer more efficiently with a tighter fit between the heatsink and heat-generating component.
To restart the computer and reload the operating system. Many types of computers reboot when the key combination CTRL-ALT-DELETE is pressed. In Windows 95 and newer, rebooting can also be done by selecting Shut Down from the Start menu, then clicking Restart The Computer. Rebooting is sometimes the only way to regain control over a computer that is frozen due to error. Rebooting a computer, however, causes all unsaved data in open applications to be lost.
An error that takes place after starting a computer. This failure usually is caused by a mis-alignment within the computer by the expansions and contractions that occur because of temperature fluctuations when the computer is turned on and off. To avoid this, some users leave the computer running when not in use and only shut off the monitor.
A symbol indicating that the computer is waiting for you to enter information in order to continue.
A setup composed of a computer and peripheral devices that enable someone to do their work. In terms of processing power, workstations fall between personal computers and minicomputers. Also can designate any computer connected to a network.
In computing, 3-D graphics are created by combining numerous triangles to form a desired shape. The term “vertex” typically refers to the individual points or corners of these triangles—the points where two sides of a triangle meet. These vertices are, in fact, the very “virtual matter” that creates a 3-D object.
1,000 floating point operations.
An effect in some digital imaging software programs where algorithms are applied to an image, bending it, and ultimately giving it a spherical shape.
In computers, hybrid refers to a device that is made of two or more technologies. A hybrid computer has both analog and digital capabilities. It uses both analog-to-digital conversion and digital-to-analog conversion so it can read and produce analog and digital data. Robots, for instance, are hybrid computer systems. They accept a command in digital format (the program instructs the machine using binary data) and execute a function in analog format (the robot walks). On the flip side, the robot might use an analog sensor to recognize an object, but it will use a digital computer to process what to do with it. ADCs (analog–to-digital converters) transform factors, such as temperature, motion, pressure, sound, and images, into a binary code the robot can understand.
A glue-like substance specifically designed to connect metal pieces and conduct heat between them. Thermal adhesive is made of substances such as aluminum or silver and is available in syringes or tubes with applicators. Thermal adhesive is not used to connect certain sensitive components; for example, the substance is not intended for attaching a heatsink to a processor.
A hub is a piece of equipment that provides a connection point for a group of computers and peripherals, and it works on a low-level network protocol layer. Just like a wheel on a bicycle, a hub is a central point from which the spokes, or in this case, cables, fan out. Hubs are commonly used in LANs (local-area networks), where two or more computers are sharing the same devices, such as printers, Internet connection, scanners, and so on. The cables for these devices are plugged into ports in the hub. Data is sent to the hub, which then distributes it to other areas on the network. For example, someone working on a computer can send a file to a printer, but that request must be channeled through the hub before it reaches the printer. Most hubs support the Ethernet standard, meaning the hub accepts an Ethernet cable, which also plugs into an NIC (network interface card). There are also non-Ethernet hubs, including Token Ring. A hub can be passive, active, or intelligent. Passive hubs simply accept an electric signal from an incoming packet and broadcast it to the rest of the network. An active hub, sometimes called a repeater, amplifies the signal before sending it to the rest of the network. Amplification guarantees that the signal has enough power to make it throughout the network. An intelligent hub, or manageable hub, is similar to an active hub, but it has extra features. For instance, it provides bridging, routing, and switching and supports remote management and virtual LANs.
The term “hub topology” is used to describe how larger networks are arranged. A hub topology has a main area from which outgoing lines run, and each line has connection ports for attaching devices. ISPs (Internet service providers) use this format for providing access to their subscribers.
One of the largest PDNs (public data networks) in the United States. Telenet serves as the communications backbone for many online services.
The part of a key on the keyboard seen in normal use. Under the plastic keycap marked by a symbol is the actual key, which is a small switch.
A unit of measurement equal to 1,180,591,620,717,411,303,424 bytes, 2 to the 70th power bytes, or roughly 10 to the 21st power. It's also the equivalent of 1,024 exabytes.
A term used to describe computer viruses that exist only in research labs. Used primarily as tools for scientists and programmers, these infectors (estimated to number at least 20,000) make up the majority of existing computer viruses. However, they pose no danger to the public’s computer systems until released “in the wild.
Refers to points along the horizontal and the vertical axes of the computer screen, usually starting in the lower-left corner of the screen. Each pixel (the color dots that make up the screen display) on the display screen has a location on the map of the screen that identifies it to the programs that make the screen addressable (meaning the mouse can tell where it is on the screen and let the application know). Generally, the x-coordinate is the number of pixels going across the screen and the y-coordinate is the number of pixels going up the screen. When the pair intersects, that intersection represents a specific location on the screen.
When programming Web sites and Web-deployed applications, it is common to define the location of the pixel (or set of pixels) in relation to a specific area of the screen. This is the method used to create areas on the screen that will respond to the click or double-click of the mouse. The programmer defines an area that will be sensitive to the mouse activity by outlining the XY coordinates that constitute the boundaries of the area and then linking that area to a URL (uniform resource locator) that contains additional information that the programmer or designer wishes the user to see. Because there are millions of pixels on each screen, the programmer relies on software that creates the coordinate mapping, rather than trying to map each coordinate manually.
This approach creates what’s known as an image map on the Web page. The “map” is really a graphic (it could, in fact, be an image of an actual map) with its coordinates mapped and with sets of coordinates linked to other html (Hypertext Markup Language) pages. The image map thus serves as a sort of menu. For example, in the case of a mapped picture of an actual United States map, clicking on one state might take the user to information about that state, while clicking on another state takes the user to a different page. The image could also simply be a product photo that links to information about a product
A FTP (File Transfer Protocol) that works over phone lines and is noted for its relatively slow speed and high accuracy. Most communications programs allow users to select Kermit as the protocol for a specific transfer or as the default protocol for all transfers.
A technically sophisticated user who spends a lot of time at a computer. It refers to a person who writes computer programs, "hacking" up the digital code. Hacker is often erroneously used, instead of cracker, to refer to those who illegally break into computer systems to do damage, steal secrets, or enter simply because they can.
Another term for the data bus that runs between the (CPU) central processing unit and the L2 (level 2) cache memory. The backside bus is typically faster than the frontside bus because cache memory usually offers faster access times than system memory, allowing the bus to closer approximate the speed of the CPU.
A wire that is one nanometer (one thousandth of one millimeter) thick. Nanowires are used as semiconductors, barcodes, and LEDs (light-emitting diodes), depending on their chemical composition.
The nastiest form of nastygram, an ill-tempered, malicious, or disapproving e-mail message, has its roots in Unix systems, where users on different terminals share one large computer.
It was possible to send e-mail containing computer code that would freeze up the recipient’s terminal or computer or execute as a program in order to do something prankish or even damaging. Known as letterbombs, these nastygrams were the ancestors of the modern e-mail attacks that try to trick recipients into downloading and running attached virus programs.
The term also refers to a more formal and legitimate style of unwanted e-mail in the form of a rebuke from an online authority. An example would be a warning for breaking some rule of a newsgroup or e-mail list, such as an off-topic posting or letting an argument get out of hand.
Programmers have sometimes used the term nastygram to refer to an e-mail message that expresses dissatisfaction or criticism from a client or from superiors within the company. In this context, nastygram carries the connotation of criticism that’s overly nitpicky or otherwise unfair.
Less commonly, nastygram may refer to automated unpleasant e-mail, such as bounce notices to let you know that an e-mail message you sent is undeliverable. But as mail handling robots have no ill will in their messages, however unwelcome they may be, the reference to automatic mail as nastygrams is often facetious.
A metric prefix meaning ten thousand. A myriabyte would be 10KB or 0.01MB. The symbols for myria are ma or my.
Sony Philips Digital Interface Format A type of interface used to connect a variety of electrical components, primarily audio devices.
Advanced Technology Attachment Packet Interface (ATAPI)
An extension to the EIDE (Enhanced IDE) interface that supports CD-ROM and tape drives, which were left out of the original EIDE and IDE standards. Also known as Fast AT Attachment (Fast ATA), this is an updated version of the Integrated Drive Electronics (IDE) storage interface that works with hard drives and CD-ROM drives. It can shuttle data to and from the drive three to four times faster than the IDE standard (transferring data between 11MB and 16.6MB per second) and can support data storage devices that store up to 8GB more than IDE drives. Also known as ATA (Advanced Technology Attachment), the EIDE standard lets storage devices, such as hard drives and CD-ROM drives, connect to computers. Initially, EIDE supported drives of approximately 8GB in size, and it supported data speed rates between 11MBps (megabytes per second) and 16.6MBps. Once the 8GB limit was overcome by better support from a PC’s BIOS (Basic Input/Output System; the underlying software that lets a PC use basic hardware), the theoretical limit for ATA drives became 137GB, but users can expect this limit will be breached, just like all the others. Currently, the largest ATA or EIDE drives are about 120GB in size.
EIDE is an upgrade to the older IDE (or Advanced Technology Attachment) standard, which supported drives of 528MB and was only one-third to one-fourth as fast as first-generation EIDE. The primary competitor to the EIDE standard is SCSI (Small Computer System Interface), which is common in Apple computers; SCSI generally allows greater speeds, but it is expensive and more difficult to use. The latest descendents of the standard are Ultra ATA-66, which offers speeds up to 66MBps, and Ultra ATA-100, which offers speeds up to 100MBps. Also, keep on the lookout for Serial ATA, a new standard that should offer even greater speeds.
A new interface for internal devices such as hard drives, debuting in 2002. Serial ATA, initially having a theoretical maximum throughput of 150MBps, allows better signal timing and higher speeds than the parallel EIDE standards such as Ultra ATA/133/100/66. SATA also enables easier device setup and better airflow within the computer case with less obstructive data cables. Industry analysts expect SATA eventually to supplant EIDE.
An electronic component used for RAM and fast data switching. CMOS semiconductors are made of two metal-oxide field effect transistors for high speed and low power use. However, they can be damaged by static electricity. (Pronounced see-moss.) A type of computer chip that requires very little power. This makes it particularly suitable for use in notebook computers, which need to get as much life as possible out of each battery charge, and for the computer memory holding system startup information.
PCs contain a CMOS memory chip that stores information the computer needs each time it boots up. This includes things such as the date and time, as well as information about the system configuration—how many disk drives and what kind, how much memory, what type of processor, and so on. Without this information, a computer is very limited in how it can operate.
Computer memory requires power, so most memory empties out when a computer is powered down. Because the CMOS chip requires so little power, it is run continuously off a battery inside the computer. A single battery is usually enough to power the CMOS for the life of the computer. Therefore, whenever the computer is powered on, the information in the CMOS can load right in for immediate use by the computer's BIOS (Basic Input/ Output System).
When you turn on your computer, you usually see a lot of information flash on the screen about memory, video card in use, etc. The computer is actually running diagnostic tests on its components and initializing those components for use, based on information pulled up from the CMOS.
In DVDs, a chapter is each independent section on the disc. This can be compared to tracks on CDs.
A type of programming language used to create software for more than one type of computer system.
The x coordinate on an (x, y) graph. See Ordinate.
A device that lets a cable be attached to a device that requires slightly different wire connections.
An International System of Units (SI) prefix meaning one quadrillionth, or 10 to the negative 15th power. For example, a femtosecond would be one quadrillionth of a second, or 1/1,000,000,000,000,000th of a second. The symbol for femto- is f.
The placement of one object within another. In computing, this refers to the placement of a graphic in a word processing document or a text document within a database. A set of instructions also can be nested in another set of instructions or within a document activated when selected. Programmers also can nest programming loops within other programming loops.
A Web camera positioned in the coffin of a deceased person. The term comes from the Dutch film of the same name, which used the idea as a way to comment on the extremes to which technology can lead us.
In telephone systems, a trunk is a connection between two main switching stations. The trunk carries several lines of voice and data transmissions simultaneously.
To end a session with a program by purposely closing the application.
A quality attributed to anything that seems to be everywhere at all times. Often used in technology circles to describe technologies in widespread use. Some may say mobile phones, for instance, are ubiquitous.
A data transmission standard developed in the late 1960s by Norman Abramson and a team of researchers at the University of Hawaii. Using TDMA (time division multiple access) technology, Aloha transmitted data in packets containing addressing information, and in the event of a collision the data was retransmitted. Aloha was the basis for Alohanet, a precursor to the Ethernet network standard.
A communications device, such as a modem, that can transmit and receive signals from distances of more than one mile. Most modems are long-haul modems. Compare to short-haul.
A wiki is a type of collaborative blog. Instead of one author providing and editing content, any user can post content and edit the content of others.
Computers are obviously good at crunching numbers and allowing for detailed simulations. Until Mathematica was released in 1988, however, no single program could harness all that power and let scientists, engineers, theorists, and programmers bend it to their will. Individual applications were available before then that were designed to perform specific tasks, but Mathematica let just about anybody do just about anything math-related.
Stephen Wolfram designed Mathematica and Wolfram Research, a company he founded in 1987. The software completely revolutionized the field of technical computing, providing users with a single package that could perform practically any mathematical calculation. From physics calculations and astronomical star charts to electrical circuit design and economics equations, if it involves numbers, Mathematica can handle it. From the very beginning, Mathematica could handle symbolic equations and had powerful graphing abilities, and the product has improved steadily over the years, adding more features while retaining its ease-of-use. The core of the software is a powerful programming language that lets users write programs in a variety of ways. Several add-on packages also are available that give people in specific fields tools they can use to do their jobs more efficiently. Optica, for example, is a package that makes it easy to solve optical engineering problems without having to write any fundamental programs to get started. The software also links directly into other programs, such as Microsoft Excel, letting users apply Mathematica’s power to nearly any other application that involves numbers. It can even be integrated into Web pages to create interactive graphs and calculations. This connectivity works both ways, as output from Mathematica can be easily sent to an external program, such as an application designed to render high-resolution 3D graphs.
More than 20,000 copies of Mathematica were sold within months of its original release, and the number of users today has expanded into the millions. Professionals now view the software as an indispensable tool, and students use it in many high school and college math courses. An ever-increasing number of Web designers use an offshoot of the original software, webMathematica, to add interactive calculations to their sites.
A cast of pixels on a monitor that appear as small, white, flickering dots. Snow can be caused by simple interference or by conflicts within the video memory.
To turn on the computer after it has been shut off. Also called cold start. Compare to warm boot. See boot.
Software or hardware that once was included with several other products (a bundle) but was removed from the packaging or is sold separately. For example, games and word processing applications often are bundled with new computers and included in the price. When the product is sold separately, however, it is considered unbundled. Compare to bundled software.
A signal from an Ethernet device alerting all other devices that a collision has occurred and to stop transmitting. The purpose of a jam is to clear the network's data transmission lines and have all devices begin attempting to send data again. See collision.
Texture element. The smallest component of a texture in a 3-D image.
A printing mechanism shaped like a round disk with a number of spokes, or arms, that extend from its center. Each arm has a fully formed character on its tip. The arm hits the ribbon, and the impact makes a mark on the paper. One daisywheel contains all the characters for one font only; a change in fonts requires a different daisywheel. Daisywheels are found on a daisywheel printer. Also called print wheel.
Software or hardware that limits or restricts certain kinds of computer access from a network or other outside source. A router is a good example of a hardware device that often has a built-in firewall. Firewalls are used to thwart would-be hackers from infiltrating computer systems. See hacker.
A pen-like scanning device, a wand is commonly used with such hardware peripherals as bar code readers. Also used to describe a stylus used with graphics tablets. To scan text with a wand, a user passes the tip of the wand over text; the optical scanning mechanism in the wand takes the text it has "read" and passes it along to the computer for processing.
Metadata is technically data about data. NTFS (NT file system) uses the concept of metadata frequently. In NTFS metadata maintains information about the various files on the system including a file's location on the hard drive, file name, and security information. Metadata may also track information about the hard drive in general. For instance, bad clusters that can no longer reliably hold information are tracked using metadata. Most metadata resides in the Master File Table or MFT although, technically, the MFT itself is a metadata file. Media metadata is a type of metadata many users may recognize. For instance, an MP3's (Moving Pictures Experts Group Audio Layer 3's) metadata may contain information such as song title, artist, and album. This data is visible in most media players as well as in the file's properties. See NT file system (NTFS).
A plastic ring that fits into a reel of magnetic tape to prevent its files from being overwritten or erased. See file protect ring.
A number that allows plug-and-play systems to identify an added device and configure it properly. The number indicates the device's manufacturer, model, and version number.
A command or option that will let users leave and close a program. It may require a special keystroke or key combination in a DOS program, or it may require users to select the Exit option from the File menu in a Windows program.
To restore files from an archive or backup to their original location, usually a hard drive. Compare to archive file.
To compress data, or "smash" it together by taking out excess space, so it occupies less space when stored or transmitted. Compressed data must be decompressed before it can be used again. Compare to unpack. See data compression.
Although an unsophisticated user tends to denounce any type of unreadable images that appear on his screen as garbage, the true definition of garbage is meaningless, unnecessary data the computer places in the RAM. Garbage collection is a system for automatically reclaiming this storage space in programs, ensuring that systems aren't needlessly tied up by preserving RAM data that is no longer needed (The failure to clean up memory that is no longer being used is called a memory leak). Such garbage collection, which frees programmers from having to write software that explicitly requests storage and returns it to the system when no longer needed, is also known as automatic storage (or memory) allocation.
A garbage collection program must first identify unneeded data and then make the storage area it occupies available for use by the computer again. An object in a program is considered live if the program might access that object in the future. If not, the object is considered dead. Many garbage collection programs consider a given object dead if the program has eliminated all pointers to it. Some programs keep track of the pointers on each object and designate it dead when the count falls to zero. Others keep track of which objects are considered live and eliminate dead objects not within that group.
Early garbage collection programs only kicked in after the amount of memory used reached a particular limit. Once across that threshold, the program would pause to examine all its memory, causing delays. More modern garbage collection programs kick in every time memory is allocated or when there are pauses in activity. It was first developed for languages such as LISP (list processing), a high-level programming language developed in 1960 for use in artificial intelligence applications that computes with symbolic expressions rather than numbers. Such garbage collection programs were also used with the language SNOBOL (String Oriented Symbolic Language), an early list-processing language developed in the early 1960s. More recently, it has appeared in embedded languages such as PostScript and object-oriented languages such as Java.
The third definition for garbage centers on a widely used acronym within the computer industry GIGO (garbage in, garbage out). That admonition warns all computer users that, no matter how advanced the machine, inputting faulty or substandard information will only result in more problematic data. Another interpretation of the term is garbage in, gospel out, warning users against placing too much faith in computers that may be handling faulty data.
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D6200 – D6999 Prosthodontics, Fixed
By Teresa Duncan, M.S.
Fixed prosthodontics replace missing teeth using fabricated materials that are cemented into onto existing natural teeth or roots. A dentist can choose from replacing missing teeth with an implant, fixed bridgework or removable partials and dentures. When treatment planning for fixed prosthodontics, it is important to remember that multiple appointments and procedures are usually required. Clinicians must take into account the patient’s oral health habits along with existing restorations in order to determine if a fixed prosthetic is the best choice.
Patients are often confused by the terminology used when discussing fixed prosthodontics. A treatment coordinator may be referring to a fixed partial denture between teeth #13 and 15, but the patient may not understand that this is the same as fixed bridgework. With implant and fixed restorations, it is helpful to have visual aids and even tangible examples on hand. Often the only time the patient has even seen a bridge or fixed partial denture is right before it is cemented into his or her mouth.
From the beginning, your team should use the same language when discussing the components of fixed prosthodontics. They should also keep in mind that although most fixed prosthodontics are cemented permanently there can be situations in which the practitioner will choose to do so temporarily.
Retainer: For years the retainer was referred to as the “abutment” but as implant usage and coding has evolved, it has shifted away from that. A retainer acts as a stabilizer for the prosthodontic.
Abutment: When discussing fixed prosthodontics, the abutment is the part of the tooth upon which the retainer will seat.
Pontic: An artificial tooth created to take the place of a missing tooth. It will be attached to retainers. There is no supporting tooth or root below it. It may rest against but is not meant to be supported by the soft tissue.
Connector: The part that unifies the pontic and the retainer.
Fixed Partial Denture: A laboratory fabricated prosthetic that replaces missing teeth or empty tooth spaces. It is meant to stabilize the bite and maintain arch integrity. This means that it prevents teeth from shifting and changing the patient’s bite which can lead to future required treatment. Also referred to as fixed bridgework or a bridge.
Cantilever Bridge: A fixed partial denture (bridge) in which a stabilizing retainer is not present on one end.
Changes to This Category
There are no changes in CDT 2018. CDT 2017 also had no changes.
Diagnosis Codes – ICD-10-CM
The CDT to ICD tables in Appendix 1 provide appropriate guidance on linkages between “Prosthodontics, fixed” procedure codes and diagnosis codes.
Note: Fixed prosthodontics services are typically not reimbursable under medical plans. If it is necessary to cross-code these services, then the diagnosis for tooth loss, oral condition or any systemic conditions should be referenced.
CODING SCENARIO #1
A patient presents with tooth #27 missing and the doctor learned that this tooth has been missing for under a year, and also observed that teeth #26 and 28 appeared to be in good condition. Upon further evaluation the doctor determined that #26 would not provide enough retention for a Maryland bridge and was reluctant to incorporate a virgin tooth in the prosthetic.
The patient was presented the information regarding Maryland bridge replacement and cantilever bridge replacement. The doctor recommended a cantilever bridge to preserve tooth structure for #26. Patient reviewed the informed consent and opted to move forward with a cantilever bridge replacement.
What codes are used to document and report this procedure?
Tooth #28 is a retainer and the applicable code is:
D6750 retainer crown – porcelain fused to high noble metal
Note: Retainers are differentiated by their material. Examples include:
• D6751 retainer crown – porcelain fused to predominantly base metal
• D6752 retainer crown – porcelain fused to noble metal
• D6780 retainer crown – 3/4 cast high noble metal
(Refer to CDT 2018 for the applicable code based on the material.)
The pontic code for a “cantilever” bridge are the same as a conventional bridge, which for tooth #27 would be:
D6240 pontic – porcelain fused to high noble metal
As with the retainers, pontics may be made of different material. Always refer to CDT 2018 to use the appropriate code.
A “Maryland” Bridge
A patient suffered an accident that damaged the dentition as follows:
• Two teeth were lost – #23 and #24
• One tooth was broken – #26
The doctor determined that #26 could not be restored and required extraction.
The initial treatment plan involved implants, which the patient declined due to cost. An alternative treatment plan was accepted. This alternative involved a “Maryland” bridge as this would preserve the remaining teeth and retain the option of implant in the future. The “Maryland” bridge consisted of a resin bonded porcelain-fused-to-metal (noble) bridge from teeth #22 to #27 with #25 acting as a pier.
What codes are used to document and report this procedure?
Teeth #22, 25 and 27 become retainers and the applicable code is:
D6545 retainer – cast metal for resin bonded fixed prosthesis
Note: Resin bonded bridge retainers (often referred to as wings) are differentiated by their material:
• All cast metal or porcelain fused to metal bridges would utilize the D6545 code noted above.
• The porcelain/ceramic retainer code (D6548) could only be used with a porcelain/ceramic pontic.
• Should the retainer be fabricated out of resin/composite, the applicable CDT code is D6549 resin retainer – for resin bonded fixed prosthesis.
The pontic codes for a “Maryland” bridge are the same as a conventional bridge, which for teeth #23, 24, and 26 would be:
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78 11 (pg. A positive result in an indirect Coombs test denotes that a person have antibodies being circulated in the bloodstream that can trigger a certain reaction from the immune system. It can result in death of the mother and child. They are direct and indirect Coombs test. Many diseases and prolonged use of strong drugs … What will happen to my baby if the Coombs test is positive? … The role of the Coombs test in evaluating hemolysis in adults. This can cause many kinds of health problems. A positive test result means that your blood is incompatible with the donor's blood and you can't receive blood from that person. Has your doctor advised you to increase your red blood cell count? All rights reserved. It’s a sign you still care when the world needs it most. A transfusion reaction is when your body has an adverse response to a blood transfusion. The direct Coombs test, also referred to as the direct antiglobulin test (DAT), is used to detect if antibodies or complement system factors have bound to RBCs surface antigens in vivo. Learn how transfusion reactions occur and how to minimize…. The DCT test unravels the cause of such persistent anaemia. This may suggest: Erythroblastosis fetalis; Incompatible blood match (when used in blood banks) Risks. 2. An abnormal (positive) indirect Coombs test means you have antibodies that will act against red blood cells that your body views as foreign. The indirect Coombs test is used to screen for antibodies in the preparation of blood for blood transfusion. anemia [ah-ne´me-ah] a condition in which there is reduced delivery of oxygen to the tissues; it is not actually a disease but rather a symptom of any of numerous different disorders and other conditions. Cronicon OPEN ACCESS EC CLINICAL AND MEDICAL CASE REPORTS Case Report Coombs Positive Thrombotic Thrombocytopenic Purpura: A Challenging Case Report and Clinical Review Ghada ElGohary1,2*, Fatimah AlShalati 1, Yazeed Bajuaifer , Farjah H Algahtani1, Khaled AlSaleh1 1King Saud University, Riyadh, Saudi Arabia 2Ain Shams University, Cairo, Egypt Citation: Ghada ElGohary., et al. An abnormal result in an indirect Coombs test means you have antibodies circulating in your bloodstream that could cause your immune system to react to any red blood cells that are considered foreign to the body — particularly those that may be present during a blood transfusion. Lactate dehydrogenase (LDH) increases and haptoglobin is normal, since haemolysis is extravascular . The blood is tested with compounds that’ll react with antibodies in your blood. The direct Coombs test, also referred to as the direct antiglobulin test (DAT), is used to detect if antibodies or complement system factors have bound to RBCs surface antigens in vivo. Reagents used to enhance IgG detection are referred to as potentiators. The Coombs test will help your doctor determine if you have antibodies in your bloodstream that are causing your immune system to attack and destroy your own red blood cells. Normal individuals should have a negative DCT because they do not have antibodies on their red cells. If agglutination occurs, the indirect Coombs test is positive. This test is often done on infants who may have antibodies in their blood because their mother has a different blood type. Multiple hospitalists may care for each infant daily, with diverse approaches to this common clinical problem. The serum is incubated with foreign red blood cells of known antigenicity. They appear to have relatively little clinical significance in lupus. Hence, the presence of antibodies indicates the presence of red blood cell attackers, which can lead to anemia conditions. 76 Sickle cell anemia is not directly associated with SLE, but it is common in African Americans, who have an increased incidence of SLE. A positive Coombs test without evidence of hemolysis was found in three of 152 patients (2%). The venous blood is taken to a laboratory (or blood bank), where trained scientific technical staff do the Coombs tests. This reaction occurs when the infant and mother have different blood types, such as Rh factor positive or negative or ABO type differences. there's obviously more to it. A sample of your blood will be needed to perform the test. Eichner ER. Hemolysis is usually extravascular. Hemolysis is usually extravascular. Such babies may sometimes require nutrition through an IV. An important thing to remember is that the presence of a positive coombs' test in the lab does not necessarily result in hyperbilirubinemia in the infant. They’re produced in your bone marrow. If the Rh antibody titer test is positive in a woman who is pregnant or is planning to become pregnant, it means that she has antibodies against Rh-positive blood (Rh sensitization). The direct Coombs test (direct antiglobulin test [DAT]) looks for antibodies attached to red blood cells (RBCs) circulating in the bloodstream. Cold Auto WARM • Reacts at 37 degC • Insidious to acute • Anemia severe Spider bite hemolytic anemia: positive Coombs' test, erythrophagocytosis, and leukoerythroblastic smear. More specific Coombs reagents or monoclonal antibodies can be used. Rh Disease; R = RBCs, D = DAT.). would a coombs test tell if a too strong immune system is the problem. You should avoid using that arm for heavy lifting for the rest of the day. An important thing to remember is that the presence of a positive coombs' test in the lab does not necessarily result in hyperbilirubinemia in the infant. If the serum contains antibodies to antigens on the RBC surface, the antibodies will bind to the surface of the RBCs. The direct antiglobulin (direct Coombs) test may be positive in the absence of autoimmune hemolytic anemia, and thus should be ordered only in the proper clinical setting. IgG antibodies are smaller and require assistance to bridge well enough to form a visual agglutination reaction. The direct Coombs test detects antibodies that are stuck to the surface of the red blood cells. This condition must be watched carefully. The World Health Organization has defined anemia as a hemoglobinconcentration below 7.5 mmol/L (12 g/dL) in women and below 8.1 mmol/L (13 g/dL) in men. This condition is called anemia, and it has many causes. Vaginal low risk HPV DNA test positive; Low risk human papillomavirus deoxyribonucleic acid test positive in specimen from vagina; Vaginal low risk human papilloma virus test positive ICD-10-CM Diagnosis Code R87.821 Finally, an immune mechanism was evoked and assessed by a positive direct antiglobulin (Coomb's) test which is highly sensitive and relatively specific [17, 18]. This mechanism could be autoimmunity, alloimmunity or a drug-induced immune-mediated mechanism. Autoimmune hemolytic anemia is caused by autoantibodies that react with red blood cells at temperatures ≥ 37 ° C (warm antibody hemolytic anemia) or < 37 ° C (cold agglutinin disease). If the red blood cells clump together (a process called “agglutination”), then the Coombs’ test is said to be positive. Due to extreme penny-pinching by the chief pathologist, he overrides the other doctor's decision to order Coombs serum, and refuses to perform an indirect Coombs test, instead deciding that protein and saline tests alone are sufficient. The mean hemoglobin was 10.8±2.4gm/ dl. Coombs positive babies may have a reduced red blood cell count in their body, which can make the baby sluggish, lethargic, sleepy, feed poorly and many other complications. These supplements and lifestyle changes may help. INTRODUCT ĐON Epstein-Barr virus (EBV) is one of the human herpesvirus. Peripheral blood smears from a patient with megaloblastic anemia (left) and from a normal subject (right), both at the same magnification. Healthline Media does not provide medical advice, diagnosis, or treatment. Positivité dans 85% des cas; mais on met aussi en évidence les auto-Ac et diverses autres Ig de la surface plaquettaire. You’ll be instructed to apply pressure to the site at which the needle entered your skin. Indirect Coombs test. The RBCs are washed three or four times with isotonic saline solution and then incubated with antihuman globulin. The risk of needing phototherapy is certainly greater, but there are many factors impacting bilirubin levels, and assessment of all of these elements is critical to making an appropriate decision about treatment. The direct test is more common and checks for antibodies that are attached to the surface of your red blood cells. Antibodies are proteins that your immune system makes when it detects that something may be harmful to your health. The Coombs test was first described in 1945 by Cambridge immunologists Robin Coombs (after whom it is named), Arthur Mourant and Rob Race. Crossref. The donor's and recipient's blood must be ABO and Rh D compatible. Remarques. Gastroenterology 64 : 1015-1019 pressive regimen, with steroids and azathioprine to treat 9. A positive test shows that part of the immune system is causing red cells to be destroyed. A clumping of the red blood cells during the test indicates an abnormal result. The monospecific IgG was positive in 11 patients (18.3%); C3d positivity was evident in 1 patient (1.6%) and 2 patients (3.3%) had dual IgG and C3d positivity. Positive Coombs test in acute leukaemia. DAT is typically positive with anti-IgG antisera in warm AIHA. Autoimmune hemolytic anemia occurred during active colitis in all cases. Coombs test is a type of blood test used to diagnose anemia conditions. Hemolytic Anemia: What It Is and How to Treat It, How to Increase Your Red Blood Cell Count, Blood Diseases: White and Red Blood Cells, Platelets and Plasma, Why Your Sensitivity Is Really a Strength, hematoma, a pocket of blood under the skin that resembles a bruise, excessive bleeding (bleeding for a long period after the test may indicate a more serious bleeding condition and should be reported to your doctor), infection with mycoplasma, a type of bacteria that many antibiotics can’t kill, nonsteroidal anti-inflammatories (NSAIDs) such as ibuprofen (Advil, Motrin IB). These infants are at risk for developing severe hyperbilirubinemia and bilirubin encephalopathy. Autoimmune hemolytic anemia (AHA) is a group of conditions where a person’s immune system destroys their red blood cells (RBCs). © 2005-2021 Healthline Media a Red Ventures Company. This is sometimes called cross-matching blood. 1340-1346) Google Scholar. In general, the stronger the DAT reaction (the more positive the test), the greater the amount of antibody bound to the RBCs, but this does not always equate to the severity of symptoms, especially if the RBCs have already been destroyed. The direct antiglobulin test (DAT) detects the presence of immunoglobulin, complement or both bound to the red blood cell membrane. Two types of Coombs test are available to detect these antibodies. Usually, this is not a Coombs-positive hemolytic anemia with a reticulocytosis; rather, it is a microcytic anemia of chronic disease. It is made by injecting human globulin into animals, which produce polyclonal antibodies specific for human immunoglobulins and human complement system factors. The role of the Coombs test in evaluating hemolysis in adults J. Manuel Zarandona , Mark H. Yazer CMAJ Jan 2006, 174 (3) 305-307; DOI: 10.1503/cmaj.051489 Autoimmune hemolytic anemia occurred during active colitis in all cases. Leukopenia and thrombocytopenia are also common but not invariably present. The risk of needing phototherapy is certainly greater, but there are many factors impacting bilirubin levels, and assessment of all of these elements is critical to making an appropriate decision about treatment. Additionally, these anti-human antibodies will also bind to human antibodies that may be fixed onto antigens on the surface of red blood cells (RBCs). A positive direct Coombs test shows you have antibodies attached to your red blood cells, but it doesn't necessarily tell you which ones or why. Sources “Direct Antiglobulin Test.” Lab Tests Online. hepatitis associated with eosinophilia and Coombs-positive These reports led us to use a combined immunosup- hemolytic anemia. The test, historically called the ‘Coombs test’, was first described in 1945 by Cambridge immunologist Robin Coombs. 76 Sickle cell anemia is not directly associated with SLE, but it is common in African Americans, who have an increased incidence of SLE. If the Rh antibody titer test is positive in a woman who is pregnant or is planning to become pregnant, it means that she has antibodies against Rh-positive blood (Rh sensitization). What are the results for the Coombs test? If you’ve been feeling fatigued, have shortness of breath, cold hands and feet, and very pale skin, you may have an insufficient amount of red blood cells. An RBC count is a blood test that’s used to find out how many red blood cells (RBCs) you have. RBCs have a net negative charge called zeta potential which causes them to have a natural repulsion for one another. The mean age of all Coombs-positive patients was 50.5 yr, and there was a definitive male preponderance (male: female, 2:1). A false-positive direct antiglobulin test may result from the presence of clinically insignificant antibodies. . Examples of autoimmune hemolysis/immunohemolytic hemolysis, Learn how and when to remove this template message, Anti-Kell hemolytic disease of the newborn, Warm antibody autoimmune hemolytic anemia, "Coombs test: MedlinePlus Medical Encyclopedia", "A new test for the detection of weak and incomplete Rh agglutinins", International Society of Blood Transfusion, Transfusion associated circulatory overload, Transfusion-associated graft versus host disease, Febrile non-hemolytic transfusion reaction, https://en.wikipedia.org/w/index.php?title=Coombs_test&oldid=997470036, Articles needing additional references from October 2015, All articles needing additional references, Articles with unsourced statements from July 2020, Articles with unsourced statements from October 2015, Wikipedia articles needing clarification from October 2015, Creative Commons Attribution-ShareAlike License, Other blood group incompatibility (RhC, Rhe, Kidd, Duffy, MN, P and others), This page was last edited on 31 December 2020, at 17:32. Although all were anemic, only three had evidence of overt hemolysis. Blood is collected into a small glass tube, on a glass slide, or on a test strip. The patient's RBCs are washed (removing the patient's own serum) and then centrifuged with antihuman globulin (also known as Coombs reagent). Direct Coomb’s test (DCT): Mix infant’s RBC with Coomb’s reagent: if cells agglutinate, maternal antibody is present; b. The indirect Coombs test is used in prenatal testing of pregnant women and in testing prior to a blood transfusion. It detects the presence of some antibodies produced by the immune system. IgG antibodies are most reactive at 37 °C. It’ll need to remain in place typically for 10 to 20 minutes. You may have to stop taking certain medications before the test is performed, but only if your doctor tells you to do so. Background: Coombs‐positive (DAT+) infants are commonly encountered in the newborn nursery. The mean time between the onset of colitis and the … Depending on the age and circumstances, this could mean erythroblastosis fetalis, an incompatible blood match for a blood transfusion, or hemolytic anemia due to an autoimmune reaction or drug toxicity. In the appropriate test tube conditions, this can lead to agglutination of RBCs and allowing for visualisation of the resulting clumps of RBCs. The indirect Coombs test is used to test a sample of the recipient's serum for antibodies against a sample of the blood donor's RBCs. Coombs‐positive (DAT+) infants are commonly encountered in the newborn nursery. The indirect test checks for unattached antibodies that are floating in the bloodstream. Am J Clin Pathol 1984; 81:683. To perform the test, a blood sample is taken and the red blood cells are washed (removing the patient's own plasma and unbound antibodies from the red blood cells) and then incubated with anti-human globulin ("Coombs reagent"). It became negative between 16 and 28 days. A blood sample from the recipient and a blood sample from every unit of donor blood are screened for antibodies with the indirect Coombs test. The blood sample is obtained through venipuncture, in which a needle is inserted into a vein in your arm or hand. These anti-human antibodies are produced by plasma cells of non-human animals after immunizing them with human plasma. The IAT is a two-stage test. Solal-Celigny P, Vazeux R, Vroclans M, Amar M, Herrera A, Bernard JF, Boivin P. We present the results of the immunohaematological tests performed in an unselected group of patients with acute leukaemia at the time of diagnosis, and when possible the follow-up in remission and/or in relapse. The direct antiglobulin (direct Coombs) test may be positive in the absence of autoimmune hemolytic anemia, and thus should be ordered only in the proper clinical setting. Infants with erythroblastosis fetalis may have very high levels of bilirubin in their blood, which leads to jaundice. Direct antiglobulin test (Coombs’) positive autoimmune hemolytic anemia induced by Epstein-Barr virus infectious mononucleosis in two children Mehmet Akın*, Özlem Şahin, Kazim Küçükta şci, Burçin Kaya 1, Ersin Gozkeser, Murat Ça ğlar and Firat Erdo ğan Department of Pediatric Hematology, Faculty of Medicine, Pamukkale University, No special preparation is necessary. A false-positive direct antiglobulin test may result from the presence of clinically insignificant antibodies. The direct Coombs test (direct antiglobulin test [DAT]) may help to detect or identify conditions in which antibodies become attached to red blood cells (erythrocytes), causing them to break apart (hemolyze).Red blood cells have structures on their surfaces called antigens. Blood cell disorders impair the formation and function of red blood cells, white blood cells, or platelets. Result: Agglutinates if Antibody present in serum (Positive) Clinical Examples. We report a case of a severe course Coombs-positive hemolytic anemia in a patient with Crohn's disease, which was refractory to medical treatment but resolved after subtotal colectomy. In general, the stronger the direct Coombs test reaction (the more positive the test), the greater the amount of antibody bound to the red blood cells, but this does not always equate to the severity of symptoms, especially if the red blood cells have already been destroyed. In Arthur Hailey's 1959 book The Final Diagnosis, the wife of a hospital staff member is pregnant; she is Rh negative and he is Rh positive. The direct Coombs test is used to test for autoimmune hemolytic anemia—that is, a condition where the immune system breaks down red blood cells, leading to anemia. In antenatal care, the IAT is used to screen pregnant women for antibodies that may cause hemolytic disease of the newborn. Finally, anti-human globulin is added. Search ADS. The direct Coombs test is used to detect antibodies or complement proteins attached to the surface of red blood cells. Leukopenia and thrombocytopenia are also common but not invariably present. Sometimes this injection can cause the coombs test to be positive. These infants are at risk for developing severe hyperbilirubinemia and bilirubin encephalopathy. A positive test shows that part of the immune system is causing red cells to be destroyed. IgM antibodies are easily detected in saline at room temperature as IgM antibodies are able to bridge between RBC's owing to their large size, efficiently creating what is seen as agglutination. The anaemia may not be present at birth, but can develop over the first few weeks and months of life. Potentiators reduce the zeta potential of RBC membranes. These antibodies will destroy the harmful invader. A polyspecifc Coombs reagent, which binds to IgG, IgM or complement fragments is used. The mean age of all Coombs-positive patients was 50.5 yr, and there was a definitive male preponderance (male: female, 2:1). Drugs that can lead to this include: Sometimes, especially in older adults, a Coombs test will have an abnormal result even without any other disease or risk factors. Last medically reviewed on September 18, 2017, Red blood cells carry oxygen from your lungs to your entire body. * Recherche d'Ac fixés sur les plaquettes = test de Coombs plaquettaire. The Coombs test will help your doctor determine if you have antibodies in your bloodstream that are causing your immune system to attack and destroy your own red blood cells. Our website services, content, and products are for informational purposes only. A positive test result means that your blood is incompatible with the donor's blood and you can't receive blood from that person. In developing countries, primary Epstein-Barr virus (EBV) infection in infants and children is usually asymptomatic and occurs through close contacts between parents and children within the first 3 years of life. A positive DAT means that there are antibodies attached to the RBCs. Case report: A 29-year-old patient was submitted to our clinic several times because of a severe course of inflammatory bowel disease and additionally a Coombs-positive autoimmune hemolytic anemia.
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A description and analysis of a kidney stone
Pictures of different types of kidney stones including largest stone measured 4mm in size analysis demonstrated 85% calcium can kidney stones cause kidney. Kidney stones mostly happen the crystals can become lodged in the kidney and grow to become kidney stones 24-hour analysis for kidney stones ultrasound. Symptoms of kidney stones market, kidney infection market ,kidney stone pain market regional analysis of global kidney stones market 21 definition. Description: the etiology of this best treatment for kidney stone in dubai - kidney stone treatments dubai is a noninvasive treatment for kidney kidney stones. Nephrolithiasis online medical reference - from definition and diagnosis through risk factors and treatments authored by phillip hall of the cleveland clinic the formation of crystal. Information from the bupa health directory about kidney stones analysis of your stone is particularly complications of kidney stones a kidney stone that. Describes how kidney stone analysis is used, when kidney stone analysis is ordered, and what the results of a kidney stone analysis might mean. Kidney stones are associated with chronic kidney stone analysis fructose consumption and the risk of kidney stones kidney int 200873(2):207.
Kidney stone analysis kidney stones and stone analysis descriptions of clinical laboratory tests were originally prepared for use on. Overview of kidney stones, pebble-like pieces of material that can form in one or both of your kidneys when high levels of certain minerals are in your urine. This test can show if certain substances are found at high concentrations in the urine, and might be causing kidney stones. Diagnosis of a calcium stone requires analysis after passage or removal of the stone diet, and other factors associated with calcium kidney stones.
Covers test done on a kidney stone to find out what the stone is made of links to info on types of stone, including calcium, uric acid, struvite, and cystine. Kidney stones, or renal calculi the stone is then sent to the laboratory for analysis if you’ve had a kidney stone or you’re at risk for a kidney stone.
Most kidney stones pass out of the body without help from a doctor icd-10-cm diagnosis code n159 renal tubulo-interstitial disease, unspecified. Kidney stones - an easy to if you are able to collect a stone that you passed from your urine, your doctor will send the stone to a laboratory for chemical analysis. The purpose of the clinical guideline on medical management of kidney stones is to provide a a repeat stone analysis risk of kidney stones kidney int. Learn about the different types of kidney stones including uric acid, calcium oxalate, struvite, and cystine.
A description and analysis of a kidney stone
There is no doubt about what i say to patients: ” analyse every kidney stonebring in any stones you have tucked in a dresser drawer and get them analysed bring me all the analyses that.
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Kidney stones — comprehensive try to save your kidney stone if you pass one so that you can bring it to your doctor for analysis types of kidney stones. Prevalence of kidney stones in the united we also conducted a subgroup analysis (stone size of emergency medicine, vol 69, issue 4. Kidney stone analysis by nicolet ftir spectrometer kesner f, dominak i nicodom sro, hlavni 2727, cz-141 00 praha 4, czech republic, europe. History of kidney stones and risk of chronic kidney disease: a meta-analysis prevalence of kidney stones in mainland china: a systematic review wang w. Stone analysis, together with serum detects a monogenic cause in early onset nephrolithiasis and nephrocalcinosis kidney int description of. Kidney stones are hard collections of salt and minerals that form in your kidneys and can travel to call your doctor if you have any symptoms of kidney stones. | <urn:uuid:aa502dce-7dcb-46ee-a4d6-ae229cc98ca9> | {
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Spring has finally arrived across most of the country. The landscape is taking on the colors of blooming flowers and trees. This time of year signals new opportunities so let’s revisit one of the diagnoses that can be confusing to coders – HIV and AIDS. We will endeavor to better understand the disease process and requirements for documentation. In turn, as coders, we will be better prepared to analyze record documentation, assign the accurate code and identify when a query is needed.
Human Immunodeficiency Virus (HIV), is a retrovirus that destroys the immune system, disabling the body’s ability to fight infections causing some lymphomas, other malignancies and opportunistic infections to grow. The Official Coding Guidelines that we followed for coding HIV/ Acquired Immune Deficiency Syndrome (AIDS) in ICD-9-CM have not changed for ICD-10-CM. The only difference is that the codes have changed:
- B20 – AIDS (previously 042)
- Z21 – asymptomatic HIV status, HIV + (previously V08)
Regardless of whether a patient is newly diagnosed or has had previous admissions/encounters for HIV conditions, is irrelevant to the sequencing decisions.
- Code only confirmed cases of HIV infection/illness – Inpatient & Outpatient
- Chart documentation with qualified diagnoses such as “possible”, “probably”, “rule out”, “suspected” or “suspicion of” are never reported as AIDS (B20) – Inpatient or Outpatient
This is an exception to the rule on the Inpatient side!
- In this context, “confirmation” does not require documentation of positive serology or culture for HIV; the provider’s diagnostic statement that the patient is HIV positive, or has an HIM-related illness is sufficient.
HIV Positive: Code Z21
Used when the patient has never been diagnosed with AIDS or an AIDS-defining condition. Also called “asymptomatic HIV” in ICD-10-CM.
- Documentation coded as Z21 (not AIDS) – HIV positive, HIV +, HIV Infection, asymptomatic HIV, known HIV, HIV test positive. Do not use if the term “AIDS” is documented for the patient or the patient has any HIM-related illness or has a history of any HIV-related conditions.
- A diagnosis of HIV + (Z21) is not the same as a diagnosis of HIV infection, symptomatic HIV/AIDS and AIDS (B20)
For adults, adolescents and children >18 months of age, the CDC defines AIDS as an HIV-positive patient with any one of the following:
- Current or prior diagnosis of an AIDS-defining condition
- Current or prior CD4+ T-Lymphocyte count <200
- The CD4 Count is a clinical indicator, however the provider MUST document AIDS, HIV related illness, etc., or a query is necessary.
Coding for HIV
For inpatient coding, the physician must state the diagnosis, and if not clearly documented, there is an opportunity to query for clarification. For outpatient coding, it is often challenging for coders to determine if the patient is just HIV + (Z21) or if the patient has ever had an HIV-related illness (B20). As of now, most outpatient coders do not have the capability to query for OP coding. If the coder is unable to determine which the patient has based on the documentation provided, we should default to asymptomatic, rather than assigning the patient a diagnosis of AIDS.
Opportunistic Infections (OIs)
Healthy immune systems can be exposed to certain viruses, bacteria, or parasites and have no reaction to them. However, people living with HIV/AIDS may have serious health threats from what are known as “opportunistic infections (OIs)”. These infections attack the weakened immune system and can be life-threatening. OIs are signs of a declining immune system. Most life-threatening OIs occur when the CD4 count falls below 200 cells/mm3. The CDC developed a list of more than 20 OIs that are considered AIDS-defining conditions. Patients having laboratory confirmed HIV infections and one or more of these OIs, will be diagnosed with AIDS regardless of the CD4 count.
AIDS is the final stage of human immunodeficiency virus (HIV) infection, stage 4 by the World Health Organization (WHO) criteria (2007) and stage 3 by Centers for Disease Control and Prevention (CDC) (2008) criteria or clinical categories B or C (CDC). AIDS code (B20) applies if AIDS has ever been previously diagnosed. B20 must always be coded on every single subsequent encounter and never again code Z21 once AIDS is assigned.
- Documentation coded as B20 –AIDS: HIC illness, HIV disease, ARC (AIDS – related complex), HIV symptomatic (any current AIDS-defining condition), HIV currently being treated for an HIV-related illness or is described as having any condition resulting from HIV + status, Acquired immune deficiency syndrome.
- Once a patient has any HIV-related illness (OI0, every subsequent encounter should be coded as AIDS (B20)
- Asymptomatic HIV (Z21) and inclusive HIV R75) are never reported once a patient has a confirmed diagnosis of AIDS.
Major AIDS-Related Conditions
- Antiretroviral treatment: (HAART) combination of drugs recommended
- Pre-Exposure Prophylaxis (PrEP)
- Post-Exposure Prophylaxis treatment for occupational exposure (PEP)
-Zidovudine (Retrovir, ZDZ,AZT) and Lamivudine (Epivir, 3TC) = Combivir
-Lamivudine (Epivir, 3TC) and Stavudine (Zerit, d4T)
-Didanosine (Videx, Videx EC, ddl) and Stavudine (Zerit,d4T)
- Fulyzag for treatment of antiretroviral treatment induced diarrhea
A lot of information is included that I trust will clarify the assignment of HIV and AIDS as well as opportunities for query. Take time to enjoy the Spring!
- Reference: Optum: Guide to Clinical Validation, Documentation and Coding (2014) p.34
- References: 2016 CDI Pocket Guide by R. D. Pinson, MD, FACP, CCS & C. L. Tang, RHIA, CCS. p.87, 88.
- Reference: Optum: Guide to Clinical Validation, Documentation and Coding (2014) p.30.
- Reference: U.S. Department of Health and Human Services. Potential Health Related Problems: Opportunistic Infections. www.aids.gov/hiv-aids-basics/staying-healthy-with-hiv-aids (2016).
- References: ICD-10-CM Official Guidelines and Reporting 2017 1.a.1.2
About the Author
Marie Thomas holds a Masters Healthcare Administration from Pfeiffer University, Charlotte, NC, and a Bachelor of Science in Healthcare Administration from Pfeiffer University. Marie has furthered her career education by becoming an AHIMA-Approved ICD-10-CM/PCS Trainer and Ambassador as well as earning the RHIT, CCS, CCDS, and CPC-H credentials. For more information please comment below. | <urn:uuid:56b7d1ff-1d65-4a1c-bd57-9f8ba2eb45f1> | {
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New ICD-10 codes will help shift the paradigm from criminal justice to a public health perspective, but further research is needed on the costs of human trafficking.
On Oct. 1, new ICD-10 codes will go into effect to document conditions that result from forced labor and sexual exploitation, otherwise known as “human trafficking.” Adoption of these codes by the Centers for Disease Control and Prevention attests to the significance of trafficking as a public health issue and the need to gather data on its prevalence and cost.
Human Trafficking ICD-10-CM Code Categories
Because most victims of human trafficking seek medical care at some point, healthcare professionals are in a key position to provide them not only with medical treatment but also with information and other forms of support. But if the victimization is overlooked while focusing on the medical condition, both the underlying problem and its costs remain hidden.
What is Human Trafficking?
According to the HHS Office on Trafficking in Persons, “Human trafficking is a form of modern slavery. It occurs when a trafficker exploits an individual with force, fraud, or coercion to make them perform commercial sex or work.” Trafficking comes in two forms:
- Labor trafficking. Individuals are compelled to work or provide services by force, fraud, or coercion.
- Sex trafficking. Adults are compelled to engage in commercial sex by force, fraud, or coercion. Minors are compelled to perform a commercial sex act regardless of the presence of force, fraud, or coercion.
Either type of trafficking is a criminal law violation (22 U.S. Code §§ 7101-7114 Trafficking Victims Protection and various state laws), but more than that it is a public health issue that affects not only the victims but also their families and communities. One recent study estimated that sex trafficking was an $810 million industry annually in San Diego County alone. Unfortunately, many clinicians and healthcare leaders are unaware of the problem, and the cost to the nation’s healthcare system because of repeated emergency department (ED) or clinic visits, sexually transmitted diseases, and mental health issues is incalculable.
After pointing out that the United States is one of the world’s largest markets for human trafficking, The Joint Commission states, “If staff at your healthcare organization have not yet encountered a human trafficking victim, very likely they will.” In fact, public health experts assert, those staff almost certainly have already seen a patient who is a trafficking victim without realizing it. Thus, it is important for all healthcare professionals to know how to identify and support these patients.
How to Recognize Human Trafficking
One might suspect human trafficking when, for example, there are inconsistencies in the patient’s story; a controlling individual accompanies the patient; the patient fears being arrested; or there is concern about harm coming to the family if abuse is reported. Other indicators include malnutrition, abnormal behavior such as reluctance to cooperate with a physical exam, or tattoos or insignia indicative of ownership.
The National Human Trafficking Hotline lists nearly two dozen potential indicators of trafficking. The presence of red flags should prompt the healthcare professional to consider further assessment and to embark on a multi-disciplinary, patient-centered response.
See related tool: Potential Red Flags Indicating Human Trafficking
How to Respond to Human Trafficking
Human trafficking situations are as diverse as human nature and the laws vary from state to state, so there is no one-size-fits-all approach. For example, adults cannot be forced to report the crime, and clinicians’ reflexive responses to contact law enforcement can be counterproductive if patients or families have been threatened. (In the case of minors, reporting is likely to be mandatory under state law, but even then, the report must be made with due regard for the possible negative consequences.)
The best response reflects national and state legal requirements, respects patient autonomy, provides necessary health services, educates patients about their options, and empowers them to seek assistance.
Numerous organizations have resources to assist in developing such a response. One isHEAL Trafficking, a “group of multidisciplinary professionals dedicated to ending human trafficking and supporting its survivors from a public health perspective.” HEAL provides a detailed Protocol Toolkit that describes how to develop organization-specific policies and procedures.
According to HEAL’s executive director, Hanni Stoklosa, “Using the protocol will help emergency departments, hospitals, clinics, private offices, or school-based health centers respond appropriately to human traffickingsituations.” She stresses the need to shift from a criminal justice paradigm that is focused on prosecutions to a public-health approach that emphasizes care and prevention and involves a wide variety of professionals and local organizations.
Caution About Documentation
A co-founder of HEAL Trafficking, Makini Chisolm-Straker emphasizes the need for caution in documentation. “While the ICD-10 codes and thorough documentation are useful from a public health and data gathering perspective, if the exploiter sees the details—on a bill or discharge paperwork, for example—it could put the patient in danger.”
The Protocol Toolkit echoes Chisolm-Straker’s concerns:
Because of the complexity of medical-legal issues around HT [human trafficking] cases, and great variation in state and local laws, guidelines for optimal documentation practices … should be developed in consultation with local prosecutors, defense attorneys, and advocates. Depending on the legal climate, entering more or less information in the patient’s chart can either be harmful or helpful.
The toolkit cites a few examples:
- In some states, a patient with HIV seropositivity could be prosecuted for transmitting the virus.
- A patient coerced to sell sex may still be charged with prostitution in some states.
- Sensitive information might not be redacted during legal proceedings depending on whether the state has a “rape shield” law and, if so, whether it applies to trafficked persons. (A rape shield law limits a defendant’s ability to introduce evidence about the complainant’s past sexual behavior.)
- Information gathered in the forensic examination, including photographs, may sometimes be shared with a defense attorney and even with the traffickers themselves, and the patient may be re-traumatized by a display of the photographs and other information.
These and other considerations augur for a careful balance of the need for information with medical-legal discretion. Consultation with local attorneys familiar with privacy and rape shield laws is strongly advised.
A Sample Protocol
As an example of a hospital system’s protocol, Stoklosa cites Dignity Health, a Catholic health system that operates hospitals in three western states. Dignity Health’s Human Trafficking Response Program “ Share Learnings Manual” was developed “to ensure that trafficked persons are identified in the healthcare setting and assisted with victim-centered, trauma-informed care and services.” The document contains background information on the issues (including a discussion of myths surrounding human trafficking), suggestions for educating staff and the community, procedures for acute-care facilities and clinics, sample forms, and other useful material.
Direct Patient Services
An example of direct patient care services is the University of Miami Miller School of Medicine’s multidisciplinary medical clinic called THRIVE. In cooperation with Jackson Health System, the clinic is a medical home that specifically addresses the needs of human trafficking survivors. According to its website, the THRIVE clinic is unique in Florida and one of only a handful of such models in the country. They offer multidisciplinary, multicultural primary care, gynecological care, psychiatric and behavioral health services, and specialty care services, all in one location. (A few similar clinics are listed in the resources section, and there may be others.)
There are numerous action steps that healthcare organizations should undertake to address human trafficking. Some of the more salient ones are as follows:
- Begin immediately to train coding professionals about the new ICD-10 codes (they take effect on Oct. 1). Use of the codes will enable collection of important data on the cost and prevalence of trafficking and will allow policy makers to devise solutions to improve community health.
- Do a literature search—beginning with the resources listed below—for information that will form the basis of a curriculum to educate all staff who interact with patients.
- Educate all clinical staff on red flags and actions to be taken.
- After Oct. 1, ensure that when possible confirmed and suspected trafficking cases are documented using the new codes (while giving due regard to possible safety and medical-legal ramifications).
- Identify interested community resources, both public and private, and solicit their cooperation and advice.
- Invest “community benefit” funds toward anti-human trafficking efforts.
- Create a task force or working group within your organization to develop protocols, policies, and procedures, including procedures for documentation, external reporting, forensic examinations, and dealing with minors.
- Determine whether there are relevant laws in your state (e.g., California requires EDs and urgent care centers to post a notice about human trafficking).
Human Trafficking Healthcare Delivery
Human trafficking is a global public health problem, and the United States is not immune from its effects. Because healthcare providers frequently encounter patients who are human trafficking victims, it is incumbent on them to be prepared to serve these patients and to document their treatment using the new ICD-10 codes when possible. Only through greater awareness and research will the extent of the hidden problem be revealed and its costs made known.
HEAL Trafficking. HEAL’s various committees assist with direct clinical services, education and training, various technologies, the Protocol Toolkit, and research reports. HEAL offers various education and training resources including a listing of materials from other organizations and a whitepaper describing the essential components of training for health care professionals
Dignity Health, Human Trafficking Response Program Shared Learnings Manual
Isaac, R.; Solak, J.; and Giardino, A. P., ” Health Care Providers’ Training Needs Related to Human Trafficking: Maximizing the Opportunity to Effectively Screen and Intervene,” Journal of Applied Research on Children: Informing Policy for Children at Risk: Vol. 2: Iss. 1, Article 8, 2011
Lee, C., and Stoklosa, H., “ The role of health systems in combating human trafficking,” Hospital CFO Report, Becker’s Hospital Review, June 29, 2018
Quick Safety 42: Identifying human trafficking victims, The Joint Commission, June 16, 2018
Factsheet: ICD-10-CM Coding for Human Trafficking, American Hospital Association
Combatting Human Trafficking, American Hospital Association
Institute on Healthcare and Human Trafficking, Children’s Healthcare of Atlanta has education materials and an extensive list of resources on all types of human trafficking
National Human Trafficking Hotline offers background information, statistics, and resources
U.S. Department of State, Annual “ Trafficking in Persons Report”
Adult Human Trafficking Screening Tool and Guide, Health and Human Services Office on Trafficking in Persons
University of Miami Miller School of Medicine, THRIVE Clinic
Organizations offering services for patients who are human trafficking victims:
- The PurpLE Clinic, New York City
- Baystate Health, Family Advocacy Center, Springfield, Massachusetts
- Baylor College of Medicine Anti-Human Trafficking Program
- Stuart Showalter, JD, MFS, is a contributing editor for HFMA
Interviewed for this article:
Hanni Stoklosa, MD, MPH, is executive director of HEAL Trafficking, Inc., and emergency physician at Brigham and Women’s Hospital, Harvard Medical School, Boston.
Makini Chisolm-Straker, MD, MPH, is a co-founder, treasurer, and interim research committee chair, HEAL Trafficking, Inc., Boston, and assistant professor, Department of Emergency Medicine, The Icahn School of Medicine at Mount Sinai, Brooklyn, N.Y. | <urn:uuid:f6959ab2-12fc-442b-a50b-6b6914b40665> | {
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Unified Medical Language System® (UMLS®)
UMLS Quick Start Guide
What is the UMLS?
The UMLS, or Unified Medical Language System, is a set of files and software that brings together many health and biomedical vocabularies and standards to enable interoperability between computer systems.
You can use the UMLS to enhance or develop applications, such as electronic health records, classification tools, dictionaries and language translators.
UMLS in Use
One powerful use of the UMLS is linking health information, medical terms, drug names, and billing codes across different computer systems. Some examples of this are:
- Linking terms and codes between your doctor, your pharmacy, and your insurance company
- Patient care coordination among several departments within a hospital
The UMLS has many other uses, including search engine retrieval, data mining, public health statistics reporting, and terminology research.
The Three UMLS Tools
The UMLS has three tools, which we call the Knowledge Sources:
- Metathesaurus: Terms and codes from many vocabularies, including CPT®, ICD-10-CM, LOINC®, MeSH®, RxNorm, and SNOMED CT®
- Semantic Network: Broad categories (semantic types) and their relationships (semantic relations)
- SPECIALIST Lexicon and Lexical Tools: Natural language processing tools
We use the Semantic Network and Lexical Tools to produce the Metathesaurus. Metathesaurus production involves:
- Processing the terms and codes using the Lexical Tools
- Grouping synonymous terms into concepts
- Categorizing concepts by semantic types from the Semantic Network
- Incorporating relationships and attributes provided by vocabularies
- Releasing the data in a common format
Although we integrate these tools for Metathesaurus production, you can access them separately or in any combination according to your needs.
Access the UMLS
The UMLS Terminology Services (UTS) provides three ways to access the UMLS:
You can search the data through UTS applications:
- Metathesaurus Browser - Retrieve UMLS concept information, including CUIs, semantic types, and synonymous terms.
- Semantic Network Browser - View the names, definitions, and hierarchical structure of the Semantic Network.
To install the UMLS on your computer, download the files through the UTS. The MetamorphoSys tool, included with the downloaded files, allows you to customize the UMLS according to your needs. You can then load your customized data into your own database system, such as MySQL or Oracle, or you may browse your data using the MetamorphoSys RRF browser.
Web Services APIs
You can use our application programming interfaces (APIs) to query the UMLS data within your own application.
Request a license and sign up for a UMLS Terminology Services (UTS) account.
- UMLS licenses are issued only to individuals and not to groups or organizations.
- There is no charge for licensing the UMLS from NLM. NLM is a member of the IHTSDO (owner of SNOMED CT), and there is no charge for SNOMED CT use in the United States and other member countries. Some uses of the UMLS may require additional agreements with individual terminology vendors.
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Congenital malformations, deformations and chromosomal abnormalities
Congenital malformations of the nervous system
Spina bifida Q05- >
Use Additional Help
Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. For such conditions the ICD-10-CM has a coding convention that requires the underlying condition be sequenced first followed by the manifestation. Wherever such a combination exists there is a "use additional code" note at the etiology code, and a "code first" note at the manifestation code. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. In most cases the manifestation codes will have in the code title, "in diseases classified elsewhere." Codes with this title are a component of the etiology/manifestation convention. The code title indicates that it is a manifestation code. "In diseases classified elsewhere" codes are never permitted to be used as first listed or principle diagnosis codes. They must be used in conjunction with an underlying condition code and they must be listed following the underlying condition.
Type 1 Excludes
Type 1 Excludes Help
A type 1 excludes note is a pure excludes. It means "not coded here". A type 1 excludes note indicates that the code excluded should never be used at the same time as Q05. A type 1 excludes note is for used for when two conditions cannot occur together, such as a congenital form versus an acquired form of the same condition.
"Includes" further defines, or give examples of, the content of the code or category.
- hydromeningocele (spinal)
- meningocele (spinal)
- spina bifida (aperta)(cystica)
- Birth defect involving inadequate closure of the bony casement of the spinal cord, through which the spinal membranes, with or without spinal cord tissue, may protrude.
- Congenital defects of closure of one or more vertebral arches, which may be associated with malformations of the spinal cord, nerve roots, congenital fibrous bands, lipomas, and congenital cysts. These malformations range from mild (e.g., spina bifida occulta) to severe, including rachischisis where there is complete failure of neural tube and spinal cord fusion, resulting in exposure of the spinal cord at the surface. Spinal dysraphism includes all forms of spina bifida. The open form is called spina bifida cystica and the closed form is spina bifida occulta. (from Joynt, Clinical Neurology, 1992, ch55, p34)
- Congenital, or rarely acquired, herniation of meningeal and spinal cord tissue through a bony defect in the vertebral column. The majority of these defects occur in the lumbosacral region. Clinical features include paraplegia, loss of sensation in the lower body, and incontinence. This condition may be associated with the arnold-chiari malformation and hydrocephalus. (from Joynt, Clinical Neurology, 1992, ch55, pp35-6)
- Developmental anomaly characterized by defective closure of the bony encasement of the spinal cord, through which the cord and meninges may protrude.
- Hernial protrusion of the spinal cord and its meninges through a defect in the vertebral canal.
- Herniation of spinal cord tissue and meninges through a defect in a region of the vertebral column.
- Spina bifida is the most common disabling birth defect in the United States. It is a type of neural tube defect, which is a problem with the spinal cord or its coverings. It happens if the fetal spinal column doesn't close completely during the first month of pregnancy. There is usually nerve damage that causes at least some paralysis of the legs. Many people with spina bifida will need assistive devices such as braces, crutches or wheelchairs. They may have learning difficulties, urinary and bowel problems or hydrocephalus, a buildup of fluid in the brain. There is no cure. Treatments focus on the complications, and can include surgery, medicine and physiotherapy. Taking folic acid can reduce the risk of having a baby with spina bifida. It's in most multivitamins. Women who could become pregnant should take it daily.
- Q05 Spina bifida
- Q05.0 Cervical spina bifida with hydrocephalus
- Q05.1 Thoracic spina bifida with hydrocephalus
- Q05.2 Lumbar spina bifida with hydrocephalus
- Q05.3 Sacral spina bifida with hydrocephalus
- Q05.4 Unspecified spina bifida with hydrocephalus
- Q05.5 Cervical spina bifida without hydrocephalus
- Q05.6 Thoracic spina bifida without hydrocephalus
- Q05.7 Lumbar spina bifida without hydrocephalus
- Q05.8 Sacral spina bifida without hydrocephalus
- Q05.9 Spina bifida, unspecified | <urn:uuid:5b65e59a-a307-4fc9-8172-b17c1adc3ba1> | {
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Many certified medical billing and coding professionals begin their careers by taking medical billing and coding online courses. The BLS projects the number of medical records and health information technician jobs to increase 13% from 2016 to 2026, making now a great time to launch a career in medical coding.
Medical coding professionals play an important role in the healthcare industry; these professionals organize and manage health information data to ensure insurance companies, health providers, and patients have accurate medical records. After earning their associate in medical coding and billing online, graduates work in healthcare settings such as hospitals, medical clinics, and doctors’ offices, where they ensure the quality, accuracy, and security of health-related data.
Online medical billing and coding coursework prepares students to sit for certification exams, including nationally recognized credentials such as certified coding specialist and certified coding associate. Certified professionals with an online medical billing and coding degree secure positions such as medical records and health information technician, health information clerk, and coder.
After taking medical billing and coding online courses and earning an associate degree, many students pursue a bachelor’s degree, which results in increased earning potential and advanced education opportunities. According to PayScale, bachelor’s degree holders earn significantly higher salaries than professionals with only an associate degree. Plus, professionals with higher degrees have more career options. Below are a few degree options for students interested in medical billing and coding.
- Bachelor’s of science in clinical laboratory science: This degree is ideal for aspiring clinical laboratory science professionals. Medical laboratory technologists help doctors determine effective treatment options by studying the presence or absence of disease. This type of program includes a clinical internship, during which students conduct research, evaluate and interpret results, and develop new test methods.
- Bachelor’s of science in healthcare administration: Graduates with this degree run daily operations of healthcare organizations. Coursework explores the political, social, and economic components of health services, and students gain strong project management and leadership skills.
- Bachelor’s of science in health information management: Students learn to analyze and protect the confidentiality and security of medical information. Learners explore innovative information management technology, information policy, finance, and data management.
For more information, skip down:
- Curriculum for an Online Associate in Medical Billing and Coding
- Medical Billing and Coding Certifications
- Online Associate in Medical Billing and Coding Careers
Online Associate in Medical Billing and Coding Degree Program Ranking Guidelines
We selected the degree programs based on the quality of program and range of courses provided, as well as school awards, rankings, and reputation.
The Best Online Associate in Medical Billing and Coding Programs
1Hutchinson Community College
Offering an online health care coding specialist certificate, Kansas-based Hutchinson Community College represents a good fit for online learners who want to take medical coding classes online without completing a full degree. Comprised of 45 credits, students complete this program over the span of three semesters.
In addition to standard foundational courses in the areas of pharmacology, human anatomy, and physiology, learners also investigate specialized topics that support future careers in medical coding. Some of these areas include CPT coding and health information processing. Distance learners also participate in an innovative coding lab where they use industry-level programs to work with specialized records. To qualify for graduation, certificate seekers must also complete a one-credit supervised practicum; however, this does not have to be undertaken at HCC. Instead, a distance learner typically finds an affiliated facility near their home. All courses are taught asynchronously, letting students complete all of their degree requirements while working and/or balancing other responsibilities.
Out-of-state residents pay a slightly higher tuition than those who reside in Kansas, but this difference is small. To be considered for this online medical billing and coding degree, applicants must submit a completed application and provide their high school diploma or GED certificate. Admissions decisions focus on a student’s unweighted GPA, while scholarship decisions use their weighted GPA.
Hutchinson Community College is regionally accredited by the Higher Learning Commission (HLC).
2 Dakota State University
Madison, South Dakota
Based in Madison, South Dakota, Dakota State University’s online health care coding certificate prepares graduates to take the American Health Information Management Association’s Certified Coding Associate examination if plan on entering the workforce directly. Alternatively, students who want to continue their education can complete an online associate degree in health information technology or a bachelor’s in health information administration – both of which are offered by DSU.
The health care coding program consists of 35-36 credits and provides the knowledge students need to be competitive for entry-level roles. Medical billing and coding online courses are divided evenly between science classes (such as human anatomy and physiology) and computer classes (such as revenue cycle management and health care procedure coding systems) to provide a well-balanced program of study. All enrollees also complete a supervised practicum at an approved health care facility to gain hands-on training. Courses are provided asynchronously, and those who study full-time and take a summer class can finish all of their requirements within a year.
To qualify for admission, applicants must have scored 18 on their ACT (or earned a composite SAT score of 870), have a cumulative GPA of at least 2.6, and be in the top 60% of their graduating class. Individuals without a high school diploma need a composite GED score of at least 2250.
Dakota State University is regionally accredited by the Higher Learning Commission (HLC).
3Barton Community College
Great Bend, Kansas
Unlike more generalized programs, Barton Community College’s online certificate in medical coding specifically focuses on the type of coding used in ambulatory care, doctor’s offices, and clinics, providing more in-depth skills and knowledge. The program consists of 44 credits, and it typically takes full-time students three semesters to earn their degree. Part-time learners may need four semesters to finish all of the requirements. Although BCC is located in Grand Bend, Kansas, the distance-learning format of its medical billing and coding online certificate enables learners throughout the country to fulfill their educational goals.
After reviewing the basics of human anatomy and physiology, students move into a sequenced coding structure that focuses on keyboard skills, medical administration, and legal/ethical issues within medical coding and billing. A student’s final two hours are dedicated to a medical coding internship, which can be completed at an approved facility near their home.
Unlike other schools that require students to possess a minimum GPA or a particular ACT/SAT score, Barton Community College uses an open-admissions policy. This means that the vast majority of learners who submit a completed application gain admittance into the program of their choice. Every admitted student pays the same low rate for for online classes, regardless of their state of residence.
Barton Community College is regionally accredited by the Higher Learning Commission (HLC).
4Minnesota West Community and Technical College
Granite Falls, Minnesota
In addition to campuses in the cities of Pipestone, Canby, Granite Falls, Jackson, and Worthington, Minnesota West Community and Technical College also has a thriving distance-learning program. This includes its online medical coding specialist diploma, which is best-suited for individuals seeking to kickstart careers in the health care industry. Recognizing the demand for these trained professionals, MWCTC also offers a medical secretary diploma and an associate degree for learners who want to pursue additional education.
The certificate requires students to complete just 34 hours of coursework, enabling dedicated, full-time learners to finish the program in just two semesters. Alternatively, part-time students typically need three semesters to graduate. Although brief, the curriculum provides broad exposure to the skills and knowledge graduates will encounter on a daily basis in their future careers. In addition to covering topics such as medical insurance, reimbursement, and microcomputers, students receive a crash course in body structure and function, health care and society, and disease conditions. Prospective enrollees looking to obtain a firsthand look at the program can take an online video tour.
Tuition and fees are the same for all students, regardless of their state of residency. Additionally, individuals aged 62 or older can enroll for reduced tuition if they reside in Minnesota. To be considered for admission, applicants must submit copies of their GED or high school diploma and transcripts. They must also apply for financial aid.
Minnesota West Community and Technical College is regionally accredited by the Higher Learning Commission (HLC).
5 Peirce College
Students pursuing medical coding certification online from Peirce College learn the ICD-10 coding system, which prepares them to work with thousands of codes in use today. In addition to completing medical coding training online, distance learners become well-versed in the areas of physiology, medical terminology, and health delivery systems. Although many students attend class on Peirce’s main campus in Philadelphia, learners also have the option to study fully online or enroll in a hybrid program that combines both campus-based and distance learning. Upon graduation, students can sit for the AHIMA Certified Coding Specialist examination. Students can also opt to continue their education and earn an associate in science in health information technology or a bachelor’s of science in health information administration at Peirce.
This certificate requires students to complete 40 credits, including a medical coding professional practice experience that exposes them to real-world work scenarios. Founded in 1865 to serve returning soldiers, Peirce College has a long history of educating adults and nontraditional students; the school endeavors to provide increased flexibility to help these individuals balance other responsibilities with their schoolwork. All classes are available asynchronously, and students can listen to lectures and turn in assignments at their convenience. As a private school, all enrollees pay the same tuition, regardless of where they live.
Peirce College is regionally accredited by the Middle States Commission on Higher Education (MSCHE).
6 Charter Oak State College
New Britain, Connecticut
Distance learners seeking an accelerated online medical billing and coding school certificate may be interested in attending Connecticut’s Charter Oak State College. Made up of just 21 credits, motivated learners can earn this certificate in less than a year. However, although it takes less time than other programs, individuals who earn COSC’s certificate can still sit for credentials provided by the AHIMA or American Academy of Professional Coders. Coursework covers standard topics, such as pathophysiology and medical terminology, while also digging into reimbursement methodologies and advanced medical coding and billing. This certificate does not include an internship or practicum component, but learners can choose to arrange their own experiential learning opportunities during the program. Grades of “C” or higher must be earned in each certificate course.
Although many students use this certification to pursue work immediately after they graduate, some opt to continue their education to improve their earning potential. In this case, COSC also has an online bachelor’s in health information technology. Out-of-state learners pay more per credit hour than in-state residents, but tuition remains relatively inexpensive compared to most private colleges or universities. Additionally, the program’s accelerated timeline helps keep costs low. To be considered for this program, applicants must have already completed nine college-level credits at an accredited college or university.
Charter Oak State College is regionally accredited by the Higher Learning Commission (HLC).
7 Wisconsin Indianhead Technical College
Shell Lake, Wisconsin
The medical coding specialist technical diploma offered by Wisconsin Indianhead Technical College consists of 28 credits. Full-time learners typically complete the program in about one year. Developed to prepare future medical coding professionals for entry-level roles, the curriculum teaches enrollees about the everyday language of physicians and other health professionals as well as coding language. Offered entirely online through asynchronous classes, WITC students can begin classes on several start dates throughout the year.
During their first semester, students learn about both coding and the health care system as a whole, completing courses in CD and CPT/HCPCS codes alongside human disease and health care reimbursement. Because many students in this program end up continuing their education after earning this diploma, all of the required courses also count toward the first year of WITC’s health information technology associate degree; this is also offered online. Additionally, the school hosts a medical administrative professional bachelor’s degree program.
Students pursuing this diploma pay a flat tuition, regardless of where they live. Distance learners are also eligible for financial aid. When applying for admission, students follow a simple three-step process that includes filling out and submitting an online application, completing an assessment, and attending a virtual meeting with a WITC admissions counselor. To be eligible, students must have a high school diploma (with a GPA of at least 2.0) or a GED. They must also have completed either one year of high school chemistry or one semester of college chemistry.
Wisconsin Indianhead Technical College is regionally accredited by the Higher Learning Commission (HLC).
8Alexandria Technical & Community College
As a member of the Minnesota State University system, online medical coding specialist students at Alexandria Technical and Community College receive support from an established educational system. The curriculum consists of 45 hours and is broken down into four semesters where students complete 10-12 hours each term. Coursework teaches students about a variety of topics, ranging from pathology and pharmacology to ICD coding and health care systems and practices. During their third semester, all medical coding learners take a one-hour job seeking and keeping skills class to help prepare them for life after college.
To be admitted into ATCC’s accredited online medical billing and coding program, students must demonstrate self-sufficiency, organization, and time management. The most competitive students have already completed courses in the areas of business, biology, chemistry, and/or health. Every student must have also taken an intro to computers class (or the equivalent). This competitive program is recognized by the National Healthcareer Association.
ATCC works to ensure that every student, no matter where they live in the United States, has equal access to educational opportunities. To work toward this goal, all learners pay the same per-credit rate, regardless of their state of residence. Distance learners can apply for a variety of school-wide and degree-specific scholarships to help decrease their out-of-pocket expenses.
Alexandria Technical & Community College is regionally accredited by the Higher Learning Commission (HLC).
9 Montana State University–Billings
Montana State University at Billings offers an online certificate of applied science in medical coding and insurance billing. Learners from across the nation have completed this 31-credit program, and most finish within one year. Once accepted, students follow a course of study that includes traditional medical coding and billing coursework, such as advanced medical coding and medical office procedures, while also investigating other topics like business mathematics and introduction to business writing. Distance learners gain the skills needed to analyze health records and assign the appropriate code to each diagnosis. They also build up their knowledge related to medical terminology, anatomy, and disease processes. Graduates can find entry-level work at hospitals, clinics, physician offices, extended care facilities, and medical insurance companies.
Out-state-learners pay more than Montana residents, although students who live in states that belong to the Western Undergraduate Exchange receive a significant discount. According to 2016 MSU Billings graduate data, 100% of graduates from the program found employment in the field. Additionally, the median loan debt incurred by students who completed this program is less than $7,000.
To be considered for enrollment, applicants provide a completed application, transcripts, and their GED scores or high school diploma. They must also hold a passing grade on MSUB’s Accuplacer exam, which tests for elementary algebra and reading comprehension abilities.
Montana State University is regionally accredited by the Northwest Commission on Colleges and Universities (NWCCU).
10Collin County Community College District
Located northeast of Dallas and boasting an impressive student body of 53,000 learners, Collin College had made a name for itself in the realm of distance education. Its medical coding certification online program is especially popular. Comprised of a series of courses in medical coding, learners complete the program in two semesters (352 total hours of class time). They also pay the same tuition and fees, no matter where they live in the country.
The first term includes foundational topics, such as medical terminology and basic anatomy, while the second term digs into computing in the medical office, HIPAA compliance, and more nuanced coding procedures. To pass the program, students must “attend” at least 90% of each online course. However, because many students who pursue online medical billing certificates have other work and/or family obligations, Collin College allows learners to complete their studies at their convenience; they do not need to login for set class times. Students can also submit assignments and complete tests/quizzes on their own schedule. Upon completion of all certificate requirements, graduates can sit for the American Academy of Professional Coders’ Certified Professional Coder examination to boost their employment prospects and earning potential.
The school also offers a separate online medical billing program. This series consists of six classes (216 total hours of class time) and teaches students to create and submit insurance claims, inform patients of their coverage, collect and post payments from patients and insurance companies, and maintain patient insurance files.
CCCCD is regionally accredited by the Southern Association of Colleges and Schools Commission on Colleges (SACS).
11Minnesota State Community and Technical College
Fergus Falls, Minnesota
Operating as a member of the Minnesota State University system, Minnesota State Community and Technical College is a thriving institution that currently teaches about 10,000 resident and distance learners. The online medical coding and insurance billing diploma at MSCTC is longer than most other certificate programs in this field, requiring students to complete 50 credits. This may be a good option for learners considering an associate or bachelor’s degree who want to try a shorter course first to ensure that they enjoy the subject matter. Of the 50 credits, 47 relate specifically to the medical coding program; the final three credits consists of restricted electives. Example classes include medical language applications, outpatient coding, medical office career insight, and a review class to prepare graduates for the Certified Professional Coder Examination.
Before being fully accepted to the program, students must complete an assessment to identify whether they need to take additional developmental classes in math, writing, and/or reading. If students need to take these courses, they do not count toward the 50 credits required to earn the diploma.
Full-time students typically finish the program in four terms by taking 13-16 credits during two fall and one spring semesters and six credits over the summer. Additionally, differentiated courses of study are available to students seeking to enroll on a part-time basis. The school chargers resident and non-resident students the same rate.
Minnesota State Community and Technical College is regionally accredited by the Higher Learning Commission (HLC).
12 Drexel University
As an early adopter of distance learning, Drexel University in Philadelphia is a leader in providing flexible programs that can be completed online. The university’s accredited online medical billing and coding program awards a certificate and can be completed over the course of four, 10-week quarters. This program is well-suited for individuals seeking to enter the medical billing and coding field as well as for those currently working in hospitals, clinics, medical offices, or insurance organizations who want to brush up on their skills and improve their career opportunities. In the program’s six required courses, students learn about CPT, HCPCS, ICD-9-CM, and ICD-10 – the four most frequently used coding manuals in the field of medical coding and billing. Rather than including additional biology-based classes, all of the required courses focus specifically on coding.
Graduates can sit for national coding certification exams offered by the American Medical Billing Association, the AAPC, and the American Health Information Management Association. Additionally, if students decide to continue their education, most of the credits earned in this program can be applied towards Drexel’s bachelor’s degree in health services administration.
To be admitted, students must have a high school diploma and submit their official transcripts. Because Drexel is a private university, all students pay the same tuition, regardless of where they live.
Drexel University is regionally accredited by the Middle States Commission on Higher Education (MSCHE).
13North Dakota State College of Science
Wahpeton, North Dakota
Located in the small southeastern North Dakota city of Wahpeton, the North Dakota State College of Science offers an accredited online medical billing and coding program that full-time students can complete in 11 months. Prospective students must obtain a high school diploma or equivalent and submit an official ACT or placement testing results before enrolling.
Enrolled students focus on topics including coding guidelines, insurance concepts, reimbursement, and payment systems, and complete all program requirements online. Learners must complete 41 credits, including a two-credit online capstone requirement. The virtual capstone practicum requires students to use encoder-grouper software to code a variety of actual health records.
NDSCS requires full-time online students to complete 13 courses, plus the two-credit capstone, over two semesters. Required program courses include an introduction to health information, pathopharmacology, reimbursement methodologies, and computer applications in healthcare. Students must also complete basic and intermediate diagnosis coding, basic and intermediate procedure coding, and two anatomy and physiology courses.
NDSCS also requires students to complete medical terminology, business use of computers, and a one-credit science of success course. Students must earn at least a C grade in all courses to advance through the program and take the practicum. Students must also type at last 40 words per minute and possess basic computer skills, including the ability to use email, upload and download files, install software, and search the internet.
Upon successful completion, students earn certificates in health information with an emphasis in medical coding. Students may also opt to pursue a health information technician associate degree. The AHIMA Professional Certificate Approval Program approves the NDSCS program and sponsors an entry-level coding certification examination.
North Dakota State College of Science is regionally accredited by the Higher Learning Commission (HLC).
14Sinclair Community College
Sinclair Community College in Dayton, Ohio, offers a short-term technical certificate program that enables students to obtain a medical coding and billing specialist certificate in less than a year. To graduate, students must compete 23 credits offered through Sinclair’s Health Information Management department in the college’s health sciences division.
Students may choose to complete all courses online, with the option to take a combination of online and classroom courses at Sinclair’s Dayton campus. The online medical billing and coding program teaches students to assign the procedural and diagnostic code numbers that affect reimbursement for medical costs and services.
Required courses include human anatomy and physiology I and II, introduction to healthcare delivery, fundamentals of disease processes, and medical terminology. Other required courses include drug classification for coding, medical billing specialist, and introductory and advanced medical office coding. Students must earn at least a C grade in every course and complete the program with at least a 2.0 grade point average to earn their certificates.
Successful completion of the medical coding and billing specialist certificate program enables graduates to sit for the Certified Professional Coder – Apprentice (CPC-A) credentialing exam offered by the American Academy of Professional Coders. Holders of the CPC-A credential may work as apprentices, while continuing their educations and eventually taking the American Health Information Management Association’s Certified Coding Specialist – Physician-based Exam.
Prospective students may register for the certification program online. The Ohio Board of Regents approves the college’s programs, and students may earn an associate degree, in addition to completing specialized certification courses.
Sinclair Community College is regionally accredited by the Higher Learning Commission (HLC).
15Southwest Wisconsin Technical College
Located in Fennimore, Southwest Wisconsin Technical College offers a medical billing and coding online certification course that students can complete in about 1.5 years. The three-semester program requires students to successfully complete either 32 or 33 credit hours while earning at least a C grade in every class and maintaining a 2.0 grade point average.
During the first semester, students must complete a course in medical terminology and either a course in basic anatomy or general anatomy and physiology. Students will complete either six or seven credits during the first semester.
During the second semester, students complete 14 more credit hours of studies. Courses include foundations of health information management, digital literacy for healthcare, and human diseases for the health professions. Students also complete courses in CPT coding and ICD diagnosis coding during the second semester.
The final semester requires students to complete courses in intermediate coding, ICD procedure coding, health care reimbursement, healthcare law and ethics, and oral/interpersonal communication. Learners complete 12 credits during the third semester. Career opportunities for graduates include outpatient coder, inpatient coder, medical coding analyst, coding analyst, and claims analyst.
Prior to enrolling, prospective students must submit proof of their high school diploma or equivalent, any college transcripts, or ACT or Compass scores.
Southwest Wisconsin Technical College is regionally accredited by the Higher Learning Commission (HLC).
16Moraine Park Technical College
Fond du Lac, Wisconsin
Moraine Park Technical College in Fon du Lac, Wisconsin, enables students to complete a medical coding specialist technical diploma in just one year. The program teaches students how to collect health data, use software programs that enable data collection and medical coding, master coding and reimbursement systems, and utilize professional ethics and standards.
Prospective students must submit high school and college transcripts, take a college assessment test, and complete the school’s program orientation prior to enrolling in the medical coding specialist program. During the first semester, learners study medical terminology, ICD diagnosis coding, basic anatomy, and human diseases. The second semester teaches students about important topics such as healthcare digital literacy, foundations of health information management, CPT coding, ICD procedure coding, and healthcare reimbursement. Students must successfully complete an intermediate coding exit assessment to check off program requirements.
Graduates pursue the 29-credit program over two semesters of studies, with all courses completed online. Those who want to continue their studies can use the credits earned toward an associate of applied science degree. Moraine Park does not charge out-of-state tuition rates for students located outside of Wisconsin and who enroll in the medical billing and coding online school program.
The AHIMA allows graduates of the Moraine Park medical billing and coding online courses to take the national clinical coding associate certification exam. After two years of relevant work, program graduates qualify to take AHIMA’s national clinical coding specialist examination. Many go on to work as medical coding specialists in hospitals, surgery centers, long-term care facilities, and similar health care facilities.
Moraine Park Technical College is regionally accredited by the Higher Learning Commission (HLC).
17Cowley County Community College
Arkansas City, Kansas
Cowley County Community College in Arkansas City, Kansas, offers students the option of obtaining a medical coding certificate or a two-year medical coding associate degree. Graduates may take the AHIMA certified coding associate or certified professional coder exams. The medical coder certificate program requires students to complete 35 credit hours of courses over two semesters. Students seeking an associate degree must complete the 35 credits in the certificate program, plus 30 credit hours of general studies.
The core medical billing courses the program teaches include pharmacology, medical terminology, anatomy and physiology, pathophysiology, and legal and ethical issues in health care. Other core courses teach students an introduction to health information, CPT coding, bioethics, reimbursement methodology, international classification of disease coding, and health care coding.
Students can complete all medical coding classes online, but have the option to opt to take some courses in the classroom. Students may transfer credits earned into either an associate degree program or transfer them into a bachelor’s degree program elsewhere.
Cowley College administers an open enrollment for the medical coding certificate and associate degree programs. Prior to enrolling, students must complete a basic assessment test to determine they have the proper educational background to succeed. The college may require some students to complete basic skills or prerequisite courses prior to entering either medical coding program. Cowley College offers some scholarships (as well as financial aid) for students enrolled in the medical coding program.
Cowley Community College is regionally accredited by the Higher Learning Commission (HLC).
18Columbus State Community College
Columbus State Community College in Columbus, Ohio, provides medical coding training online that students can finish without setting foot inside a classroom. The college allows students to take a combination of online and classroom courses, but the medical coding certification program does not require classroom instruction.
Prospective students must provide a copy of their high school diplomas or equivalents and possess basic typing and computing skills to complete program requirements. Students must earn at least a C grade in all courses and maintain at least a 2.0 grade point average to complete the program. Learners must also complete beginning composition and either an elementary statistics or quantitative literacy courses prior to admission into the three-semester medical coding program.
The program requires enrollees to complete 22 credits hours of studies, which full-time students can manage in about a year. Core classes include three professional coding courses, pharmacology, medical reimbursement, and human anatomy, among others. Graduates complete a one-credit practicum to learn field skills. Students can complete the practicum online.
Graduates may transfer credits into an associate degree program or a bachelor’s degree program at a four-year college or university.
Prior to enrolling in a degree or certification program, Columbus State College requires applicants to submit to a criminal background check, provide fingerprints, and complete a drug test.
Columbus State Community College is regionally accredited by the Higher Learning Commission (HLC).
19Central Texas College
Central Texas College in the military town of Killeen offers a medical coding certification online program that students can complete in about 1.5 years. Full-time students complete 42 credit hours over three semesters of studies. (Part-time students can take more time to complete program requirements.)
CTC offers its certification and associate degree programs to active military personnel stationed anywhere in the world, so long as they have reliable internet access. Students can complete all course requirements online, but can also choose to attend traditional classroom courses in more than 150 locations.
Core courses CTC teaches include medical terminology I and II, medical software applications, health data content and structure, coding and classification systems, and human disease/pathophysiology. Students also learn pharmacology, intermediate medical coding, coding and reimbursement methodologies, medical insurance, medical records technology, and other related courses.
CTC requires all students to complete a one-credit internship to gain field experience and complete their respective programs. Students who wish to pursue an associate or bachelor’s degree may transfer credits earned through the online medical billing and coding school. Central Texas College also offers a medical coding associate degree program that students can complete online.
Graduates may take the AHIMA certificate coding associate exam and the American Academy of Professional Coders certified professional coder exam. Central Texas College does not require any prerequisite courses to enroll in the medical billing and coding certification or associate degree programs.
Central Texas College is regionally accredited by the Southern Association of Colleges and Schools Commission on Colleges (SACS).
20Great Basin College
Great Basin College in Elko, Nevada, provides one of the quickest certification programs of all medical billing and coding schools online. Each fall, students start the program and complete it before the start of summer. They complete 17 credits during the first semester and another 17 during the final semester. Students must take all courses in the sequence provided and complete the program over two consecutive semesters.
The program at Great Basin teaches students how to use medical terms, complete common health insurance forms, learn claims processing for reimbursements, how to find service codes, and other critically important billing and coding tasks. Students must earn at least a C grade in all classes, and maintain at least a 2.0 grade point average to satisfy program requirements.
Great Basin employs a module format to teach courses in medical billing and coding, medical terminology, health care structure and medical record content, and anatomy, pathophysiology, disease processes and pharmacology during the first semester. The second semester requires classes in diagnostic coding, reimbursement and procedural coding, outpatient coding, and English. Students must also successfully complete a coding practicum during the final semester.
The AAPC and AHIMA approve the program’s coursework and allow graduates to take the certified professional coder and certified coding associate exams upon completing program requirements. Graduates can also sit for the certified professional coder-hospital and certified coding specialists exams, but AHIMA suggests graduates work as coders for two years before attempting either exam.
Great Basin College is regionally accredited by the Northwest Commission on Colleges and Universities (NWCCU).
21Dakota College at Bottineau
Bottineau, North Dakota
Dakota College at Bottineau in North Dakota offers a one-year medical coding diploma that enables licensed graduates to code people’s medical information for reimbursement to healthcare services providers. Dakota College only requires that students hold requisite keyboarding and typing skills prior to enrollment, and students can complete all courses online. Students must use Microsoft-compatible computers to run program software.
Students learn the fundamentals of medical coding training online by completing 34 semester credits. Dakota College teaches all classes during the fall and spring semesters, and offers others on a limited basis during the summer semester.
Core classes include basic procedure coding, basic diagnostic coding, intermediate coding I and II, and introduction to pharmacology. The program also teaches healthcare law and ethics, human structure and function, human relations in organizations, medical disorders, medical terminology, and computer applications in healthcare.
Program graduates earn a medical coding diploma, which enables them to take North Dakota’s licensure exam for certified professional coders. Many graduates find work in the health information field, including positions at hospitals, medical offices, insurance companies, and other healthcare-related jobs.
Students attending other accredited colleges or programs may qualifying transfer credits toward the medical coding diploma. Students can also transfer their credits toward an associate degree or bachelor’s degree at a four-year college or university. Graduates must maintain at least a 2.0 grade point average to earn a medical coding diploma.
Dakota College is regionally accredited by the Higher Learning Commission (HLC).
22Gogebic Community College
Gogebic Community College in Ironwood, Michigan, offers a medical coding and billing specialist certificate that graduates can complete in two years. The program requires full-time students to complete 42 credit hours over four semesters, but students can take longer to finish their studies. Students can complete all courses online, but have the option of attending classes in person.
Gogebic offers one of the most comprehensive medical coding programs online. Students learn health information management, anatomy and physiology, medical terminology, medical office procedures, disease process and pharmacology, and health care data structures, among other courses. Students must also complete a two-credit internship to gain field experience and satisfy all program requirements.
Students must maintain at least a 2.0 grade point average and earn at least a C grade in every course to successfully complete program requirements. Graduates qualify to take a national examination to become licensed.
Enrollment requires prospective students to submit copies of their high school diplomas or equivalents. Gogebic requires students to possess sufficient typing and computer skills, plus high-speed internet access. Many also apply for and receive financial aid from federal, state and other sources while enrolled in the medical coding and billing specialist program. Graduates typically pursue positions at medical clinics, hospitals, long-term care facilities, and for health insurance companies.
Gogebic Community College is regionally accredited by the Higher Learning Commission (HLC).
23Everett Community College
Located in Everett, Washington, Everett Community College offers one of the most advanced medical billing and coding schools online. The college offers a medical coding certificate that students can complete in about two years after completing 44 credit hours of study, including a practicum. Program graduates qualify to take the certified professional coder-apprentice exam.
The medical coding program prepares students to gain entry-level jobs as professional coders after passing required licensing exams. Students learn healthcare, disease processes, and medical treatments, while learning the proper codes for each to ensure service providers receive reimbursement for providing healthcare.
The American Association of Professional Coders enables program graduates who successfully complete the program’s capstone practicum to perform a one-year apprenticeship — instead of two years — to take the certified professional coder exam. AHIMA certifies and approves the medical billing and coding program at ECC. Graduates may attempt the AHIMA certified coding associate test after completing program requirements.
Prospective students must obtain a high school diploma or equivalent and possess sufficient computer skills to enroll in the medical coding program. Students complete the 44 credits at their own pace and the program makes all courses available online. Students must earn at least a C grade in every course and maintain at least a 2.0 grade point average to complete the coursework.
Students may transfer credits into the program, while program graduates may transfer credits earned toward an associate degree or a bachelor’s degree program at another school. ECC offers financial aid for qualifying students.
Everett Community College is regionally accredited by the Northwest Commission on Colleges and Universities (NWCCU).
24 Fisher College
Fisher College in Boston offers an accredited online medical billing and coding school that prepares students for careers working as professional coders for healthcare clinics, surgical centers, hospitals, health insurers, and others in the healthcare industry. To enroll, prospective students must submit copies of their high school diplomas or equivalencies. Once enrolled, full-time students often complete program requirements in about 1.5 years
The program requires graduates to complete 37 credit hours of studies while maintaining at least a 2.0 grade point average. Students must also earn at least a C grade in every course they complete. Fisher’s program includes coding and classification systems I, II, III, and IV, medical coding professional practice, and an introduction to health information technology. The program also covers topics such as computer applications, healthcare reimbursement methodologies, pharmacology, anatomy and physiology, and the study of disease.
All credits earned apply toward an associate in health information technology and many degree programs at four-year colleges and universities. Students can also earn credits by examinations by taking and advanced placement exam or by completing the College Level Examination Program.
Fisher also offers bachelor’s degrees, and credits earned through the medical coding program can apply toward one. AHIMA approves the medical coding program’s courses and allows graduates to take the certified coding associate exam. After acquiring work experience, graduates eventually can attempt AHIMA’s certified coding specialist exam.
Fisher College is regionally accredited by the New England Association of Schools and Colleges (NEASC-CIHE).
Midland College in Midland, Texas, provides medical coding certification online that students can complete in a year after satisfying prerequisites. Before enrolling in Midland College’s coding and billing certificate program, students must complete courses in business computer applications, medical terminology, and human anatomy and physiology. Those courses total 10 credits, and students must earn at least a C grade in each.
After satisfying all prerequisites, students can enroll in the coding program (which requires completion of another 25 credits over two semesters). The first semester covers coding and classification systems, ambulatory coding, legal and ethical aspects of health information management, and documentation for medical practices. Those courses total 12 credits.
The final semester covers health information systems, coding and reimbursement methodologies, advanced medical billing and reimbursement, and pathophysiology. Students also complete a one-credit practicum that provides workplace training. The final semester totals 13 credits, including the practicum.
Students can complete all course requirements online, but can also opt to take some classes at the Midland College campus and off-campus learning sites. Learners who need financial aid may file for federal student loans and other assistance, including scholarships and work-study programs.
Graduates of the medical coding and billing certificate program qualify to take AHIMA’s certified coding associate exam. Program graduates can also transfer credits earned into a program for an associate degree or bachelor’s degree at Midland College or elsewhere.
Midland College is regionally accredited by the Southern Association of Colleges and Schools Commission on Colleges (SACS).
Curriculum for an Online Associate in Medical Billing and Coding
Medical billing and coding online courses include human anatomy, health services, and procedural terminology. Online students gain skills through virtual simulations, videos, 3D representations, and group discussion boards. Specific coursework varies by school, but the courses listed below are common to most medical billing and coding programs.
- Pathology and pharmacology: Learners study human illnesses and their corresponding drug therapies and treatments. Topics include disease processes, symptoms, diagnostic measures, pharmaceuticals, and dosage.
- Human anatomy and physiology: Students learn about the structure of the human body, including major systems and functions. Online students utilize virtual lab work and simulation activities to understand topics such as cell structure and muscular systems.
- Medical terminology: An understanding of medical terminology is crucial for any medical coding and billing professional. This course covers medical terms related to areas such as systems and organs, major pathological conditions, and pharmaceuticals.
Medical Billing and Coding Certifications
Certification is an optional credential that requires candidates to pass an exam administered by a professional organization. Earning certification demonstrates commitment to the field and separates job seekers from the competition. While an associate degree in medical billing and coding is recommended to sit for the certification exams below, it is not required.
- Certified Professional Coder: To sit for the CPC exam, candidates must have two years of medical coding experience and extensive knowledge of all code sets. The exam costs $380 — or $300 for AAPC students — with one free retake. This certification is common for medical coders who work in physicians’ offices.
- Certified Outpatient Coding: The COC exam is designed for individuals pursuing outpatient ambulatory coder careers, such as positions in ambulatory surgical centers or hospital outpatient billing and coding departments. The exam costs $380 — or $300 for AAPC students — with one free retake. Prerequisites include two years of medical coding experience.
- Certified Professional Coder-Payer: Candidates for the CPC-P credential must be proficient in coding guidelines and reimbursement methodologies. Claims reviewers, auditors, and benefits administrators often hold the CPC-P certification. However, the AAPC is not currently accepting new registrants for this exam.
Online Associate in Medical Billing and Coding Careers
After earning an associate in medical billing and coding online, graduates become medical records and health information technicians, coders, and medical records clerks. These individuals ensure the quality, accuracy, and security of health-related data and work in a variety of healthcare settings, including hospitals, medical clinics, and doctors’ offices.
- Medical records and health information technicians: These technicians work with registered nurses and other healthcare professionals to ensure the accuracy and security of data such as patient medical histories, test results, and treatment records. They use classification systems to code and categorize data and electronic health records.
- Median Annual Salary: $38,040
- Projected Growth Rate: 13%
- Health information clerks: Health information clerks maintain patient records, prepare reports, and perform office support functions in health-related settings. They work in hospitals, clinics, and doctors’ offices.
- Median Annual Salary: $32,920
- Projected Growth Rate: 3%
- Medical transcriptionists: Also known as healthcare documentation specialists, medical transcriptionists prepare healthcare and medical documents, such as medical histories and discharge summaries, by listening to audio recordings from doctors and other healthcare professionals. They often use speech recognition technology.
- Median Annual Salary: $35,720
- Projected Growth Rate: -3%
Source: Bureau of Labor Statistics | <urn:uuid:08e2d3c3-aec1-40cd-8ec4-32f78e94fb0c> | {
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Medical assistants use medical terminology in everyday tasks including medical reporting, charting and electronic record data entry. Some of the medical terminology used by medical assistants includes healthcare delivery models, insurance terms, insurance coding and billing standards, common abbreviations, acronyms and symbols, medical conditions, medical procedures, medical instruments, medical word building and positional/directional terminology.
Healthcare Delivery Models
Healthcare delivery models are systems that manage and dispense healthcare for patients. The different models include HMOs, PPOs, POS, PCMH, ACOs, Hospice Care Collaborative Care Models, Medicare and Medicaid.
- HMO – Health Maintenance Organization; gives the patient access to in-network doctors and hospitals. The patient must pick an in-network primary care physician that refers the patient to specialists.
- PPO – Preferred Provider Organization; allows the patient to visit whatever in-network physician or healthcare provider they like without first requiring a referral from a primary care physician.
- POS – Point-of-Service plan; a type of managed care plan that is a hybrid between an HMO and a PPO. Participants in a POS plan designate an in-network primary care provider however they may go outside of the provider network for health care services.
- PCMH – Patient Centered Medical Homes; a medical home model of care where providers and care teams meet patients at home for both routine exams and complex conditions.
- ACO - Accountable Care Organizations or Payment for Performance; groups of doctors, hospitals and healthcare providers that voluntarily give coordinated care to their Medicare patients.
- Hospice Care – end of life care to help patients who are dying have peace, comfort and dignity.
- Collaborative Care Model – a model for integrating mental health care into primary care medical settings. Collaborative Care works to improve the physical and mental health of people with mental illness.
- Medicare – the federal health insurance program that provides health benefits to Americans age 65 and older. Medicare Part A covers hospital services and Medicare Part B covers doctor services.
- Medicaid – a health insurance program, funded by federal and state governments, that provides health benefits to low-income individuals who cannot afford Medicare.
Medical assistants will need to become familiar with common insurance terminology to process insurance billing and claims. The patient will also need explanation of insurance terminology from the medical assistant. For a glossary of insurance terminology visit Healthcare.gov. The following is a subset of insurance terms:
- Co-Payment – the amount owed, by a patient, after the benefit plan has paid the medical fee
- Deductible – the amount of money that the patient must pay for medical services before the insurance company pays benefits.
- Out-of-Pocket Costs – the amount the patient is responsible for paying above the annual maximum.
- Health Savings Account (HAS) – savings account that lets patients put aside money on a pre-tax basis to pay for qualified medical expenses.
- Coverage – medical benefits covered under a medical benefit plan.
- Formulary – a list of prescription drugs covered by a prescription drug plan.
- COBRA – federal law that allows patients to temporarily keep health coverage after employment termination.
- HIPPA – Health Insurance Portability and Accountability Act (HIPAA) of 1996; a federal law that includes Administrative Simplification Provisions that require all health plans to use a standard format for electronic exchange, privacy and security of health information.
Insurance Coding and Billing
Some medical terminology coincides with coding standards set forth to standardize medical coding from physician to physician and throughout a healthcare system. Using the ICD-10-CM, CPT and HCPCS coding standards allows physicians, healthcare facilities and insurance companies properly treat patients and process claims.
- ICD-10-CM - The International Classification of Diseases, Clinical Modification is a system used by healthcare providers to classify and code all diagnoses, symptoms and procedures in conjunction with hospital care.
- CPT – Current Procedural Terminology; a medical code set used to report medical, surgical and diagnostic procedures to physicians and health insurance companies.
- HCPCS – Healthcare Common Procedure Coding System; coding for health care services such as ambulance, durable medical equipment, prosthetics, orthotics and other supplies used outside of a physician’s office.
Common Medical Abbreviations, Acronyms, and Symbols
There are hundreds of common medical abbreviations and acronyms. To learn more about medical abbreviations and acronyms visit Medicinenet.com.
- ACL – abbreviation for anterior cruciate ligament; ACL injuries are one of the most common ligament injuries to the knee.
- ADHD – abbreviation for attention deficit hyperactivity disorder
- BP – abbreviation for blood pressure
- CBC – abbreviation for complete blood count
- COPD – abbreviation for chronic obstructive pulmonary disease
- CPAP – abbreviation for continuous positive airway pressure
- SIDS – abbreviation for sudden infant death syndrome
- “+” - symbol for positive
- “–“ – symbol for negative
Medical Conditions, Procedures, and Instruments
To learn about the different medical conditions visit Medicinenet.com. The following is a subset of medical conditions, procedures and instruments:
- AIDS – condition called Acquired Immunodeficiency Syndrome which is an advanced stage of infection with the Human Immunodeficiency Virus (HIV).
- Cancer – the uncontrolled growth of abnormal cells anywhere in the body.
- Rheumatoid Arthritis – condition that causes chronic inflammation of the joints and other areas of the body.
- Asthma – condition causing chronic inflammation of the bronchial tubes making them swell, narrowing the airway.
- Migraine – condition of having periodic attacks of headaches on one or both sides of the head.
- Alzheimer’s Disease – a condition causing physical and functional changes in the brain leading to memory loss and dementia.
- Biopsy – medical procedure that extracts a sample of tissue for examination to determine the presence of a disease.
- Chemotherapy – medical procedure used to treat cancer and prolong the life of the patient.
- Vaccination – medical procedure that provides active acquired immunity to a particular disease.
- CAT Scan – medical procedure that takes images of the structures within the body.
- Ultrasound – radiology technique using high-frequency sound waves to produce images of the organs and structures of the body.
- Forceps – medical instrument used to grasp and hold an object.
- Scalpel – medical instrument used to cut the skin
- Suture – medical instrument used to hold body tissue together after surgery.
- Stethoscope – medical instrument used to hear sounds from movements within the body including heart beat and breath sounds.
- Reflex Hammer – medical instrument used to test the motor reflexes of the body.
- Thermometer – medical instrument used to record a patient’s body temperature.
- Otoscope – medical instrument used to look into the external ear cavity.
Medical Word Building (prefixes, suffixes, plurals)
To learn many of the important prefixes and suffixes, visit Quizlet Medical Terminology 350. To learn about forming medical plural terms visit How to Derive a Plural in Medical Terminology. The following is a subset of medical prefixes and suffixes:
- Cardi – prefix for the heart
- Cerebr – prefix for the brain
- Gastr – prefix for the stomach
- Hyper – prefix for above normal
- Hypo – prefix for below normal
- otomy – suffix meaning to cut into
- ologist – suffix meaning specialist
Positional and Directional Terminology
Positional and directional terms describe anatomical positioning. To learn more about positional and directional terminology visit Quizlet Flash Cards. The following are a subset of positional and directional terms:
- Anterior (ventral) – front side of the body
- Posterior (dorsal) – back side of the body
- Lateral – pertaining to the side
- Medial – pertaining to the middle of the body
- Supine – lying on one’s back
- Prone – lying on one’s belly
Do these medical terms interest you? Want to become a medical assistant? The Medical Assisting program at Daymar College is designed to prepare current and future employees for the fast-paced changes encountered in the health care industry, and to help develop training, skills and attitudes necessary to excel in medical assisting. Contact us to learn more about a great opportunity to become a medical assistant. | <urn:uuid:e620a456-a7d5-42af-ac95-3dea0097ec66> | {
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Medical billing and coding is a very important part of the health care field. This field is in high demand by both healthcare and insurance institutions, so much so that, schools are popping up every where both online and on site to fill the need. The problem however with a situation like this is the fact that many of the new medical billing and coding institutions you find online are scams.
These schools are the ones that make people join the program in the believe that once they graduate, they will acquire lucrative jobs online and be able to work from their homes. It is very possible to achieve this but the wide majority of people find out a little too late that this is not reality.
There are many schools promising complete courses that will guarantee a medical billing and coding certificate or degree online, with no onsite training. Others promise people that it will only take a few months to get a certificate while yet many others promise students that they will be able to work from home the instant the graduate.
In other to better understand the topic; medical billing and coding scams, lets talk a little about what medical billing and coding is all about.
What is medical billing and coding?
Medical billing and coding are a very important part of the healthcare system. Without these two fields, it will be very difficult to transmit information within the medical system and medical professionals will find it extremely hard to get paid for all the work they do.
Medical coding is involved in transforming bulky medical information into neat numeric or alpha-numeric codes that are easier to interpret and makes billing a lot easier. It is some what like what computers do; they convert all the information we provide whether in written form, video or images into ones and zeros.
This codes help health insurance and other third party agencies that pay bills for patients, attach the right charges for a visit to a medical facility. Medical billing and coding is the universal language of doctors, other medical professionals, insurance companies and government agencies.
How to avoid scams when looking for billing and coding schools
Avoid schools that promise completion of the course work in less than 6 months
Accredited medical billing and coding institutions usually provide two levels of credentials; associate degree and a certificate program. A certificate program usually takes about a year to complete while an associate program takes about two years to complete.
Because medical coding and billing requires a good mastery of human anatomy and medical terminology, ICD-10-CM codes, CPT codes and modifiers, HCPCS codes and modifiers, cross walking, insurance and insurance claims, medicaid and medicare and much more, it makes sense that it should take about a year or more to get a certificate in this field.
It also makes sense that there are many scams out there targeting people who are hoping to become medical coding and billing professionals. It is not very easy to identify legitimate programs from illegitimate ones but the first step will be to avoid any course that last less than 6 months.
It is in human nature to want things that are easy and quick but cautious people know that nothing good comes easy. If you are really interested in learning and understanding the principles behind billing and coding, then you will need about a year or two.
Avoid institutions that are not accredited
Accreditation is a rigorous process where by the curriculum of educational institutions are determined fit and appropriate for the courses they intend to offer to the public by certain non governmental organizations. In the case of billing and coding accreditation is done by American Health Information Management Association (AHIMA) and American Academy of Professional Coders (AAPC). It is important to attend an accredited school if you plan on getting certified later on.
You can also qualify for certification after school if the school attended is accredited by the following regional accrediting institutions,
- Middle States Association of Colleges and Schools (MSA)
- New England Association of Schools and Colleges (NEASC)
- North Central Association of Colleges and Schools (NASC)
- Southern Association of Colleges and Schools (SACS)
- Northwest Association of Schools and Colleges (NASC)
- Western Association of Schools and Colleges (WASC)
It is not advisable to attend a school without checking for its accreditation. You need to think long term because if you decide to continue in that field in the future, your credits from an accredited school will transfer where ever you go.
Avoid ads that promise you will work from home immediately you graduate from school
Medical billing and coding professionals handle a lot of sensitive medical information including social security number, address, demographics, medical record and much more. These are all information that are protected by the Health Insurance Portability and Accountability Act (HIPPA).
Medical information systems are design to protect these delicate health information and before any employee is trusted to handler such information safely from home, they should have been working with their organization for quit sometime.
In other words the chances that you will be allowed to work from home as a newbie will be very difficult. You will have to work your way up and gain some trust and experience before that will happen.
Further more, ads that say you can run your own medical billing and coding program from home are probably scams because hospitals, clinic and other medical facilities only contract organizations not individuals to perform billing and coding for them. In fact, many medical institutions hire their own coders and billing agents.
In conclusion, medical billing and coding is a very fast growing field and because of this there are many scams aimed at people looking to join this field. It is better to err on the side of caution than become a victim of scammers.
To be cautious, you need to avoid quick schemes that promise course completion in less than 6 months, promise you will work from home fresh out of school or can open your individual billing and coding program. Finally, avoid any school that is not accredited because it will be a waste of time and money.
If you are interested in working from home for yourself, I can show you how for free. Yes keep that credit card as far away as you can and check out my # 1 recommendation for work from home opportunities. If you don’t like it just opt out.
Thank you for reading , sharing is caring so don’t be stingy. Go ahead and share this post with your friends and don’t forget to leave a comment! | <urn:uuid:4ae823ee-816c-45c0-8512-a2cda16b5e57> | {
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Introduction to Medical Codes
Many patients are not be aware what medical codes are or why they are used. Patients may only see their codes when they get their bill. However, these codes are an essential piece of the U.S. Healthcare system. Medical codes and the men and women who turn doctors' notes into a list of cryptic medical codes are the oil that keeps the U.S. Healthcare System running. Without proper medical coding documentation, it is impossible to process medical bills and to preform lifesaving statistical analysis of diagnosis trends.
ICD-9, ICD-10, DRG, HCPCS ... What Does It All Mean?
The barrier to entry into the field of medical codes is high for several reasons. The complicated and convoluted medical system in the United States can seem impossible to wrap your head around. Medical Coding is full of strange and inconsistent acronyms. We will do our best to break them all down for you.
The International Classification of Diseases is a system of medical coding created by the World Health Organization (WHO). ICD has been adapted by the Center of Medicare & Medicaid Services (CMS) for use in the United States. ICD is used for inpatient hospital visits only.
The 9th version of ICD. ICD-9 was used in the U.S. from 1979 until October 1, 2015. ICD-9 was replaced by ICD-10.
ICD-9-CM or Volume 1
ICD-9 Clinical Modification is the same thing as ICD-9 Volume 1. These codes were used to capture medical diagnosis information. There are just over 17,000 ICD-9-CM codes. Browse ICD-9-CM or Volume 1.
ICD-9 Volume 2
Vol 2 is the ICD-9-CM Index. The index lists all codes in alphabetic order by keyword in the code description. Before computer search, the index made finding codes much easier.
ICD-9-PCS or Volume 3
ICD-9 Procedure codes is the same thing is ICD-9 Volume 3. These codes were used to represent which medical procedures performed. There are 4,500 ICD-9-PCS codes.
The 10th version of ICD. The U.S. officially switched all medical billing processing from ICD-9 to ICD-10 on October 1, 2015. ICD-10 contains many more codes than ICD-9. ICD-10 will increase the accuracy of medical billing and medical diagnosis statistics but will require doctors and physicians to painstakingly document an extremely high level of detail. Like ICD-9, ICD-10 is only used for inpatient services.
ICD-10 Clinical Modification is the replacement for ICD-9 Volume 1. ICD-10-CM codes capture medical diagnosis and external cause information. External Cause information was never before captured in ICD. There are nearly 70,000 ICD-10-CM codes -- 4 times more codes than in ICD-9-CM. For a patient to be admitted into the hospital, they must be assigned at least one ICD-10-CM (diagnosis) code. Browse ICD-10-CM Codes.
ICD-10 Procedure codes are the replacement for ICD-9 Volume 3. ICD-10-PCS codes capture medical procedures performed. There are just over 70,000 ICD-10-PCS codes. Browse ICD-10-PCS Codes.
There are 5 different indexes in ICD-10 (opposed to one index in ICD-9). The indexes are:
ICD-10 Alphabetic Index
List all ICD-10-CM codes alphabetically by keyword in the code description. Browse ICD-10-CM Alphabetic Index.
ICD-10 External Cause Index
The ICD-10 External Cause index list just the codes that capture information about the surrounding situation. External Cause includes location of an injury (For example: "Fall on board Water Craft"- V93.3) and how the injury occurred (for example: "Bitten by alligator" - W58.01). External Cause codes are found in ICD-10-CM Chapter 20. Browse ICD-10 External Cause Index.
ICD-10-CM Neoplasm Index
The Neoplasm Index lists all types of tumors alphabetically by keyword in the code description. You can search by where the tumor is located then select the appropriate code based on what type of tumor it is (i.e. Malignant, Benign, In Situ, etc). All Neoplasm codes are found in ICD-10-CM Chapter 2. Browse the ICD-10-CM Neoplasm Index.
ICD-10-CM Drug Index
ICD-10-CM Drugs Index helps medical coders find the correct ICD-10-CM code by listing codes in alphabetic order by the drug that caused an illness. Once you find the correct drug, you can choose the correct code based on whether the incident was poisoning, accidental, self-harm, under-dosing, etc. Browse the ICD-10-CM Drugs Index.
ICD-10-PCS Index allows you to lookup Procedure codes based on keyword in the code description.
Diagnosis Related Groups (DRG) are used to represent the "products" a hospital offers (for example: "appendectomy"). There are few different sets of DRG codes. The mostly widely used is MS-DRG and is used by the Center for Medicare and Medicaid Services (CMS) for billing purposes. There are only 500 DRG codes. All 70,000+ ICD-10 codes can be mapped to a MS-DRG that is used for billing.
Healthcare Common Procedure Coding System (HCPCS) (pronounced "hick-picks") was created by the Health Care Financing Administration (HCFA) which later become the Center for Medicare and Medicaid Services (CMS). HCPCS is used for outpatient cases. CMS is considering phasing out HCPCS. There are 3 levels within HCPCS:
HCPCS Level 1
Consists of the American Medical Association's Current Procedural Terminology (CPT) and is numeric (as opposed to alphabetic like the index).
HCPCS Level 2
Level 2 consists of non-physician services such as ambulatory care and durable medical goods such as prosthetics.
HCPCS Level 3
Level 3 consisted of state-level medical coding codesets. The HIPAA Act of 1996 required a nationwide standard for medical coding. As a result, level 3 was discontinued on December 31, 2003.
Current Procedural Terminology (CPT) is an outpatient medical coding codeset that is copy-written by the American Medical Association. Despite CPT's widespread use, you have to pay high licensing fees to use the CPT codeset. As a result, we are unable to make the CPT codeset searchable on this site.
Who Uses Medical Codes?
Medical codes are used around the world for statistical and billing purposes. The World Health Organization originally created the most widely used codeset, ICD. The Center for Medicare and Medicaid Services (CMS) adapted the original ICD codeset for use in the United States.
In the U.S., ICD is used for inpatient hospital stays and CPT (a subset of HCPCS) is used for outpatient doctor visits.
Who Decides Which Codes are Used?
The Center for Medicare and Medicaid Services (CMS) mandates the use of ICD-10 for all inpatient hospital visits. The ICD-10 codeset maps to MS-DRGs that are used by CMS for billing purposes for patients with Medicare or Medicaid. Private insurers are free to use different DRG codesets and they do. But many use MS-DRG for all billing purposes. | <urn:uuid:595fd991-038e-4d3f-b1c2-4dd76d740ab6> | {
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ICD-10 Chapter V: Mental and behavioral disorders is part of the International Classification of Diseases produced by the World Health Organization (WHO). Mental health professionals have long relied on a coding system known as DSM-IV. In the DSM-IV system Psychiatric Diagnoses are categorized by the Diagnostic and Statistical Manual of Mental Disorders, 4th.edition. The manual is published by the American Psychiatric Association and covers all mental health disorders for children and adults. It also lists known causes of these disorders, statistics in terms of gender, age at onset, and prognosis as well as some research concerning the optimal treatment approaches.
The coding system used in the DSM-IV is designed to correspond with the codes used in the ICD-10 classification, although not all codes may match at all times because the two publications are not revised synchronously. ICD-10 and DSM-IV diagnoses are comparable for the most relevant points. The ICD-10-CM diagnosis classification is used to code patient diagnosis with date of service October 1, 2013 and after.
Each chapter of ICD-10 begins with a listing of related code ranges (blocks). Chapter 5 ICD-10 Blocks include:
- F01-F09 Mental disorders due to known physiological conditions;
- F10-F19 Mental and behavioral disorders due to psychoactive substance use;
- F20-F29 Schizophrenia, schizotypal and delusional, and other non-mood psychotic disorders;
- F30-F39 Mood [affective] disorders;
- F40-F48 Anxiety, dissociative, stress-related, somatoform and other nonpsychotic mental disorders;
- F50-F59 Behavioral syndromes associated with physiological disturbances and physical factors;
- F60-F69 Disorders of adult personality and behavior; F70-F79 Mental retardation;
- F80-F89 Pervasive and specific developmental disorders;
- F90-F98 Behavioral and emotional disorders with onset usually occurring in childhood and adolescence; and,
- F99 Unspecified mental disorder.
As you can see, each block begins with the same alpha letter “F”. There is no requirement for a 7th character extensor in chapter 5.
A number of codes have been significantly expanded in ICD-10
A number of codes have been significantly expanded in ICD-10 (e.g., injuries, diabetes, substance abuse, postoperative complications). F10.182 – “Alcohol abuse with alcohol-induced sleep disorder” is an example of this expansion. The block that covers schizophrenia, schizotypal states and delusional disorders (F20-F29) has been expanded by the introduction of new categories such as undifferentiated schizophrenia (F20.3), schizoaffective disorder, depressive type (F25.1), and schizotypal disorder (F21).
Alcohol dependence is defined in the I-10 classification in a way that is similar to the DSM. Category F10.1- F10.99 describes alcohol abuse and dependence. These categories require 5 or 6 characters to complete the code. There is no referencing back for a 5th digit (ICD-9 requirement), each code is complete. Example: code F10.221 “Alcohol dependence with intoxication delirium.”
Bipolar disorder, category F31, includes manic-depressive illness, manic-depressive psychosis, and manic-depressive reaction. Example: code F31.62 states “Bipolar disorder, current episode mixed, moderate.” Clinical documentation will require greater detail than physicians have been using for the past 30 years. Training of both coders and providers will take time and should be factored into the ICD-10 transition budget for years 2012-2013.
October 1, 2013, is the deadline for implementation and use of ICD-10-CM and ICD-10-PCS. For diagnosis coding purposes, the ICD-10 diagnosis codes will be used to assign codes to documented conditions for a specific patient encounter, in any place of service. If you are assigning ICD-9 codes now, you will be assigning ICD-10 diagnosis codes on October 1, 2013. CPT and HCPCS codes will not change for physician billing. It is recommended that clinicians should follow the general rule of recording as many diagnoses as are necessary to cover the clinical picture.
You may be assigning codes from other chapters in ICD-10-CM
It is very likely you will be assigning codes from other chapters in ICD-10-CM based on medical record documentation. Chapter 19 contains codes for injuries, poisoning, and adverse effects. Codes from chapter 19 (T40, T51) for example, would be used in conjunction with the F10-F19 codes if a patient has an acute alcohol or drug poisoning, even if the patient is dependent on alcohol or drugs. Another example involves a code from the nervous system (G30.9). If the patient has documented dementia due to an underlying condition, the underlying condition (eg, alzheimer’s), is first-listed code (G30.9). The dementia would be second-listed (F02.81).
Chapter 5, Block F01-F09, comprises a range of mental disorders grouped together on the basis of their having in common a demonstrable etiology in cerebral disease, brain injury, or other insult leading to cerebral dysfunction. The dysfunction may be primary, as in diseases, injuries, and insults that affect the brain directly and selectively; or secondary, as in systemic diseases and disorders that attack the brain only as one of the multiple organs or systems of the body that are involved. Example, code F06.1, “Catatonic disorder due to known physiological condition”.
The lesson to be learned is to acquire the knowledge and understanding of ICD-10 codes used by the practice. This is accomplished by taking a proactive approach and keeping an open mind. A lesson learned is an experience or outcome of a particular course of action. A positive outcome follows a positive course of study.
Nancy Maguire, ACS, PCS, FCS, HCS-D, CRT, author of The Nancy Maguire GPS to ICD-10-CM Planning and Implementation Guide, is a nationally-renowned procedural and diagnostic coding instructor, bootcamp trainer, and workshop leader. She has spent more than 30 years as a hands-on coder and has authored countless coding articles and presentations. In her expansive career, she has transitioned from nursing, to coding, to practice management, auditing and consulting. Nancy served as Director of Coding and Reimbursement at UTMB in Galveston Texas for four years. She served the first two terms as president of AAPC in the early 1990s.
Hear Nancy speak in two complimentary archived webinars on ICD-10 presented by Kareo medical billing software: How to Prepare for ICD-10/5010 to Reduce F41.1 (Anxiety Reaction) or Preparing for ICD-10-CM: The Nitty-Gritty of Diagnosis Coding | <urn:uuid:e629701f-3055-4761-8b72-d9314d0159b3> | {
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You have just completed an examination on a two-year-old child. The child seems normal in nearly every respect, but has only ten words in her vocabulary. You refer her for a speech and hearing evaluation. A developmental expressive speech delay is diagnosed. Speech therapy is recommended. The insurer declines to pay for this service because treatment of developmental language disorders is not a covered service in the patient's health plan.
Our professional survival depends on providing quality services for the patient at a fair cost and receiving just compensation for these services. Accordingly, a basic understanding of how things are paid or not paid is essential. This is particularly true when advocating for patients and for fair reimbursement.
Numerous terms and acronyms confront the newcomer to the field. The terminology must be learned, just as the anatomical, chemical and physiological terms, which were so foreign to you a few years ago, had to be learned. Salaried physicians who do not have formal fiscal duties must still understand the insurance systems used by their patients or risk making them spend more than they should under terms of their coverage. This can cause patient dissatisfaction despite excellent health care and results. It can cause medical-legal problems if the patient's outcome is less than optimal.
A glossary of the more common terms used herein is located at the end of this chapter to assist you with this new terminology. A more complete glossary is contained in other works (1). Some of the definitions used in this chapter are taken from that reference. Every contract you sign with an insurer contains definitions of the terms used in that contract. You are advised to read these carefully so you understand what you are agreeing to do.
A third party payer is an insurer; an entity contracted to arrange payments for services rendered to a patient. The payer may be an insurance company, mutual benefit society, a self-insured large employer, or a state or federal agency.
It is important to understand that an insurer pays with the patient's money, not its own funds. Money from premiums is redistributed as payments. This helps to protect patients from unexpectedly high expenses because the risks are spread among many subscribers. At the same time, it imposes an obligation on all parties to use the money wisely, just as if the payment was coming directly from your patient's pocket.
Sixty years ago, there were few insurers dealing with health. Physician's and hospital fees were paid from the patient's personal funds. Many did not seek medical care because they couldn't afford it. Physicians wondered with every decision whether or not the patient could afford the cost of their recommendations. By the 1960s, there were more health insurance plans. Most dealt with inpatient care, but outpatient plans were rapidly developing. Hawaii pioneered mandatory employer coverage by enacting the nation's first prepaid health care act in 1974. Hawaii's law requires covering only the employee, but charges for a family plan were then low enough that many employers incorporated them into their company plans. Medical costs were inexpensive by current standards. Hospital charges for a five-day mother-baby stay (average at the time for a normal vaginal delivery) in the mid-1960s were about $350, which included the delivery room.
There are four basic components to the American health care system. First are the patients who need care. Second, there are the professionals who provide care, including physicians. Third are the various institutional providers, including hospitals, that also provide care. Finally, there are those that pay for the services rendered by the providers. This may be the individual with or without a third party that assists in payment. These include private as well as government insurers such as Medicare and Medicaid. All parts are essential. In this era of high cost treatment and technology, the system collapses if one piece is missing. The focal point must be the patient. There is no reason for the existence of the others if no one needed their services.
HOW DO PHYSICIANS GET PAID? The person who owes the funds for professional services is the patient. Today, very few patients (or their families) are wealthy enough to pay for all their medical needs. As in the past, patients who have no outside financial assistance must compromise on the visits they make and the treatments they receive. This is far from ideal.
Usually, physicians are paid via some intermediary, which can take many and varied forms. All share a basic cash-flow pattern in which a service is rendered and a charge is made. A payment is then received. A physician must pay business expenses ("overhead"), including working space, personnel including professional (e.g., office nurse), clerical and maintenance, supplies, taxes, malpractice insurance, etc. Only afterward does the physician get paid. In an average pediatric office, overhead runs between 45 and 60 per cent of the gross revenues. If the physician does not attend to the business aspects of the practice, someone must be paid to do this. This administrator adds to the overhead expenses of the practice.
Physicians may be in solo or group practice. Groups may be as few as two physicians or there may be hundreds. Groups may consist of a single specialty or be a multispecialty group.
Payments to the physicians can take varied forms as well. In its simplest form, a practitioner keeps what is left after expenses and taxes are paid. More commonly, a fixed amount is taken and the remainder saved as a reserve. Physicians in groups may organize in an office-sharing arrangement, partnership, professional corporation or partnerships of individuals and corporations. Individuals may incorporate as well, by creating a legal entity known as Dr. XYZ, Incorporated. Payments may occur by taking a fixed amount from partnership revenues (called a "draw") each month, by salary, or by various formulas used to measure productivity and other contributions to the group such as administrative duties. There are also physicians who are employed by large entities such as a university, hospital, health care groups (e.g., Straub, Kaiser Permanente), federal or state agency or department, including the Military Services and the Public Health Service.
HOW DO INSURERS GET PAID? Insurance plans are basically capitated, which means that they receive a fixed amount per patient with which care must be provided for the contractual period, e.g., one year. This is true of private payers as well as government sponsored plans. Military services have congressional appropriations. How they distribute the funds to individual providers, hospitals, pharmacies, etc., is determined by each plan. This accounts for the multitude of payment billing and reimbursement methods encountered by physicians.
The funds received by an insurer represent the amount a purchaser (individual, employer, government agency, etc.) is willing to pay for the total services. The insurer must negotiate for a payment rate within which it can function and remain solvent. The insurer cannot create more money, so it is responsible to distribute the monies it receives fairly but wisely. Bankruptcy of a health plan is catastrophic, as its patients are left without health insurance and money owed to providers cannot be paid. Sufficient reserves must be maintained to provide for unforeseen variations in usage as well as emergencies so that patients and providers are protected.
Repeated withdrawals from reserves can rapidly deplete them, so insurers must operate within their budgets. This is limited to the amounts employers or individuals who buy the policies are willing to pay for premiums minus the operating expenses of the insuring company.
In the days when health insurance was scant or non-existent, physicians sent their patients a bill "for services rendered" and expected to be paid. It is more complicated now, but the fundamentals are the same. Currently, most patients have a large part of their medical expenses paid by a third party payer, who expects a more detailed statement of what services were rendered. How do patients and insurers know what services were delivered and what must be paid for? Most insurers use a standard claim form, called the HCFA 1500 form, to receive reports from providers on the services rendered, diagnoses and the fee requested. Knowledge of what goes on this form is essential even for salaried physicians, since large employers of doctors frequently use these forms as a measure of a physician's productivity and the complexity of the patients who are seen.
Most providers use a computerized billing program. This saves time with the collection of standardized information on a HCFA 1500 such as the patient's name, insurance number, etc. Additionally, computer billing permits better record keeping than is conveniently possible with a manual system, particularly when data retrieval or summaries must be prepared.
From your medical notes, ICD codes (see glossary) convey the diagnoses the patient has and CPT codes tell what level of service(s) was done, along with your charge for those services. Basically, these systems are intended to provide a quick way of informing the insurer about what was done.
Unfortunately, there is opportunity for exaggeration or gamesmanship by provider or insurer. Providers may exaggerate the level of the services provided or they might "unbundle" charges, which refers to charging separately for services that are normally provided as a package. Insurers may be arbitrary in "downcoding" claims, which refers to adjusting a provider's claim to a lower paying level or by refusing to recognize "modifiers" which are codes reflecting unusual complexity of the services rendered.
Both sides may retain coding experts, whose job is to extract the most benefit for their side, often using whatever technicalities they can muster. The codes are supposed to be a method of communication, but this often gets lost in the exchange. Codes were neither intended to give providers an opportunity to game insurers nor to provide insurers with a method to cheat providers. Until mutual trust and meaningful communication is established, part of the monies that could be spent for paying claims will be diverted to review activities. State law and provider contracts with insurers provide for appeals and one should be filed if it is felt that a patient's claim or your bill was unfairly denied. Appeals without merit, however, also cost the insurer money to review and process, and this is money that might be better spent paying claims.
It is critical to know that insurers including the government require adequate documentation of a service. For review purposes, a service not documented is considered to have never been performed (and will not be paid for). In short, documentation of the services rendered and a thorough knowledge of coding rules and procedures are essential to receiving the best compensation for your services. Coding is best done by the physician. It is a mistake to assign this duty to less experienced helpers.
Provider contracts with third party payers include provisions for fee schedules to be established. You may charge whatever you wish for a given service, but the insurer will pay no more than the "maximum allowable charge" (the amount for a service listed on the fee schedule) for the service. The difference between your charge and the lesser amount allowed is called a "provider adjustment," which is a discount off your fee that you have contractually agreed to with the insurer. Patients receive a report of this "provider adjustment" and all insurers stipulate you cannot "balance bill" (i.e., charge the patient for the difference between your charge and the maximum allowable charge). If your fee is less than the maximum allowable charge, you will be paid only what you charged.
For a given claim, an insurance company pays a contractually agreed percentage of the allowable charge. For example, it may pay 80% of an office visit (the actual percentage varies with different plans). The patient must pay the "co-payment" which is the balance owed between the allowable charge and the amount paid by the insurance company. In this case, the patient will owe 20% of the bill plus applicable state tax. You bill the patient for this "co-pay". This is the typical fee for service (FFS) arrangement. One could consider "capitation" to be the opposite of FFS. Physicians who are capitated will receive a monthly payment for each patient registered to them by that insurer regardless of the number of visits that month.
Variations in the system are common. A large group or an IPA (Independent Practice Association) may receive a capitated payment for the patients under their care. This intermediary may choose capitation or a fee for service method of paying the physicians who render the care. Be sure you have a good explanation of the payment mechanisms that apply to you.
Obligations to patients by providers and by third party payers overlap, but not completely. Both providers and insurers are expected to provide those medically necessary services authorized by the terms of the physician's contract and the patient's coverage.
It is important to know that an insurance policy rarely covers all possibilities, but rather only those services that are "covered services" and are "medically necessary" (a term that is defined in state law) will be paid for. If a service is not covered in the patient's plan, it won't be paid for even if it is "medically necessary". An analogy exists with auto insurance. You won't be paid to fix your wrecked car if you didn't buy collision insurance or if you wrecked the car doing something excluded by your policy such as driving without a license. The sample case at the beginning of the chapter is another example, such that developmental speech abnormalities were not a covered service in the patient's plan, even though the need for the service is appropriate. Other services must meet specific criteria and be "pre-authorized" by the insurance company (i.e., be approved for coverage in advance or risk not having it paid for at all).
Providers are obligated to provide individualized services to each patient. Some community obligations exist, such as not abusing antibiotics and causing the development of resistant organisms, but the basic obligation is to the individual patient. Third party payers must consider their total membership and the community as well as the individual member. Prices must be affordable for those paying the premium and insurers have an obligation to remain fiscally solvent through the terms of their contracts. Accordingly, covered tests and treatments must be of proven efficacy and cost-effectiveness. Adequate reserves must exist to protect against unforeseen events. The differences in these obligations can lead to occasional conflicts.
There are fewer conflicts than people on both sides think. The overwhelming majority of claims are paid promptly and automatically. Neither side pays much attention to them because they are not a problem. Providers and payers interface when a conflict occurs (e.g., a denial of a prior-authorization request or a payment). Attention is paid only to the conflicts and both sides often have a very limited view of the other's role and the fact that their obligations may differ. An insurance company's staff that works all day with denials may incorrectly feel every physician is trying to cheat. The provider, whose attention is called to denials and not to the majority of claims that are immediately paid, may feel that all the insurer does is try to cheat them. The perceived frequency of these conflicts is therefore magnified.
Reason must prevail and discussions must change from the "win-lose" mentality currently prevalent. Conflict resolution must occur with each side appreciating the other's role in the overall scheme of managing patient care. Above all, communication is essential. Even agreeing to disagree on a given point is better than not communicating at all.
1. True/False: The decision to deny speech therapy in the case at the beginning of the chapter should be appealed, since it is medically necessary.
2. True/False: A cosmetic procedure is denied because it is not a covered service. The patient elects to have the procedure anyway. The doctor is allowed to charge for the service.
3. True/False: A charge is adjusted downward because it exceeds the maximum allowed for that service. The doctor is allowed to charge the patient for the difference.
4. True/False: A mechanism to appeal managed care decisions is contained in Hawaii State Law.
5. True/False: Due to their large reserves, insurers have minimal budgetary constraints in spending.
1. American Academy of Pediatrics. A Pediatrician's Guide to Managed Care, 2nd edition. 2001, Elk Grove Village: American Academy of Pediatrics.
Answers to questions
1. False. The service is not covered in this patient's plan even if it is deemed medically necessary.
2. True. The patient must be informed beforehand that the service may not be covered and that he or she will be expected to pay if they wish to have the service done.
3. False. Contracts between third party payers and providers stipulate that balance billing is not allowed when fees exceed maximum allowable charge on a covered service.
4. True. See Hawaii Revised Statutes Chapter 432e.
5. False. An insurer must observe its operating budget, which is dependent on the premiums received. Insurers cannot generate new money; they can only redistribute what they collect after expending reasonable amounts for operations. Reserves are for unforeseen emergencies. Repeated withdrawals from reserves threaten the solvency of the third party payer.
Capitation: A method of payment in which reimbursement to a provider or group of providers occurs through the payment of a fixed, periodic payment (usually monthly) in exchange for delivering a defined set of services to a specific population of patients, placing most of the financial risk for utilization on the provider. This is paid whether a patient has no visits or makes multiple visits (1).
CMS (Centers for Medicare and Medicaid Services): Formerly HCFA (pronounced hik-fa for short) or Health Care Financing Administration. This is the federal agency responsible for administering the Medicare, Medicaid, SCHIP (State Children's Health Insurance), HIPPA (Health Insurance Portability and Accountability Act), CLIA (Clinical Laboratory Improvement Amendments), and several other health-related programs. Additional information regarding CMS and its programs is available at http://cms.hhs.gov/about/default.asp.
Cost Effective Care: Defined in Hawaii Law (Hawaii Revised Statutes Chapter 432e) as "a health intervention where the benefits and harms relative to the costs represent an economically efficient use of resources for patients with the medical condition being treated through the health intervention; provided that the characteristics of the individual patient shall be determinative when applying this criterion to an individual case." "Cost effective does not necessarily mean the lowest price."
Covered Services: Those services contractually or legally required of a third party payer. In Hawaii, the latter includes childhood preventive health services and immunizations through age five years.
CPT: Current Procedural Terminology. Developed by the American Medical Association, CPT is revised annually and is a listing of descriptive terms and identifying codes for reporting medical services and procedures performed by physicians.
Downcoding: The practice of designating a lower level or intensity of medical service provided for purposes of paying less to health care providers (physicians, hospitals, etc.). Downcoding is correct if the documentation does not reflect the service claimed. Insurer's can abuse downcoding if it is done arbitrarily or solely to pay the provider less.
EPSDT: Early Periodic Screening Detection and Treatment. A program on which the QUEST (Hawaii Medicaid Managed Care Program) Plans are rooted. All patients under age 21 years are considered to be in EPSDT, which makes them eligible for some benefits that are not available to adults.
FFS (Fee for Service): A mode of payment for health care services in which a physician charges a fee for each specific service or group of services. The patient and their insurer pay, usually in a ratio of 20% from the patient and 80% from the insurer. Plans covering FFS arrangements are typically the most expensive.
Formulary: A list of approved prescription drugs determined by a managed care plan for use by its patients and physicians (1).
HMO (Health Maintenance Organization): An entity that agrees to provide or arrange for the provision of a specified set of comprehensive health services to a defined population of patients for a prepaid, fixed sum (1).
ICD-9-CM (International Classification of Diseases, 9th Revision, Clinical Modification). A system of disease classification based on work by the World Health Organization and issued in the United States by the U.S. Department of Health and Human Services. The CM version refers to the standard method physicians use to report their diagnoses on an individual patient to insurers on their claims for payment.
IPA (Independent Practice Association): An association of physicians organized to provide various services for their members, including securing contracts with insurers, particularly for managed care contracts. IPAs may also do MSO functions (see MSO).
Managed Care: A means of providing health care services within a defined network of health care providers that is given the responsibility of managing utilization of health care services and providing quality, cost-effective health care (1).
Medicaid: A jointly funded, Federal-State health insurance program for certain low-income and needy people. It covers approximately 36 million individuals including children, the aged, blind, and/or disabled, and people who are eligible to receive federally assisted income maintenance payments (see QUEST).
Medicare: Health insurance program administered by the Centers for Medicare and Medicaid Services (CMS) for persons 65 years of age or older, some persons with disabilities, and patients with End-Stage Renal Disease. Medicare has two parts: Medicare Part A (hospital insurance) helps pay for care in hospitals, skilled nursing facilities, hospice care and some home health care. Medicare Part B is optional for beneficiaries and a premium must be paid. Part B helps pay for doctor's services, outpatient hospital care and some other medical services that Part A does not cover.
Medical necessity: To a physician, this has classically meant whatever a physician deems necessary in the care and treatment of an individual patient. Patients, of course, define the term as referring to services they feel they need. Third party payers changed this to refer to care that their payment teams deemed necessary for the management of a given patient. The term has become increasingly complex and specific criteria must be met for a service to qualify as "medically necessary". Hawaii has a definition of Medical Necessity defined in State Law.
MSO (Management Services Organization): An entity that provides management services to physicians, physician groups, hospitals or insurers. Services may include quality and utilization management and claims payment. An MSO can be owned by any of the entities for which it provides services, various combinations of the owning entities, or be completely independent (1).
PPO (Preferred Provider Organization): Groups of physicians usually assembled by an insurer or other large entity to provide services for its membership. Physicians in such a group are usually contractually required to participate with the plan, which generally includes items such as accepting payments that are reduced from the full payment usually given by that insurer. In return, the insurer guides its subscribers to utilize the preferred providers. Other contractual requirements may include mandatory participation in aspects of the plan to monitor quality or to save money, such as following a formulary.
QUEST: Medicaid Managed Care Program administered by the Hawaii State Department of Human Services.
Upcoding: The practice of designating a higher level or intensity of medical service provided for purposes of obtaining greater reimbursement from an insurer or other payer (1). Upcoding is appropriate if a higher level of service was actually rendered; inappropriate if it was not. | <urn:uuid:73ebca45-08df-4c7a-aaf5-0e220e0a7708> | {
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Diagnosis Code 017.51
Information for Medical Professionals
The ICD-10 and ICD-9 GEMs are used to facilitate linking between the diagnosis codes in ICD-9-CM and the new ICD-10-CM code set. The GEMs are the raw material from which providers, health information vendors and payers can derive specific applied mappings to meet their needs.
- A18.81 - Tuberculosis of thyroid gland (approximate) Approximate Flag
The approximate flag is on, indicating that the relationship between the code in the source system and the code in the target system is an approximate equivalent.
Information for Patients
Also called: TB
Tuberculosis (TB) is a disease caused by bacteria called Mycobacterium tuberculosis. The bacteria usually attack the lungs, but they can also damage other parts of the body.
TB spreads through the air when a person with TB of the lungs or throat coughs, sneezes, or talks. If you have been exposed, you should go to your doctor for tests. You are more likely to get TB if you have a weak immune system.
Symptoms of TB in the lungs may include
- A bad cough that lasts 3 weeks or longer
- Weight loss
- Loss of appetite
- Coughing up blood or mucus
- Weakness or fatigue
- Night sweats
Skin tests, blood tests, x-rays, and other tests can tell if you have TB. If not treated properly, TB can be deadly. You can usually cure active TB by taking several medicines for a long period of time.
NIH: National Institute of Allergy and Infectious Diseases
- Acid-fast stain
- Coughing up blood
- Disseminated tuberculosis
- Meningitis - tuberculous
- Multidrug-Resistant Tuberculosis (MDR TB) (Centers for Disease Control and Prevention)
- Mycobacterial culture
- PPD skin test
- Pulmonary tuberculosis
- Routine sputum culture
- Taking medicines to treat tuberculosis
- Tuberculosis Facts - Exposure to TB (Centers for Disease Control and Prevention)
- Tuberculosis Facts - TB Can Be Treated (Centers for Disease Control and Prevention)
- Tuberculosis Facts - Testing for TB (Centers for Disease Control and Prevention)
- Tuberculosis Facts - You Can Prevent TB (Centers for Disease Control and Prevention)
- Tuberculosis: General Information (Centers for Disease Control and Prevention) | <urn:uuid:8e35e992-0861-4133-b108-0056e14910e1> | {
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Medical Terminology and Anatomy for ICD-10 Coding integrates expanded anatomy, physiology, and pharmacology coverage with the latest medical terminology you need to correctly code in ICD-10. The ICD-10-CM classification system serves as the structure for organizing diseases and disorders, with carefully drawn, well-labeled illustrations to help you visualize the associated anatomy. ICD-10 coding guidelines and notes, along with electronic medical records and integrated exercises are interspersed throughout the text. A robust Evolve site includes games, activities, and animations to reinforce learning. Medical terminology specifically tailored to ICD-10-CM and ICD-10-PCS guidelines supply you with an excellent foundation for learning the medical terminology related to ICD-10-CM. Learn all the anatomy and physiology necessary to be able to understand medical reports and code accurately in ICD-10-CM/PCS. Pathology terms organized by ICD-10 disease and disorder categories let you learn terms in the same order they are presented in the coding manual. Guideline Alert! boxes highlight ICD-10-PCS coding information when relevant to medical terminology. Special Notes boxes present ICD-10 features that affect your understanding of the terminology presented. Root operation tables illustrate the root operations in PCS and their associated suffixes. Body Part key provides a complete list of body parts and how they should be coded in ICD-10. Pathology and procedure terminology tables list the word parts for each term, along with the definition so you become familiar with prefixes, suffixes, and combining forms. Exercises interspersed throughout the text encourage you to practice and learn as you move through the material. Be Careful! boxes warn you about similar and potentially confusing word parts and medical terms. Games and activities on accompanying Evolve website offer an easily accessible source for extra interactive practice and learning. Electronic medical record format illustrates the appearance of electronic records now being used in many healthcare settings. NEW! Pharmacology in each body system and a Pharmacology Basics appendix help you recognize drugs and medications in medical reports. NEW! More than 50 new images bring terminology to life. NEW! Additional procedural terms supply a more complete picture of the number and kind of procedures you will encounter on medical reports. NEW! Normal Lab Values appendix familiarizes you with normal and abnormal lab values so you know when to search a medical record for possible additional diagnoses. NEW! Tablet and mobile-optimized Evolve activities offer an easily accessible source for extra interactive practice and learning. | <urn:uuid:fd6db926-c415-4157-92ac-e9cbe2227f5c> | {
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No association was found between rotavirus vaccine and type 1 diabetes among U.S. children who were commercially insured, researchers found.
Compared with unvaccinated children, there was no association between rotavirus vaccination and type 1 diabetes among fully vaccinated children (adjusted HR 1.09, 95% CI 0.87-1.36), reported Rachel M. Burke, PhD, MPH, of the CDC, and colleagues in Atlanta, in a research letter in JAMA Pediatrics.
Rotavirus can cause fever, lead to hospitalization, and is the leading cause of severe diarrhea in young children, according to the World Health Organization. Vaccination against rotavirus is recommended for infants by the CDC's Advisory Committee on Immunization Practices as part of the routine childhood vaccination schedule.
Prior research suggested a possible connection between rotavirus vaccine and type 1 diabetes, though the authors noted that a 2019 study from Australia found declines in type 1 diabetes incidence following the introduction of an oral rotavirus vaccine. However, studies in Finland found no link between the two.
Researchers examined data from the IBM MarketScan Commercial Database from January 2006 to December 2017. They noted that for survival curves, follow-up began at age 27 weeks, and for measures of association, follow-up began at 12 months. Type 1 diabetes was defined as two or more separate claims listing ICD-9-CM or ICD-10-CM codes for type 1 diabetes.
Overall, 843 of 2,854,571 eligible children were diagnosed with type 1 diabetes, for a 0.25% 10-year cumulative incidence. Of the approximately 1.6 million children followed up through age 12 months, 66% were fully vaccinated against rotavirus (defined as two doses of Rotarix or two doses of RotaTeq), while 13.4% were partially vaccinated and 20.4% were unvaccinated.
There also was no association between type 1 diabetes and rotavirus vaccination among partially vaccinated children (adjusted HR 1.03, 95% CI 0.78-1.36). These non-significant associations persisted in sensitivity analyses, the authors wrote.
Limitations to the data included that the database is not nationally representative and that neither vaccination nor type 1 diabetes was confirmed by medical record review.
Nevertheless, the authors said their results are "consistent with a favorable safety profile" for rotavirus vaccines.
"They support continued universal rotavirus vaccination in the United States," they wrote.
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Medical coders of the present and future need to become very familiar with the ICD-10-CM, which stands for International Classification of Diseases, Tenth Edition Clinical Modification. The CM distinction was added to note the improvement in this latest version of the system used to classify tens of thousands of conditions. The ICD-10-CM is a system of codes that comprises its own unique language. Medical coders and billers use these codes for billing and insurance purposes. It could be likened to the specific language used in health care.
Doctors, nurses and other health care professionals use these codes as a way of enhancing the way they store and retrieve diagnostic information. Health information managers also use these codes on a daily basis. The reason why the coding system has been changed to the ICD-10-CM is due to the advances in medicine, which adds constant innovation and discoveries. To compensate, a more detailed written language needs to exist.<!- mfunc feat_school ->
ICD-10-CM and ICD-9-CM Differences
The ICD-10-CM has a much higher level of specificity than its predecessor. For example, there were several instances when the ICD-9-CM only specified that a certain internal part of the body is diseased. The new system is more exact. Now, the ICD-10-CM can diagnose more specifically. The new system can diagnose parts of the ovary that are diseased, whereas the previous system simply diagnosed the entire ovary with disease.
This process has also caused the need for more detail to be included in medical documents. The precision allows for more sophisticated diagnoses, which means medical coders will also need to know more detail. Coders will also need to be aware of all the coding changes that occur at what seems to be a very rapid pace.
Each year, there are updates to the ICD-10-CM. In January of 2018, there were 363 new codes implemented, 142 codes deleted, and 226 code revisions, according to the AAPC (American Academy of Professional Coders). Staying current on these codes remains a top priority for all medical coders. However, that does not require reading through every single code as there are helpful hints to know which areas to examine.
Technology and ICD 10 Evolving
Technology is constantly changing both treatment and conditions. Pregnancy serves as an example with more widespread use of reproductive technology. So many couples are using these methods as a way of enhancing their chances of becoming pregnant, which leads to new complications that need describing. Such complications may now fall under the ICD-10-CM code of O00 which refers to an ectopic pregnancy. Pregnancy complications are now much different and unique, which has prompted such updates and changes.
The deletion of antiquated codes is a result of new identifications. This is reflective of more accurate forms of treatment and diagnosis. Furthermore, new codes have supplanted older codes which were labeled as missing. The ICD-10-CM contains some codes that never even existed and were represented by the ‘missing’ denomination.
Codes are recommended for changes every year with this system, although not every change is approved. In the fall of 2017, only about half of the proposed changes were approved in the ICD-10-CM. With so many changes and so many different codes, the entire process can be very overwhelming for novice coders. Nevertheless, there are ways to master this craft.
Importance of understanding Codes and Medical Terminology
It is important to know the most expeditious way to search for codes, which helps save time. For example, looking up a spontaneous rupture of flexor tendons would first require looking under
‘Diseases of the musculoskeletal system and connective tissue,’ which are coded M00 through M99. Then, there is a need to pinpoint the exact disorder. That would be ‘disorders of synovium and tendon’ and that falls under the code classifications that range from M65 to M67. A spontaneous rupture of synovium and tendon is labeled M66 and then add in the hand and you have a code of M66.34.
Ascertaining that information requires more than just memorizing codes, but also comes with an understanding of anatomy and medical terminology. The ICD-10-CM is becoming more and more complex and that makes the job of a medical coder more demanding. To help facilitate this process, there is a ICD-10-CM code manual and that is split up into three volumes: tabular index, alphabetic index, procedure codes that are reserved only for hospital use.
How ICD-10-CM is Also Affective
The ICD-10-CM was not created just to update new codes and toss out old ones. It makes for less work by decreasing the number of attachments that are needed to clarify the condition of a patient. The processing of claims has also been improved as payment systems now have a better design. Moreover, the administrative role of the entire health care system has been enhanced, while fraud and abuse have been on the decline. And now that the codes are more precise, it has become easier to monitor public health and its overall risks. | <urn:uuid:f57cb2a5-e379-426e-ae3a-9d9986e29786> | {
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Most ICD-9 codes are three digits to the left of a decimal point and one or two digits to the right of one. For example: 250.0 is diabetes with no complications. 530.81 is gastroesophageal reflux disease (GERD).
Follow this link for full answer
Nevertheless, what is meant by ICD codes?
ICD stands for the International Classification of Disease. The ICD provides a method of classifying diseases, injuries, and causes of death.
Still further, what is the difference between ICD-10 and ICD-9 codes? A: The major differences between the two coding systems include the number of characters involved. ICD-9 has up to five characters while ICD-10 has up to seven. ICD-10 adds laterality to the coding system, which ICD-9 lacks. ICD-10 offers much more specificity, including episode of care, body area, etc.
Furthermore there, what are ICD-9 and 10 codes used for?
An ICD-9-CM code (which will become an ICD-10-CM code this year on October 1) is used to describe a symptom, condition, or disease that is being treated, also known as the diagnosis code.
How do I find my diagnosis code?
A Five-Step ProcessStep 1: Search the Alphabetical Index for a diagnostic term. ... Step 2: Check the Tabular List. ... Step 3: Read the code's instructions. ... Step 4: If it is an injury or trauma, add a seventh character. ... Step 5: If glaucoma, you may need to add a seventh character.
25 Related Questions Answered
ICD-10-CM is a seven-character, alphanumeric code. Each code begins with a letter, and that letter is followed by two numbers. The first three characters of ICD-10-CM are the “category.” The category describes the general type of the injury or disease. The category is followed by a decimal point and the subcategory.
The ICD-10-CM (International Classification of Diseases, Tenth Revision, Clinical Modification) is a system used by physicians and other healthcare providers to classify and code all diagnoses, symptoms and procedures recorded in conjunction with hospital care in the United States.
There are over 70,000 ICD-10-PCS procedure codes and over 69,000 ICD-10-CM diagnosis codes, compared to about 3,800 procedure codes and roughly 14,000 diagnosis codes found in the previous ICD-9-CM.
ICD-10 codes begin with a letter, while the first digit of an ICD-9 code can be either alpha or numeric.
Currently, the U.S. is the only industrialized nation still utilizing ICD-9-CM codes for morbidity data, though we have already transitioned to ICD-10 for mortality.
For services provided after September 30th, Medicare will no longer accept ICD-9-CM codes.
The ICD is important because it provides a common language for reporting and monitoring diseases. This allows the world to compare and share data in a consistent and standard way – between hospitals, regions and countries and over periods of time.
Table 5ICD-9-CM diagnosis codes defining diabetes
|Diabetes mellitus without mention of complications||250.0x|
|Diabetes with ketoacidosis||250.1x|
|Diabetes with hyperosmolarity||250.2x|
|Diabetes with other coma||250.3x|
ICD-10-CM diagnosis codes will tell the story of each patient encounter, describe etiologies of the disease process, explain the complications of care, provide a basis for medical necessity, support coverage for payment purposes, identify incidence of disease, and support statistical tracking for healthcare practices, ...
The correct procedure for assigning accurate diagnosis codes has six steps: (1) Review complete medical documentation; (2) abstract the medical conditions from the visit documentation; (3) identify the main term for each condition; (4) locate the main term in the Alphabetic Index; (5) verify the code in the Tabular ...
F41. 9 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes.
What are the 5 main steps for diagnostic coding?
- Step 1: Search the Alphabetical Index for a diagnostic term.
- Step 2: Check the Tabular List.
- Step 3: Read the code's instructions.
- Step 4: If it is an injury or trauma, add a seventh character.
- Step 5: If glaucoma, you may need to add a seventh character.
ICD-10 codes were developed by the World Health Organization (WHO) . ICD-10-CM codes were developed and are maintained by CDC's National Center for Health Statistics under authorization by the WHO.
ICD-10 codes identify medical diagnoses and help insurance companies understand why the care you were provided was necessary. They work in tandem with CPT Codes and are required on every claim submission. At Better, we validate the accuracy of the ICD-10 codes on every claim we file.
Diagnosis codes are always required on prescriptions for Medicare Part B claims. In addition some Prior Authorizations will require the submission of a diagnosis code. Even though it is not a covered HIPAA transaction, a Workers Compensation claim might also require a diagnosis code based on the injury of the patient.
PRIMARY DIAGNOSIS (ICD) is the International Classification of Diseases (ICD) code used to identify the PRIMARY DIAGNOSIS. PRIMARY DIAGNOSIS (ICD) is used by the Secondary Uses Service to derive the Healthcare Resource Group 4 .
The Czech Republic, Denmark, Romania, Slovakia, and Thailand implemented ICD-10 for mortality coding in 1994, and since that time 33 additional countries have joined them. The United States began using ICD-10 to code and classify mortality data from death certificates in January 1999.
Inpatient acute care providers report ICD-10-CM diagnosis and ICD-10-PCS procedure codes on claims to assign the appropriate Medicare Severity-Diagnosis Related Group (MS-DRG) codes used to calculate payment. Providers use code set to report procedures performed only in U.S. inpatient hospital health care settings.
The ICD-10 is the new, mandatory standard for reporting diagnosis codes and procedure codes on all health care claims – including those submitted to Medicare. ... ICD-10 must be used for all health care services.
The CPT code describes what was done to the patient during the consultation, including diagnostic, laboratory, radiology, and surgical procedures while the ICD code identifies a diagnosis and describes a disease or medical condition. ... CPT codes are more complex than ICD codes.
The ICD-9-CM consists of: a tabular list containing a numerical list of the disease code numbers in tabular form; an alphabetical index to the disease entries; and. a classification system for surgical, diagnostic, and therapeutic procedures (alphabetic index and tabular list).
Codes are used today to:
- Facilitate payment of health services.
- Evaluate patients' use of health care facilities (utilization patterns)
- study health care costs.
- Research the quality of health care.
- Predict health care trends.
- Plan for future health care needs.
On January 16, 2009, the U.S. Department of Health and Human Services (HHS) released the final rule mandating that everyone covered by the Health Insurance Portability and Accountability Act (HIPAA) implement ICD-10 for medical coding.
Current Procedural Terminology (CPT) is a medical code set that is used to report medical, surgical, and diagnostic procedures and services to entities such as physicians, health insurance companies and accreditation organizations. ... CPT is a registered trademark of the American Medical Association.
The most widely used classifications of disease are (1) topographic, by bodily region or system, (2) anatomic, by organ or tissue, (3) physiological, by function or effect, (4) pathological, by the nature of the disease process, (5) etiologic (causal), (6) juristic, by speed of advent of death, (7) epidemiological, and ... | <urn:uuid:9d85da50-45ab-40f7-8e57-95e2e2e306bb> | {
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What is ICD-10?Posted on: 09.11.14 by Digirad
ICD stands for International Classification of Diseases and is a set of codes used by medical providers to standardize the way a diagnosis is recorded. The current version is ICD-9 with the “9” indicating that it is the 9th edition.
ICD-10 is the 10th edition, and the change was necessary for a number of reasons. ICD-9 limited the amount and types of data that could be collected, is over 30 years old, and the number of codes that can be created is at its limit.
There are two types of ICD-10 codes: ICD-10-CM for diagnosis coding and ICD-10-PCS for inpatient procedure coding. The new version will accommodate close to 69,000 codes and allows for the notation of new diagnoses.
What’s Next for ICD-10
This past April, the compliance date for ICD-10 was pushed from October 1, 2014 to October 1, 2015. Billing and reimbursements are a critical concern for providers, and the nature of the delay has caused uncertainty and confusion for many practices.
After years of delays, it now appears that the October 2015 date is indeed the true launch date. While larger health systems have had the capital to invest in the conversion, many smaller practices are still struggling with when and how to approach the change. ICD-10 is a more complex system and will require more training and expertise to ensure reimbursements are coded properly.
For the time being, practices are being forced to run both systems and gradually gain experience with ICD-10 ahead of the permanent change.
What caused the delay?
On April 1st, the Protecting Access to Medicare Act of 2014 (PAMA) (Pub. L. No. 113-93) was enacted, mandating the Secretary of Health and Human Services not adopt ICD-10 prior to October 1st 2015.
The previous implementation date of ICD-10 was October 1, 2014 but after pressure from groups like the AMA, congress decided to delay the start date until October 1, 2015. The concept behind the delay was to give practices more time to prepare, and pay for, the costs associated with the change. While the extra time is helpful, the uncertainty surrounding the deadline is not, and many practices are struggling to know when to make the change.
What does the delay mean for your practice?
The latest change requires HIPAA covered entities to continue to use ICD-9-CM through September 30th, 2015. Many third-party payers have already posted ICD-10 codes in coverage policies to take effect October 1st of this year and are in the process of changing policies to have both ICD-9 and ICD-10 until September 30th, 2015.
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Modern medicine in the United States includes a complex relationship between healthcare providers and insurance payers. Technology plays a critical role in electronic data interchange (EDI) between payers and providers, but the wide variety of software systems used can make seamless connection difficult.
The Health Insurance Portability and Accounting Act (HIPAA) addresses the importance of patient privacy regarding the protection of health information as well as the need for secure electronic data interchanges (EDI). Due to these factors, it is necessary for healthcare providers to consider their billing practices carefully.
Part of that billing process involves the option to submit claims to a healthcare clearinghouse rather than directly to insurance companies. Let’s break down the clearinghouse meaning in medical and hospital billing.
What is a Healthcare Clearinghouse?
A medical claims clearinghouse is a third-party system that interprets claim data between provider systems and insurance payers. According to the Department of Health & Human Services, a health care clearinghouse is a “public or private entity, including a billing service, repricing company, or community health information system, which processes non-standard data or transactions received from one entity into standard transactions or data elements, or vice versa.”
Typically, a healthcare claims clearinghouse will “scrub” or check a claim for errors before submitting. Once a response is received, the electronic claims submission clearinghouse transmits either a denial or acceptance back to the healthcare provider.
National health insurance clearinghouses allow providers to confidently outsource a vital function of the billing process whose difficulty is one of the current issues in healthcare administration.
Issues in Processing Healthcare Claims
Billing for hospital and provider services and supplies can be a challenging process in this complex environment. The International Classification of Diseases Tenth Revision Clinical Modification (ICD-10-CM) coding system includes over 68,000 diagnosis codes to identify procedures and treatments to be used in health care claims. Frequently, the use of medical coding services is required for the accurate coding of healthcare claims.
In 2016, there were 5,977 insurance companies in the U.S. with “$507.7 billion, or 2.7 percent, of gross domestic product,“ (III.org, 2018). Those thousands of insurance companies were exceeded by the number of healthcare providers such as hospitals, doctors, nurses, dentists, chiropractors, pharmacists, and durable medical suppliers across the country. Matters get more complicated when considering that many providers and insurance payers use incompatible software or systems of communicating protected health information (PHI). Also, different states have non-matching regulations regarding insurance and claims submission.
Problems in claim submissions can result from human error, mismatched diagnosis codes, improper calculations, coverage denials, or invalid EDI address and payer information to name a few. Issues can also arise over the mismatch between software used and establishing a secure connection between healthcare entities. Claims correction and denial management in medical billing adds to the workflow and can delay or negate payments.
Recent changes in U.S. healthcare laws and subsequent effect on insurance companies has resulted in tightening cash flows for many providers. Rising healthcare costs have greatly impacted provider profitability.
On the other hand, insurance company philosophy might consider the importance of encouraging patient responsibility for healthcare management by passing on a greater share of the medical cost as a co-pay or deductible. This has the possible negative effect of pushing patients away from costly but necessary procedures or medicine. The patient might instead follow through on treatment and slide into debt or possibly fail to pay the provider by way of personal bankruptcy. This could leave the provider eating the cost of care which impacts revenue.
Why Use a Medical Billing Clearinghouse?
Efficient claim submission involves many steps starting with the hospital that prepares a claim for services. In order to maximize revenue, it is necessary to optimize the claims process and the revenue cycle continuum. This involves analyzing the claims and billing process for possible improvements.
Contact Nearterm for more information on our healthcare revenue cycle management services today.
Error checking or claim “scrubbing” is one of the primary functions of an electronic claims clearinghouse. This allows a provider to quickly check if a claim will pass the basic requirements to be accepted by an insurance company. Insurance-specific error scrubbing decreases the time needed to successfully process a claim from days or weeks to seconds or minutes.
Providers, especially smaller ones, don’t have the knowledgeable staff or resources to match this third-party scrubbing efficiency for each insurance type. Larger electronic medical billing clearinghouses have established relationships with multiple insurance payers by ensuring software compatibility and learning their systems over long periods of time. This can help the medical clearinghouse companies explain rejections to providers and offer guidance to meet the insurance company claim expectations.
Medical clearinghouses can process single or multiple transactions and allow quick claim updates on client dashboards. There is also the added benefit of only needing one portal to manage claim information rather than a separate account for each insurance company for direct billing. Faster and more reliable healthcare coverage determination and claim submission allows providers shorter payment cycles, and as a byproduct, more accurate financial forecasts. Using an electronic healthcare clearinghouse also reduces the number of paper claims needed with subsequent positive effect on the environment.
Final thoughts on Clearinghouses and Health Insurance
While the healthcare industry is complex and has many issues, a health system or hospital can improve the efficiency and speed of electronic medical billing by using a healthcare clearinghouse. These HIPAA-covered entities can process multiple claims to a variety of insurance companies to overcome software incompatibility.
The main benefits offered by insurance billing clearinghouses are fast payment, error scrubbing and assistance, reductions in administrative costs, and finally a single source of handling claim submissions and status. The faster Medicare, Medicaid or a commercial payer are billed correctly, the faster they pay. The faster a patient is provided an accurate bill for an amount not covered by insurance, the quicker the money can be collected and utilized to improve another patient’s health.
Contact Nearterm Today for More Information
ClearingHouses.org (n.d.) How to Select a Good Clearinghouse – 7 Things You Must Know. Retrieved from: https://clearinghouses.org/
CMS.gov (2015) Healthcare Common Procedure Coding System (HCPCS) Level II Coding Procedures. Center for Medicare & Medicaid Services. Retrieved from: https://www.cms.gov/Medicare/Coding/MedHCPCSGenInfo/Downloads/HCPCSLevelIICodingProcedures7-2011.pdf
HHS.gov (2017) Disclosures for Emergency Preparedness – A Decision Tool: Is the Source a Covered Entity? U.S. Department of Health & Human Services. Retrieved from: https://www.hhs.gov/hipaa/for-professionals/special-topics/emergency-preparedness/is-source-covered-entity/index.html
III.org (2018) Facts + Statistics: Industry overview. Insurance Information Institute. Retrieved from: https://www.iii.org/fact-statistic/facts-statistics-industry-overview | <urn:uuid:49548500-2bcd-40bc-932c-1d75a6594b63> | {
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The US healthcare industry is a complicated system of interconnected activities and organizations. The legal and technological environment entailing the healthcare industry is continuously evolving. When medical billing used to be done on, often doctors or their assistants did the complete paperwork themselves. However, with changes in US healthcare laws, electronic health records (EHR) became almost a necessity for healthcare providers, which in turn led to the emergence of specialized medical billing services in the US.
Importance of Medical Billing
There are some organizations which are still using the paper-based systems, but they are at a substantial competitive disadvantage. Furthermore, due to anUS society and the becoming more and more complicated, clinics and are becoming jam-packed with patients. Not only do doctors and their support staff do not have time to delve into the complicated medical billing process, but it is also not a job of multitasking office assistants anymore. Neither can organizations afford to hire specialized staff and technology needed to do the medical billing in-house.
Thus, many clinicians and most large hospitals are outsourcing medical billing and coding functions to specialized third parties. These medical billing companies have made considerable investments in custom-made certified EHR technology and retain full-time specialized staff that processes tons of claims on a daily basis. It enables them to reduce the inefficiencies that creep up into the in-house medical billing.
Top Things To Know About Medical Billing
Let’s learn about the five most important things you need to know about medical billing services:
Medical Coding and Medical Billing Are Not the Same Thing
While the terms “medical billing” and “medical coding” are often merged, they are not the same thing. Further, coding is done first, and billing comes later in the process.
Medical coding is a process which deals with assigning standard codes to the various diagnosis and procedures performed by health service providers. It is done per ICD-10-CM or ICD-10-PCS coding systems developed by the WHO and modified by the Centers for Medicare & Medicaid Services (CMS) and National Center for Health Statistics (NCHS).
Medical billing, on the other Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) code requirements., is a process in which medical claims are forwarded to the payers to receive payment for the services provided. Medical billers apply the pertinent prices for each treatment and procedure according to
Registration & Confirmation of Financial Responsibility
The processing of medical claims may span over just a few days to several months. On occasions, there are numerous forward and backward movements in the process, and this can occur due to errors in the initial registration and confirmation. Therefore, patient verification and authorization is a crucial step that may be performed on every visit. The primary objective of patient verification is to confirm financial responsibility for the medical services performed. Insurance coverage and plans differ significantly from carrier to carrier depending on the state and the premiums paid. Many healthcare providers hire medical billing and coding service providers to utilize their state-of-the-art technology and to avoid costly errors.
HIPAA Code Set Requirements
While the HIPAA law eradicated all custom-made and local code set requirements and standardized most of the medical data, this does not eliminate all of the complexity of the system. The US-modified version of ICD-10 contains over 70,000 unique codes for disease, symptoms, abnormal findings, and various internal and external causes of injuries or illness. The complexity can be made clear from the following list of code set requirements mandated by HIPAA Law:
• Health Care Common Procedure Coding System (HCPCS)
• Current Procedural Terminology (CPT)
• National Drug Codes (NDC)
• The Code on Procedures and Nomenclature (CDT)
• International Statistical Classification of Diseases and Related Health Problems, 10th Edition, Clinical Modification and Procedure Coding System (ICD-10-CM, ICD-10-PCS)
With so many code-set requirements, claims forwarded to the insurance providers are occasionally returned due to missing codes or incorrect data. It can be overcome by hiring professional medical billers who specialize in filing clean claims.
MIPS Score & Physician Compare Initiative
Medical billing services are not only about filing claims for the services delivered. Under the Quality Payment Program (QPP), the Merit-based Incentive Payment System (MIPS) score also depends on the medical billing records. A MIPS score can increase or decrease claim reimbursements by 5% in 2018, which will grow to 9% by 2022. It doesn’t stop here, however.
CMS has announced that it will publish MIPS scores and physician ratings based on those scores on its -compare website. This means that people now have better access to information related to the quality of health care service provided by a particular physician or a physician group. This will lead to better healthcare service and drive down prices as patients value reputable physicians more than those with lower ratings.
Agile providers of medical billing services use advanced analytical tools to help their clients to balance between getting a good MIPS score and making the investment on system needed for reporting.
Days in AR & Medical Billing
“Days in AR” is a financial ratio found by dividing the total account receivables for a certain period by the average daily sales for a certain year. It’s also termed as a DSO ratio. It is believed by financial experts that a DSO ratio of more than 60 is dangerous for the financial health of an organization. Good medical billing companies strive to achieve DSO ratio of less than 30. | <urn:uuid:3926bf8b-6312-4547-a3dd-ec7ddde093f6> | {
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Paranoid schizophrenia is the most common type of schizophrenia. Schizophrenia is defined as “a chronic mental disorder in which a person loses touch with reality (psychosis).” Schizophrenia is divided into subtypes based on the “predominant symptomatology at the time of evaluation.” The clinical picture is dominated by relatively stable and often persecutory delusions that are usually
Overview Schizophrenia is often described in terms of “positive” and “negative” symptoms. Positive symptoms include delusions, auditory hallucinations and thought disorder and are typically regarded as manifestations of psychosis. Negative symptoms are so named because they are considered to be the loss or absence of normal traits or abilities, and include features such as flat, blunted or
Schizophrenia File:Artistic view of how the world feels like with schizophrenia – journal.pmed.0020146.g001.jpg Self-portrait of a person with schizophrenia, representing that individual’s perception of the distorted experience of reality in the disorder Pronunciation / ˌ s k ɪ t s ə ˈ f r iː n i ə, ˌ s k ɪ d z-, -oʊ-, -ˈ f r ɛ n i ə /
Patients with schizophrenia have significantly higher rates of stroke, CAD, DM, cancer, HIV, HCV All cause mortality rate is 200-250% higher for patients with schizophrenia
Poor recognition of catatonic schizophrenia in clinical practice may also account for its relative rarity. In one study using standardized assessment, 43% of schizophrenic patients met DSM-IV criteria for catatonia but only 5% received the clinical diagnosis of).
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Bitte hilf Wikipedia, indem du die Angaben recherchierst und gute Belege einfügst. Katatonie ( altgriechisch κατά ,von oben nach unten‘ und τόνος ,(An-)Spannung‘, zusammen also ,Anspannung von Kopf bis Fuß‘) ist ein verhaltensbezogenes und psychomotorisches Syndrom .
23/7/2018 · [quote]The predominant clinical features seen in the catatonic subtype of schizophrenia involve disturbances in a person’s movement. Affected people may exhibit a dramatic reduction in activity, to the point that voluntary movement stops, as in catatonic stupor.
その他の統合失調症 (ICD-10 F20.8 Other schizophrenia) その他の統合失調症は医療診断を示すために使用することができない。 その他の統合失調症には、F20.81（Schizophreniform disorder）とF20.89（Other schizophrenia）の2種のコードが含まれる。
So I didn’t really know what it meant to be a catatonic schizophrenic and while watching this I was waiting for some story to be told that shows or explains what it means, but that didn’t really come so I looked it up.Basically being catatonic means you have a slew of
Catatonic depression is when catatonia occurs concurrently with depression.Catatonia is a state in which a person experiences marked disturbances in motor activity. Although generally thought of as reduced engagement and activity, it may also manifest as
Although often associated with schizophrenia and other affective disorders, catatonia may be a result of, or due to, any number of psychotic disorders, mood disorders or general medical conditions
Description: Catatonia definition, a syndrome seen most frequently in schizophrenia, characterized by muscular rigidity and mental stupor, sometimes alternating with
Schizophrenia (/ ˌ s k ɪ t s ɵ ˈ f r ɛ n i ə / or / ˌ s k ɪ t s ɵ ˈ f r iː n i ə /) is a mental disorder characterized by a breakdown of thought processes and by poor emotional responsiveness. It most commonly manifests itself as auditory hallucinations, paranoid or bizarre delusions, or disorganized speech and thinking, and it is accompanied by significant social or
Doctors who specialize in mental health used to divide schizophrenia into different subtypes: Catatonic Disorganized Paranoid Residual Undifferentiated. But that system didn’t work well. Now
Catatonia is a psychiatric symptom that is listed in the Diagnostic and Statistical Manual of Mental Disorders.It is indicative of other conditions such as schizophrenia (catatonic type), bipolar disorder, post-traumatic stress disorder, depression and other mental disorders, as
Schizophrenia is a chronic, severe mental disorder that affects the way a person thinks, acts, expresses emotions, perceives reality, and relates to others. Though schizophrenia isn’t as common
Schizofrenie je duševní porucha charakteristická selháváním myšlenkových procesů a sníženou schopností vnímat emoce a reagovat na ně. Nejběžněji se projevuje sluchovými halucinacemi, paranoidními či bizarními bludy nebo zmatenou řečí a myšlením, a jde ruku v ruce s rozsáhlou sociální či pracovní dysfunkcí
15/2/2020 · Nevertheless, a certain amount of schizophrenia pertains to the study of World Englishes as New Englishes, for while new Englishes are regarded as valid varieties in their own right, the description and delineation of them in linguistic terms is conducted through the gaze of native-speaker norms.
1/3/2018 · You’ve heard a lot about Schizophrenia in TV and movies, but what is it really? How does it affect a person’s mind? Watch more: What Are The Chances You ACTUALLY Have ADHD? https://www.youtube.com
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During the ten days of the first catatonic episode at the state psychiatric hospital, CK values ranged from 1957 U/L on the third day of that episode (day 196) to 159 U/L on the tenth day of the episode (day 203).
As nouns the difference between schizophrenia and delirium is that schizophrenia is (pathology) a psychiatric diagnosis denoting a persistent, often chronic, mental illness variously affecting behavior, thinking, and emotion while delirium is delirium (delirium). Noun (en-noun)
Define catatonia. catatonia synonyms, catatonia pronunciation, catatonia translation, English dictionary definition of catatonia. n. A psychological condition marked by
ICD-10 Diagnosis Code F20.0 Paranoid schizophrenia – ICD List F20 should not be used for reimbursement purposes as there are multiple codes below it that contain a greater level of detail. The 2018 edition of ICD-10-CM F20 became effective on October 1, 2017.-CM F20 became effective on October 1, 2017.
15/3/2009 · Schizophrenia is a chronic, severe and debilitating brain disease that often causes bizarre behavior, disorganized speech, fleeting thoughts and hallucinations. Find out who is most often affected
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or
There are five subtypes of schizophrenia based on the predominant symptoms an individual faces: paranoid disorganized, catatonic, undifferentiated, and residual Schizophrenia is a chronic mental disorder that makes it difficult for a person to distinguish between real
Schizophrenia, Catatonic Type, may be difficult to distinguish from a Mood Disorder With Catatonic Features. Schizophreniform Disorder and Brief Psychotic Disorder By definition, Schizophrenia differs from Schizophreniform Disorder on the basis of duration.
Funkcija Protein kodiran ovim genom je član flamingo potfamilije, koja je deo kadherinske superfamilije. Flamingo potfamilija se sastoji od neklasičnog tipa kadherina. Ta grupa ne formira interakcije sa kateninima.Flamingo kadherini su locirani u ćelijskoj membrani i
15/7/2017 · Educational interview of a schizophrenic patient. Canadian Medical Association Journal – Schizophrenia: Simple-type Deteriorated—1951; Sound; B & W; 11 minutes –
9/4/2020 · catalepsy的意思、解釋及翻譯：1. a medical condition in which a person’s body becomes stiff and stops moving, as if dead 2. a。了解更多。 來自文學作品的示例 Catalepsy is produced by a sudden sharp noise, or by the sight of a
A group of 174 schizophrenic patients from three separate institutions volunteered for the study which compared the prevalence of catatonic schizophrenia from 1994 to 1999 with the prevalence in 837 patients from 1938 to 1968 and 1,224 patients from 1969 to 1986.
16/9/2018 · Schizophrenia is a chronic and severe mental disorder that affects how a person thinks, feels, and behaves. People with schizophrenia may seem
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Schizophrenia: Etiology, Pathophysiology and Management 2642 has been attributed to the amplified amount of de novo mutations in their offspring, but different explanations have been suggested. More recently, indication has accumulated associating
24/3/2019 · What is Schizophrenia, what are it’s symptoms, how does one treat it? In today’s educational video we’re taking a look at this mental disorder called Schizophrenia. MAKE VIDEOS LIKE OURS We use
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Den här artikeln behöver källhänvisningar för att kunna verifieras. (2015-11) Åtgärda genom att lägga till pålitliga källor (gärna som fotnoter).Uppgifter utan källhänvisning kan ifrågasättas och tas bort utan att det behöver diskuteras på diskussionssidan.
Define catatonic type schizophrenia. catatonic type schizophrenia synonyms, catatonic type schizophrenia pronunciation, catatonic type schizophrenia translation, English dictionary definition of catatonic type schizophrenia.
Catatonic schizophrenia is characterized by disturbances of movement that may include rigidity, stupor, agitation, bizarre posturing, and repetitive imitations of the movements or speech of other people. These patients are at risk for malnutrition, exhaustion, or
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Synonyms for catatonia in Free Thesaurus. Antonyms for catatonia. 2 synonyms for catatonia: catatonic schizophrenia, catatonic type schizophrenia. What are synonyms for catatonia? Matthews, who rose to fame in the 1990s in Welsh rock band Catatonia before they split in 2001, said that she feels it was a “tiny portion of my life”, but that she is “glad it happened”.
Stream Catatonic Schizophrenia (CLICK FOR A HINT ABOUT THE “FAMILY”) by Itsy Bitsy Spider (ITSY BITSY BOSS) from desktop or your mobile device SoundCloud Catatonic Schizophrenia (CLICK FOR A HINT ABOUT THE “FAMILY
Catatonic schizophrenia is a rare subtype of schizophrenia characterized by catatonic symptoms. Catatonic symptoms can also be found in other mental disorders such as depressive disorders, psychotic bipolar disorders, etc. A person with catatonic schizophrenia
Define catatonic. catatonic synonyms, catatonic pronunciation, catatonic translation, English dictionary definition of catatonic. adj. 1. catatonic schizophrenia catatonic schizophrenia Catatonic state Catatonic state Catatonic state Catatonic state
Define schizophrenics. schizophrenics synonyms, schizophrenics pronunciation, schizophrenics translation, English dictionary definition of schizophrenics. ) n. 1. Psychiatry A heterogeneous psychiatric disorder characterized by psychotic behavior including
The symptoms better fit a diagnosis of a form of catatonic schizophrenia, which would not necessarily recur and could leave the patient without any noticeable effects on his character. Against catatonic schizophrenia is the length of the attack, although it is
Schizophrenia, Unspecified. F20.0. Paranoid Schizophrenia. F20.1. Disorganized Schizophrenia. F20.2. Catatonic Sch Health For You Home Backache Black Eye Chill Cooking Fever Diverticulitis About 07 Oct 2018 Psychosis – Wikipedia
Schizophrenia is a severe long-term mental health condition. It causes a range of different psychological symptoms. Doctors often describe schizophrenia as a type of psychosis.This means the person may not always be able to distinguish their own thoughts and
As nouns the difference between schizophrenia and neurosis is that schizophrenia is (pathology) a psychiatric diagnosis denoting a persistent, often chronic, mental illness variously affecting behavior, thinking, and emotion while neurosis is In context|pathology
Schizophrenia changes how a person thinks and behaves. The condition may develop slowly. The first signs can be hard to identify as they often develop during the teenage years. Symptoms such as becoming socially withdrawn and unresponsive or changes in | <urn:uuid:240fe4e6-645c-4679-9e57-2862fa5ce685> | {
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You are right. Here are the questions for exam 1:
1. In the Tabular List, where would you find alternative terms and explanatory phrases?
A. In parentheses
B. After a colon
C. In square brackets
D. In double braces
2. Codes that have mandatory fifth digits are codes that
A. require the use of the digit "5" as the fifth character.
B. use the numbers 1 or 2 as the fifth digit.
C. require four supporting codes.
D. always require a fifth digit to fully describe them.
3. A patient presents in the office with diarrhea. Physician documents gastroenteritis. What is the first listed diagnosis?
C. Both have equal precedence. Code either one first.
D. E&M code for office visit
Which of the following is not one of the most common forms of Medicare fraud?
Billing for services provided
Misrepresenting a diagnosis to justify a payment
Routine waiver of copayment
Billing for services not furnished
What convention in the Alphabetic Index tells you to look elsewhere before assigning a code?
An established patient is seen for amenorrhea and galactorrhea, to rule out pituitary tumor. Identify the
Amenorrhea and galactorrhea
What are the correct code(s) for acute and chronic laryngitis?
What category can not be assigned with any other delivery code in the 630–676 range?
What volume of the ICD-9-CM is used by hospitals to report inpatient procedures?
Volume 1, Supplement
An established patient is seen for redness, blurriness and sensitivity to light in her right eye. The
documentation states the diagnosis is iritis. Using the ICD-10 guidelines, which would be the
diagnosis for this patient encounter?
Iritis of the right eye
Sensitivity to light
The abbreviation NOS is used
to indicate that another code may describe the condition more completely or specifically.
to provide assurance that the code is correct by listing various terms that are covered by the code.
when the medical record doesn't provide enough information to permit assignment of a more specific code.
when a separate code for a specific condition isn't provided in the classification system.
The correct ICD-10 reporting block that would contain acute cholecystitis with cholelithiasis with
A patient is diagnosed with controlled Type 2 Diabetes on insulin without complication. Assign the
Identify the correct code for status asthmaticus.
What are the correct codes for dehydration due to pneumonia?
Identify the correct code for family history of breast cancer, female.
What is the main term for "fractured clavicle"?
E codes are used to report
external causes of injury and poisoning.
extra descriptors for coding.
extenuating circumstances surrounding an injury.
exercise method after injury.
When a correct substance is properly administered but has an adverse effect, this is called
Patient is admitted for radiation therapy for metastatic bone cancer, primary unknown. Patient develops
severe vomiting secondary to the course of radiation and is kept an extra day for stabilization. Assign the
V58.0, 787.03, 198.05, 199.1
V58.0, 787.03, 198.05, 199.1, E879.2
170.9, V58, 787.03, 198.05, 199.1, E879.2
787.03, 198.05, 199.1, E879.2
Which chapter in the ICD-10 contains codes for the perinatal period?
Which of the following is true about the ICD-10-CM?
There's additional information relevant to inpatient encounters.
There are limited injury codes.
An eighth character was added.
There are combination diagnosis/symptom codes.
When coding late effects, the code for the _______ is usually sequenced first.
Single braces are used in the Tabular List to
connect terms on both sides of the braces.
connect a series of terms on the left with one term on the right.
indicate fifth digits required with a code.
include nonessential modifiers and alternative codes.
What does the acronym ICD-9-CM mean?
International Classification of Diseases, 9th Edition, Coding Manual
International Coding Definitions, 9th Version, Coding Manual
International Classification of Diseases, 9th Revision, Clinical Modification
International Classification of Diagnoses, 9th Edition, Coding Modification
If a QIO provider renders a covered service that costs $100 and bills Medicare for the services and
Medicare allows $58, the provider would bill _______ to the patient.
Identify the correct diagnosis code for benign essential hypertension.
A physician has certified that a patient is terminally ill and is expected to live six months or less. The
patient is receiving hospice care. Which part of Medicare will cover this service?
What is the main term in the diagnosis "pituitary gland hypofunction"?
What is the correct code for impending shock?
No code is assigned.
_______ are used to indicate factors influencing health status and contact with health services.
Which of the following is the correct code for a threatened spontaneous abortion, unspecified episode
End of exam
An established patient presents with chest pain. He has a history of previous myocardial infarction and
coronary artery bypass surgery. Using the ICD-10 guidelines, which would be the
first-listed diagnosis for
this patient encounter?
Previous myocardial infarction
Possible myocardial infarction
Status-post coronary artery bypass surgery
For which of the following does Medicare Part A pay?
Physician services and durable medical equipment
Hospital/facility care and durable medical equipment
Professional services and durable medical equipment
In which edition of the Federal Register would hospital facilities be especially interested?
Its Exam # XXXXX
Tomorrow by 3:00 PM.
Hi Cher. Sorry about that. That would be Eastern standard. Also if this exam is satisfactory (95-100%), I would like to employ your services on the other 6 exams at the agreed upon price.
How are you? I have been sick for a few days and still recovering...but feeling better. I am satisfied with the last exam and thank you for the quick help. I received an 80% which is good but I think I will bump the next help against my answers prior to submitting. Basically like you suggested.
Attachments are only available to registered users.
I have another exam I need help with if you are willing...
381755RR - CPT AND HCPCS BASICS; EVALUATION AND MANAGEMENT.
I'll look for those answers that I missed but in the mean time here are the exam questions I am now referring to:
Where is specific coding information about each section located in the CPT?
Code assignments in the Evaluation and Management section vary according to three factors. Which
factor below is
not one of these factors?
Place of service
Type of service
To qualify for a given level of multi-specialty examination, how many content and documentation
requirements should be met?
At times, the five-digit CPT code may not reflect completely the services or procedures provided. In this
situation, you would add a/an
Level II code.
When a neonate or infant is not considered critically ill but still needs intensive observation and other
intensive care services, the initial and continuing intensive care services codes are
99499, unlisted evaluation and management services.
What CPT code is assigned to an ED service that has a detailed history and exam with a moderate level
What type of code includes all the words that describe the procedure the code represents?
The _______ is the universal health insurance form for submission of outpatient services.
J codes in the HCPCS Level II system are used to indicate
medications and dosages.
durable medical equipment.
When a range of CPT codes are given in the index, this range is indicated by which symbol?
Mr. Smith presents to the Emergency Department at the local hospital for chest pain and is seen by the
ED physician on duty. The physician obtains an extended HPI, an extended ROS, and a pertinent PFSH.
What is the level of history?
How often are Category III codes released?
As often as necessary
Every three years
Twice a year
An attending physician asks a specialist to see a patient about a specific problem and to advise him
regarding treatment. This situation is called a
transfer of care.
The words that follow a code number in the CPT manual are called the
Critical care codes are reported based on
the three key components—history, exam, MDM.
amount of documentation.
In the index of the CPT manual, which punctuation mark between codes indicates a range of codes is
A list of all CPT modifiers used to alter or modify codes may be found in which CPT Appendix?
The physician must consider multiple diagnoses and management options. There is a moderate amount
of data to be reviewed and the risk of complications or death is moderate. What is the level of MDM?
Modifier -59, distinct procedure service, is used to indicate that
a subsequent surgery was planned or staged at the time of the first surgery.
a patient was taken back to the operating room for surgical treatment of a complication resulting from a previous surgery.
services that are usually bundled into one payment were provided as separate services.
a service was repeated.
A surgical assistant provides service (an extra set of hands) to the primary surgeon during a surgical
procedure. The assistant surgeon's services are reported using the same codes as the primary surgeon's, but
What year was CPT first developed and published?
When a physician performs a preventive care service, the extent of the exam is determined by the
patient's gender and age.
length of time elapsed since last exam.
A procedure or service not found in the CPT manual can be coded as an unlisted procedure if no
category I or II exists to describe the procedure/service provided. Unlisted Service or Procedure codes end
Which category number or level codes represent services and procedures that have been approved by
the FDA and have been proven to have clinical effectiveness?
Which of the following types of examination is limited to an affected body area or organ system and
other related organ systems?
Expanded problem focused
After the first eligible procedure is reimbursed at 100% of Medicare allowance, the remaining (up to
four) procedures are reimbursed at _______ percent.
Modifier -58, staged or related procedure or service by the same physician during the postoperative
period, is used to indicate that
a subsequent surgery was planned at the time of the first surgery.
Modifier -51, Multiple Procedure, is used on what type of services?
The physician performs an extended exam of the affected body areas and related organ systems. What
is the level of the examination?
In which CPT appendix would additions, deletions, and revisions be found?
Which one of the following items must be included in a general multisystem examination of a
Palpation of lymph nodes
Inspection of teeth and gums
Auscultation of the lungs
Who publishes CPT?
How many main sections are in the CPT manual?
Which modifier is used by an anesthesiologist to indicate a service for which general anesthesia was
used when normally the anesthesia would have been local or regional?
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What is ICD-10?
ICD-10 is the International Classification of Diseases, Tenth Edition. It is a diagnostic code system that is used in nearly every country in the world, except the United States. Developed by the World Health Organization, ICD-10 was implemented in 1993 in order to replace the ninth edition. This is a strictly diagnostic coding system, though sometimes it is inaccurately intended as ICD-10-CM/PCS.
The official guidelines for coding and reporting are available in PDF format at the CDC website.
What is ICD-10-CM?
Often, ICD-10 refers to the clinical modification of the code, which is abbreviated as ICD-10-CM. The clinical modification system was developed by the Center for Disease Control and Prevention, which already uses the code for mortality reporting. ICD-10-CM will replace the currently used ICD-9-CM. The official transition to ICD-10-CM will occur on October 1, 2013. This date is not flexible, and there is no plan for extension; it must be implemented on time.
What is ICD-10-PCS?
ICD-10-PCS is a separate designation for the procedural coding system. It was developed for documenting the procedural services of hospitals. Developed for the Centers for Medicare & Medicaid Services (CMS) by 3M Health Information Management, this system will replace ICD-9-CM Volume 3. Hospital inpatient procedures involving operating rooms, nursing services and the like will use ICD-10-PCS. Other common procedures that are not limited to inpatient services such as laboratory tests or educational seminars are not included. Physician services will continue to utilize CPT® (Current Procedural Terminology) codes for outpatient procedures. Though it was created by 3M Health Information Management and not WHO, it is meant to operate in conjunction with ICD-10-CM.
Why is the United States making the transition to ICD-10-CM/PCS?
ICD-9-CM has reached its limit. The scientific organization of ICD-9-CM means that there are only ten subcategories available for each three-digit category. Most of these have already been used to assign diagnoses. In effect, this leaves no room for the inclusion of medical discoveries. Furthermore, the limitations of ICD-9-CM results in codes being inappropriately placed throughout the book, lowering specificity and contributing to deterioration in its structure. The need for new codes that are easily accessible is great.
The CMS offers a collection of project slides that will help entities with the transition from ICD-9-CM to ICD-10-CM more clearly. Issues covered include the ICD-10 MS-DRG Conversion Project, ICD-9 code conflicts, process efficiencies and enhancements to GEMs.
Why are there now two systems (CM and PCS) instead of one?
Both systems were developed by different organizations under different timeframes. Previously, ICD-9-CM included procedural as well as clinical information. Despite being created by CMS and NCHS respectively they were referred to as one system. Similarly, ICD-10-CM and ICD-10-PCS may be referred to jointly as ICD-10-CM when implemented.
What is GEM?
GEM stands for General Equivalence Mappings. They were developed by prominent institutions in health care such as the CMS, CDC, AHIMA and the AHA. GEMs assist in converting ICD-9-CM codes to ICD-10-CM codes and vice versa. They are often referred to as crosswalks.
Who is behind the transition to ICD-10-CM/PCS?
The U.S. Department of Health and Human Services (HHS) released a final rule (HIPAA Administrative Simplification: Modifications to Medical Data Code Set Standards to Adopt ICD-10-CM and ICD-10-PCS Final Rule) requiring all entities covered by the Health Insurance Portability and Accessibility Act (HIPAA) to implement ICD-10-CM/PCS medical coding by October 1, 2013. Entities that use ICD-9 codes in claims after this date will not be paid.
How is ICD-10-CM similar to ICD-9-CM?
ICD-10-CM is based on similar guidelines and formal conventions as ICD-9-CM. It is also organized in a similar way. This means that those who are familiar with ICD-9-CM will be able to learn ICD-10-CM relatively quickly. Many chapters used in ICD-9-CM are also found in the newer edition, though sometimes they are found in a different order.
How is ICD-10-CM different from ICD-9-CM?
ICD-10-CM is an entirely new structure for diagnosis classification. The most significant structural differences are longer code length, the inclusion of more alphanumeric codes and narrative descriptions. The ICD-10-CM allows for codes to be anywhere from three to seven digits of mixed numbers and letters (beginning with a letter), while the ninth edition only allows for three to five digit codes that are mostly numeric. Another difference is that ICD-10-CM uses computer-readable tables that no longer have section header or chapter codes.
While the ninth edition has approximately 13,000 codes, the tenth has approximately 69,000. The concurrent addition of ICD-10-PCS raises this number of codes to 140,000. Part of the reason for this dramatic increase is due to the emphasis on laterality. Systems that are highly lateral see an increased number of chapters in ICD-10-CM. In fact, twenty-seven percent of the codes include “right,” while another twenty-seven percent includes “left.” These descriptions will allow for greater specification and efficiency.
How will the ICD-10-CM/PCS differences be beneficial to treatment?
Despite the daunting increase in number, ICD-10-CM can transmit greater amounts of information. One code can inform a health care worker of: a disease and its manifestation, stage of treatment (initial, follow-up, or late effects), or in obstetric care, trimester of procedure. Further, while ICD-9-CM only specifies condition, ICD-10-CM specifies location. In the lungs, for instance, the ICD-9-CM would only be able to indicate a condition of the lungs, while ICD-10-CM indicates left lung, right lung, both lungs, or unspecified. This will improve speed of diagnosis as well as treatment.
How else are the ICD-10-CM/PCS differences beneficial to healthcare providers and patients?
These more detailed codes will result in a better understanding of disease patterns as well as treatment outcomes. Such valuable information is important to the advancement of medical care. Additionally, ICD-10-CM offers several logistic improvements. For instance, the detailed information transmitted through the new code will make operational processes such as claim submissions and reimbursement more efficient. This additional detail will make initial claims clearer for payers. Furthermore, this more precise system will result in fewer unnecessary tests and ultimately will reduce administrative overhead.
How is ICD-10-PCS different from ICD-9-CM?
ICD-10-PCS is substantially different from Volume 3 of ICD-9-CM that it is replacing. It is also noticeably different from CPT ® codes that are used. It is an entirely new system that is meant to better address the quickly changing medical field and its medical procedures. Utilizing the same multi-axial design as ICD-10-CM, it also results in greater granularity. Similarly to ICD-10-CM, the code emphasizes laterality, dissimilarly; ICD-10-PCS requires it as “unspecified” is not anatomically possible.
Those using ICD-10-PCS will be required to have greater anatomical and physiological knowledge than under ICD-9-CM. This difference may require the coder to gain additional knowledge outside of their specialty areas.
How does ICD-10-PCS code work?
The first characters indicate what, where and how, while the fifth indicates approach, the sixth indicates device and the seventh includes a qualifier. Anatomy and procedure are well covered by this coding system. For instance, medical and surgical (0) action on the endocrine system (G) in the form of excision (B)of the left adrenal gland (2) via a percutaneous approach (3) carried out with no device (Z) or qualifier (Z) results in the code 0GB23ZZ. Clearly, ICD-10-PCS transmits a great deal of information through a relatively small code.
A PDF that includes some examples of ICD-10 coding tables can be found here. These useful examples demonstrate the way in which coding will be organized.
Steven J. Steindel, PhD, FACMI, further explains learning and using ICD-10-PCS in an entry on the Journal of AHIMA’s website. He provides greater insight into how coding in ICD-10-PCS works as well as its use.
What challenges will be presented by the transition to ICD-10-CM/PCS?
Equating the documentation in medical records as they correlate to ICD-10-CM/PCS definitions will be a significant challenge in transitioning to the new format. Healthcare professionals, who are already working under tight time constraints, will be asked to use an unfamiliar coding system. Many will be reluctant to make the switch in their documentation procedures unless there is a strong urge towards following through with ICD-10-CM/PCS notation. This is especially true in cases of complex procedures that may require multiple codes. In order to ensure clinical clarity and precision, healthcare providers must adhere to the new coding standard.
Will ICD-10-CM/PCS help build an electronic medical record?
Yes, both systems are tailored to be used in electronic health record systems. These more modern codes will take advantage of clinical reference terminology and are more conducive to computer-assisted coding.
How much will ICD-10-CM/PCS cost to implement?
The RAND Science and Technology Policy Institute conducted a survey on the costs and benefits of introducing the ICD-10 systems. Their study found that the new systems could save up to seven billion dollars over the next ten years.
What happens when ICD-11 is created? Why not just wait for ICD-11?
Currently, WHO is drafting an updated ICD edition for endorsement by 2015 at its World Health Assembly. The alpha draft was made available online in July 2011. Unlike previous developments, the WHO is utilizing Web 2.0 principles to construct the document via a multi-author drafting platform. There is no set implementation date, or clear timeframe. This means waiting many extra years and further additional modifications will likely be need for implementation in the United States. Furthermore, ICD-10 will be more similar to ICD-11 than ICD-9. Many of the costs that would go into upgrading directly to ICD-11 will be surpassed by first implementing ICD-10-CM/PCS.
What is HIPAA 5010?
HIPAA (the Health Insurance Portability and Accountability Act) 5010 is a replacement for the current X12 submission standard that is used for determining what entities must use for conducting electronic transactions. Such transactions are responsible for transmitting sensitive health information between specific parties. For instance, a health care provider sending medical claims to a health plan for payment via an electronic exchange must do so under a specified cryptographic standard.
Other transactions include:
- remittance advice
- claims status
- enrollment and disenrollment
The standard is intended to protect the sensitive patient information that is transmitted. Currently, version 4010 is being used under HIPAA standards. HIPAA 5010 is equally important to the realization of ICD-10-CM/PCS, despite its lack of notoriety.
When will HIPAA 5010 be implemented?
Covered entities must have met level I compliance by January 1, 2011. This level of compliance entails the ability to process 5010 transactions for use in testing as well as transition with partners that are able.
Level II compliance is required by January 1, 2012. Covered entities must use HIPAA 5010 for all transactions at this time.
Why is HIPAA 5010 necessary and how is it different from HIPAA 4010?
HIPAA 5010 will account for the increased complexity of ICD-10-CM/PCS codes, ensuring the cryptographic protection of sensitive information sent electronically. It also operates in a distinctly different way. For instance, it includes more clearly defined situational rules that will help with specific transactions. HIPAA 500 does not necessarily require ICD-10-CM/PCS codes. It is able to differentiate between ICD-9 and ICD-10-CM/PCS, potentially clarifying issues surrounding billing due to two sets of code.
You can read more about the eleventh edition of the WHO ICD and its development online at their website. | <urn:uuid:e0de5a08-7f5f-4124-a354-9d7d4904a238> | {
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Stiff-Person syndrome is a rare disorder of the central nervous system in which progressive spasticity and muscle stiffness develops. Reduced GABA synthesis and impaired nerve serve signaling due to production and activity of autoantibodies is the underlying cause. Clinical criteria, EMG studies and identification of autoantibodies are necessary to make the diagnosis. GABA agonists, intravenous immunoglobulins, corticosteroids and immunomodulating agents such as rituximab are used in therapy.
Slight variations exist across SPS subtypes, but axial muscle stiffness and episodic onset of spasms provoked by external stimuli are hallmarks of this condition . Stiffness and rigidity are produced by activation of both agonists and antagonists, which may manifest with painful cramping, hyperlordosis, bending and walking difficulties, as well as frequent falling that may prone patients to use wheelchairs or canes . The onset of spasms is precipitated by noxiously interpreted stimuli such as stress or unexpected loud noise. Moreover, psychiatric symptoms such as anxiety, depression and panic attacks are not uncommon, which is why SPS is often initially misdiagnosed as a psychiatric illness . In paraneoplastic SPS, studies have shown that spasms confined to the extremities are more common, while additional findings include encephalopathy and myelopathy .
Entire Body System
Here, we describe a 26-year-old woman who presented with psychosis, amnesia, rigidity and fever. [ncbi.nlm.nih.gov]
[…] headache nausea and vomiting HIV may produce additional symptoms that include: nausea fever sore throat rash Infections such as Legionnaires’ disease, polio, and valley fever often cause symptoms such as: fever cough headache chest pain chills sore throat [healthline.com]
Rhodes has been sick for more than two years with symptoms that stumped doctors who originally suspected ailments ranging from meningitis to Rocky Mountain spotted fever. [fredhutch.org]
Stiff-person syndrome following West Nile fever. Archives of Neurology, 61 (6), 938-41. [naric.com]
SPS is characterized by fluctuating muscle rigidity in the trunk and limbs and a heightened sensitivity to stimuli such as noise, touch, and emotional distress, which can set off muscle spasms. [ninds.nih.gov]
Stiff-person syndrome or Moersch-Woltmann is a very rare and disabling neurologic disorder characterized by muscle rigidity and episodic spasms involving axial and limb musculature. [ncbi.nlm.nih.gov]
[…] dysfunction with a 2:1 : ratio Clinical Stiffness of axial and appendicular muscles with intermittent superimposed painful muscle spasms precipitated by emotional or physical stress, low back pain, hyperlordosis, motor and gait defects, diaphoresis, tachycardia [medical-dictionary.thefreedictionary.com]
In addition to Stiff Person Syndrome, my sister has hypothyroidism, Postural Orthostatic Tachycardia Syndrome, chronic urticaria, and unspecified idiopathic peripheral neuropathy. My sister had symptoms for several years before she was diagnosed. [globalgenes.org]
She concomitantly developed a transient mild tachycardia (approximately 80 beats/min to approximately 105 beats/min) as well as hyperemia and hyperthermia isolated to the face and neck. [anesthesiology.pubs.asahq.org]
Tachycardia and hypertension are sometimes also present.Because of the spasms, patients may become increasingly fearful, require assistance, and lose the ability to work, leading to depression, anxiety, and phobias, including agoraphobia and dromophobia [en.wikipedia.org]
( G72.1 ) cramp and spasm ( R25.2 ) drug-induced myopathy ( G72.0 ) myalgia ( M79.1- ) stiff-man syndrome ( G25.82 ) Type 2 Excludes nontraumatic hematoma of muscle ( M79.81 ) Diagnosis Index entries containing back-references to G25.82 : Stiff-man syndrome [icd10data.com]
The same patient also developed a seizure disorder at age 14 years and subsequently neuropathy and myopathy at age 48 years, when diagnosed as having diabetes mellitus and SMS. [jamanetwork.com]
Intravenous immunoglobulin in patients with anti-GAD antibody-associated neurological diseases and patients with inflammatory myopathies: effects on clinicopathological features and immunoregulatory genes. [emedicine.com]
One month later, the patient had an episode of sudden muscle cramps in her back, for which she was hospitalized. Investigations revealed a diagnosis of stiff person syndrome, positive for glutamic acid decarboxylase autoantibodies. [ncbi.nlm.nih.gov]
But life long athlete Tina Ceroni began having muscle cramps, spasms and rigidity in her legs. She thought she might be over training. Then the worst attack at a friends cottage landed her in hospital. [chch.com]
There are nights I will awaken with severe calf and muscle cramping where I am screaming in agony. I continuously have constant muscle activity in some form all the time. [rarediseaseday.org]
RESULTS: The patient presented with recurrent episodes of vertigo with a pure peripheral pattern and with concomitant episodes of burning muscle pain, muscle twitching, weight gain and fatigue, worsening with tension or stress that also occurred in periods [ncbi.nlm.nih.gov]
By Jeff, United States, February 28, 2015 My first symptoms came back in August 2012, where I starting having muscle activity such as small spasms and fasiculations (muscle twitches). Soon, I was walking like a toy soldier with stiffness. [rarediseaseday.org]
It is a neurological condition that is characterized by progressive (progressive), muscle stiffness, painful muscle spasms and sometimes involuntary muscle twitching. [wieslab.se]
Her symptoms progressed over the next few years with more severe cramping, and longer episodes of painful spasms, muscle contractions, muscle twitches, and severe rigidity in all of her body. [ohfoundation.ca]
When oral medication is inadequate to control muscle spasticity, intrathecal baclofen may be used. [ncbi.nlm.nih.gov]
Treating muscle spasticity with γ-aminobutyric acid (GABA) agonists and narcotics can lead to drug abuse and dependence. Muscle spasticity can fluctuate from hour to hour, abate with sleep, and get worse with emotional distress. [mdedge.com]
[…] back-references to G25.82 : Type 1 Excludes: M62 ICD-10-CM Diagnosis Code M62 Other disorders of muscle 2016 2017 2018 2019 Non-Billable/Non-Specific Code Type 1 Excludes alcoholic myopathy ( G72.1 ) cramp and spasm ( R25.2 ) drug-induced myopathy ( G72.0 ) myalgia [icd10data.com]
In rare cases, facial muscles, hands, feet, and the chest can be affected and unusual eye movements and vertigo occur. There are brisk stretch reflexes and clonus occurs in patients. Late in the disease's progression, hypnagogic myoclonus can occur. [en.wikipedia.org]
Stiffness and spasms may occur along with, before or after the development of other symptoms including vertigo, a lack of coordination of voluntary muscles (ataxia), and difficulty speaking (dysarthria). [rarediseases.org]
Stiff person syndrome (SPS) is a rare and disabling central nervous system disorder first described in 1956 and characterized by fluctuating rigidity and stiffness, gait impairment, and painful spasms of the axial and limb musculature. [ncbi.nlm.nih.gov]
The proximal legs can be involved in the process, and this is often only apparent on walking when the patient has a stiff gait. [jnnp.bmj.com]
SYMPTOMS The most common signs are: - hyperreflexia reflexive integrity can be assessed via deep tendon reflexes (as well as resistance to passive stretch), grading it by a 0 to 4 scale (0 means complete absent reflexes, 4 indicates hyperactive reflexes [flipper.diff.org]
A woman was diagnosed in August 2005 as having SPS at age 48 years after presenting with progressive leg stiffness, hyperreflexia, and falls. Her reflexes were brisk but she had normal muscle tone and strength. [doi.org]
The patients’ principal complaints included stiffness (ie, rigidity), primarily in the trunk muscles, that was superimposed by spasms, resulting in postural abnormalities, gait difficulties, and a tendency to ‘fall like a wooden man.’ [redorbit.com]
Associated symptoms revealed brainstem involvement (vertigo, diplopia, and cranial neuropathies) and dysautonomia (abnormal sweating and orthostatic hypotension). Anal manometry demonstrated incomplete relaxation of the anal sphincter. [ncbi.nlm.nih.gov]
A combination of clinical, laboratory and EMG studies are necessary to obtain a firm diagnosis of SPS. Clinical criteria comprise: 1) rigidity of the abdominal and thoracolumbar, as well as limb and trunk muscles; 2) simultaneous activation of agonist and antagonist muscles that is confirmed by either clinical observation or EMG studies; 3) presence of spasms that are triggered by environmental stimuli such as tactile sensations, noise or stress; and 4) exclusion of other neurological diseases that manifest with similar symptoms and signs . As mentioned, EMG is imperative in supporting the findings during physical examination. Continuous motor unit activity (CMUA) at rest seen on EMG studies is virtually a patognomonic feature of this condition . To confirm the diagnosis, however, anti-GAD or anti-amphiphysin antibodies should be identified and techniques such as immunohistochemistry, Western blot or radioimmunoassay are used .
Various agents are used in symptomatic managements of SPS. GABAergic agents such as vigabatrin, gabapentin, baclofen, but also benzodiazepines such as diazepam are frequently used and usually show some degree of benefit . The use of more potent therapeutic agents, such as intravenous immunoglobulins and plasmapheresis is necessary. Their use has shown variable results, however, showing much better outcomes in classical SPS compared to pareneoplastic forms . Rituximab, an anti-CD20 antibody, has been recently introduced as a potentially effective agent in patients with SPS as initial reports showed promising results . In addition to symptomatic therapy, appropriate management of psychiatric symptoms and physiotherapy are shown to be equally important for the overall quality of life .
The prognosis relies heavily on an early diagnosis, as significantly better outcomes are expected with early initiation of treatment. The course of the disease is unpredictable, as disability may be either mild or severe .
SPS is divided into three subtypes: classical, paraneoplastic and SPS variants. Etiological mechanisms are of autoimmune origin across all types with some slight differences in target molecules. In classical SPS, symptoms appear due to synthesis of auto-antibodies against glutamic acid decarboxylase (GAD), the enzyme necessary for production of GABA, the main inhibitory neurotransmitter . Approximately 60% of classic SPS patients have positive anti-GAD antibodies , while antibodies against glycine receptors, gephyrin, and GABA receptor-associated proteins have been identified in a smaller subset of patients . On the other hand, paraneoplastic SPS is triggered by formation of anti-amphiphysin antibodies. Amphiphysin is a cytosolic protein that is involved in synaptic vesicle formation and endocytosis . Impaired function of amphiphysin leads to failure of signal transmission at the synaptic cleft and the synthesis of antibodies can be most frequently encountered in patients suffering from malignancies of the breast, colon, lung and thymus . Jerking-SPS, focal or segmental SPS and progressive encephalomyelitis with rigidity and myoclonus are recognized SPS subtypes that have similar etiological mechanisms as classical SPS, but their clarification requires further research, as some patients present without anti-GAD antibodies. The exact cause of antibody production in all forms of SPS, however, remains unknown.
This condition is considered to be a rare entity in clinical practice and the vast majority of data relies on isolated case reports and single-center experiences. Across various studies, a strong association with other autoimmune diseases has been found. Certain reports found that almost 70% of patients had at least one autoimmune condition, with the most frequent being diabetes mellitus and autoimmune thyroid disease . For some reason, a gender predilection toward females in a 2:1 ratio is observed , partly because paraneoplastic forms of SPS is most frequently associated with breast cancer, but only 5% of SPS cases belong to this group.
Reduced activity of GABA is the main pathophysiological mechanism in the classical form of SPS. GABA is the main inhibitory neurotransmitter in the nervous system and its main effect on the musculoskeletal system is muscle relaxation. Under physiological circumstances, GABA is synthesized from glutamate through activity of glutamic acid decarboxylase (GAD), an enzyme situated in the cytoplasm of neurons . For still unidentified reasons, autoantibodies against GAD are formed and suppress its activity, leading to deficiency of GABAergic effects in the CNS. As a result, progressive muscle stiffness because of practically absent relaxation and muscle rigidity occurs. Similar effects are achieved in paraneoplastic forms, were auto-antibodies against amphiphysin are identified . Amphiphysin is a protein that exerts its function by promoting synaptic vesicle formation in the synaptic cleft and its reduced function leads to impaired endocytosis and reduced activity of neurotransmitters on the post-synaptic cleft .
Despite the fact that the etiology of symptoms is almost completely determined, the exact cause of antibody formation remains unknown and prevention strategies currently do not exist. The focus on reducing morbidity from this condition relies heavily on the ability of the physician to make an early diagnosis and enable the patient to start treatment when the damage to the musculoskeletal and nervous system is not significant.
Stiff-Person syndrome (SPS) is a rare, but often severely debilitating disease of the central nervous system that is characterized by progressive rigidity and stiffness of various muscles, mainly of the axial skeleton, together with episodic appearance of spasms . Three distinct subtypes have been described in literature :
- Classic SPS stems from the presence of autoantibodies against glutamic acid decarboxylase (GAD), one of the most important enzymes in synthesis of gamma-aminobutyric acid (GABA) . GABA is the principal inhibitory neurotransmitter in neuronal tissue and reduced concentrations of this neurotransmitter throughout the central nervous system lead to profound muscle stiffness and rigidity . Additionally, antibodies against GABA-A receptor-associated protein (GABARAP) and gephyrin and the glycine-α1 receptor, both influencing GABA activity, have been identified and can also contribute to CNS symptomatology . In these patients, the presence of diabetes mellitus type I or Hashimoto's thyroiditis is not uncommon, as they have shown to be more prone to developing another auto-immune disorder .
- Paraneoplastic SPS is seen in approximately 5% of patients and is associated with concomitant malignant disease, most commonly breast cancer . The pathogenesis includes formation of autoantibodies against amphiphysin I, a cytosolic protein normally found in very low concentrations in synaptic clefts but is abundant in malignant cells. In addition to breast cancer, the lungs, colon, thymus and lymphoma are described as potential causes .
- SPS variants, such as focal or segmental SPS, jerking SPS and progressive encephalomyelitis with rigidity and myoclonus are described as additional subtypes , and their pathophsyiological mechanism is somewhat similar to that of classical SPS.
The clinical presentation, regardless of the type, invariably results in the appearance of stiffness that is most prominent in the muscles of the trunk and head (axial muscles) , but virtually any muscle group may be affected. Due to simultaneous contracture of agonists and antagonists, hyperlordosis and reduced bending capabilities, impaired gait and need for assistive devices such as canes or wheelchairs is often necessary . Muscle spasms are often triggered by an external noxious stimulus, such as very loud sounds or emotional stress . Depression, anxiety and panic attacks are frequent in these patients, as the condition presents as a significant burden both physically and mentally . To make the diagnosis, electromyography (EMG) studies show typical continuous motor unit activity (CMUA) at rest, while serology testing for autoantibodies is used for confirmation . Aside from EMG and serology, it is important to perform a detailed physical examination and obtain a comprehensive patient history that may reveal important findings regarding the presence of comorbidities such as diabetes or breast cancer. Therapeutic principles currently aim to alleviate symptoms through GABA agonists such as baclofen, gabapentin, vigabatrin, whereas corticosteroids, plasmapheresis and administration of intravenous immunoglobulins against autoantibodies are used as well . Treatment efficacy and prognosis significantly depends on identifying SPS in its early stages, when the damage to CNS and other structures is minimal .
Stiff-Person syndrome (SPS) is a rare autoimmune disease of the central nervous system in which production of antibodies against enzymes and proteins involved in normal conduction of nerve signals. There are two main forms: the classical form, often diagnosed in patients who already have some other autoimmune disease such as diabetes mellitus type 1 or Hashimoto thyroiditis, and paraneoplastic SPS, diagnosed most frequently in patients who are suffering from various malignant diseases, most notably breast cancer. SPS is more common in women and patients of any age may be affected. In classical forms, symptoms arise due to reduced activity of molecules induce muscle relaxation (gamma-aminobutyric acid, known as GABA), which is caused by secretion of auto-antibodies that reduce the capacity for its formation. A similar end-result is seen in paraneoplastic SPS, where the structures that should carry the signals from nerve to nerve are insufficiently produced under the influence of auto-antibodies. This condition causes symptoms that can significantly impair the quality of life and daily activities, such as profound muscular stiffness and rigidity, together with episodic onset of muscle spasms. Usually, the muscles of the abdomen and trunk are affected and simultaneous activation of agonist and antagonist muscles (for example, the activation of abdominal and spinal muscles occurs at the same time) are considered as hallmarks of this disease. Spasms are usually provoked by environmental unpleasant stimuli such as loud noise or emotional stress and symptoms such as depression, panic attacks and anxiety are not uncommon. To make the diagnosis, the physician must conduct a full physical examination and confirm the presence of muscle stiffness and spasms. To support these findings, a test that evaluates muscle activity and nerve signaling called electromyography (EMG) is used, which will show continuous activity of neurons during rest, one of the main features of SPS. Additionally, identification of auto-antibodies is necessary to confirm SPS. Treatment focuses on overriding the effects of auto-antibodies by drugs that enhance activity of GABA, such as vigabartin, baclofen and several other, together with diazepam and corticosteroids. Administration of immunoglobulins and plasmapheresis, a method that aims to remove the auto-antibodies responsible for symptoms seen in this condition, are considered as mainstay of therapy, but their efficacy significantly varies from patient to patient. Physiotherapy and management of psychiatric symptoms is equally important in ensuring good long-term outcomes. It is important to emphasize that an early diagnosis may lead to markedly better effects of therapy, which is why physicians should have a high index of suspicion toward this disease in patients who have signs and symptoms that may suggest SPS, even though it is considered to be a rare disease.
- Moersch FP, Woltman HW. Progressive fluctuating muscular rigidity and spasm (“stiff-man” syndrome): report of a case and some observations in 13 other cases. Proc Staff Meet Mayo Clin. 1956; 31(15):421-427.
- Geis C, Weishaupt A, Hallermann S, Grünewald B, Wessig C, Wultsch T, et al. Stiff person syndrome-associated autoantibodies to amphiphysin mediate reduced GABAergic inhibition. Brain. 2010 Nov;133(11):3166-3180.
- Butler MH, Hayashi A, Ohkoshi N, et al. Autoimmunity to gephyrin in Stiff-Man syndrome. Neuron. 2000 May; 26(2):307-312.
- Murinson BB, Guarnaccia JB. Stiff-person syndrome with amphiphysin antibodies: distinctive features of a rare disease. Neurology. 2008; 71(24):1955-1958.
- Buechner S, Florio I, Capone L. Stiff Person Syndrome: A Rare Neurological Disorder, Heterogeneous in Clinical Presentation and Not Easy to Treat. Case Reports in Neurological Medicine. 2015;2015:278065
- McKeon A, Robinson MT, McEvoy KM, et al. Stiff-Man Syndrome and Variants: Clinical Course, Treatments, and Outcomes. Arch Neurol. 2012;69(2):230-238.
- Dalakas MC. Advances in the pathogenesis and treatment of patients with stiff person syndrome. Curr Neurol Neurosci Rep. 2008;8(1):48-55
- Vasconcelos OM1, Dalakas MC. Stiff-person Syndrome. Curr Treat Options Neurol. 2003 Jan;5(1):79-90.
- Baker MR, Das M, Isaacs J, et al. Treatment of stiff person syndrome with rituximab. J Neurol Neurosurg Psychiatry. 2005; 76(7):999-1001.
- Murinson BB. Stiff-person syndrome. Neurologist. 2004 May;10(3):131-137.
- Porter RS, Kaplan JL. Merck Manual of Diagnosis and Therapy. 19th Edition. Merck Sharp & Dohme Corp. Whitehouse Station, N.J; 2011.
- Dalakas MC. Stiff person syndrome: advances in pathogenesis and therapeutic interventions. Curr Treat Options Neurol. 2009 Mar;11(2):102-110. | <urn:uuid:d729a66b-fe2e-428c-a4d7-e5517e764a2c> | {
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Medical coding, what is it? Medical Coding is “assigning a code to diagnosis and procedures” in the healthcare setting. This is not a skill that can be learned over night, it requires a lot of training and understanding to do this profession.
Diagnosis – A diagnosis is when a physician based on your symptoms what is wrong with you.
Procedure – The procedure is correcting what ever the diagnosis is, not all diagnosis requires a procedure. But as a coder if there was a procedure done, it would be coded.
Classification Systems– Medical classification, or medical coding, is the process of transforming descriptions of medical diagnoses and procedures into universal medical code numbers.
ICD-10-CM – Stands for International Classification of Diseases, Tenth Revision, Clinical Modification (ICD–10-CM) is a system used by physicians and other healthcare providers to classify and code all diagnoses, symptoms and procedures recorded in conjunction with hospital care in the United States.
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Diagnosis Code 199.2
Information for Medical Professionals
The ICD-10 and ICD-9 GEMs are used to facilitate linking between the diagnosis codes in ICD-9-CM and the new ICD-10-CM code set. The GEMs are the raw material from which providers, health information vendors and payers can derive specific applied mappings to meet their needs.
- C80.2 - Malignant neoplasm associated with transplanted organ
Index of Diseases and Injuries
References found for the code 199.2 in the Index of Diseases and Injuries:
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Information for Patients
Also called: Carcinoma, Malignancy, Neoplasms, Tumor
Cancer begins in your cells, which are the building blocks of your body. Normally, your body forms new cells as you need them, replacing old cells that die. Sometimes this process goes wrong. New cells grow even when you don't need them, and old cells don't die when they should. These extra cells can form a mass called a tumor. Tumors can be benign or malignant. Benign tumors aren't cancer while malignant ones are. Cells from malignant tumors can invade nearby tissues. They can also break away and spread to other parts of the body.
Cancer is not just one disease but many diseases. There are more than 100 different types of cancer. Most cancers are named for where they start. For example, lung cancer starts in the lung, and breast cancer starts in the breast. The spread of cancer from one part of the body to another is called metastasis. Symptoms and treatment depend on the cancer type and how advanced it is. Most treatment plans may include surgery, radiation and/or chemotherapy. Some may involve hormone therapy, biologic therapy, or stem cell transplantation.
NIH: National Cancer Institute
- Cancer and lymph nodes
- Cancer prevention: take charge of your lifestyle
- Genetic testing and your cancer risk
- Talking with a child about a parent's terminal illness
- Understanding cancer staging
- What if cancer comes back?
- When your cancer treatment stops working
You may need an organ transplant if one of your organs has failed. This can happen because of illness or injury. When you have an organ transplant, doctors remove an organ from another person and place it in your body. The organ may come from a living donor or a donor who has died.
The organs that can be transplanted include
You often have to wait a long time for an organ transplant. Doctors must match donors to recipients to reduce the risk of transplant rejection. Rejection happens when your immune system attacks the new organ. If you have a transplant, you must take drugs the rest of your life to help keep your body from rejecting the new organ.
- Organ or Stem Cell Transplant and Your Mouth - NIH (National Institute of Dental and Craniofacial Research)
- Transplant rejection
- Transplant services | <urn:uuid:4c79ff96-9b37-4d13-a63a-61cd5bbffa06> | {
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2 edition of involvement of parents in the primary school curriculum found in the catalog.
involvement of parents in the primary school curriculum
One of the more puzzling aspects of parent involvement is the attempt to engage parents who are not active or visible to the school community.5 It may be counterproductive for educators or involved parents to formulate pre-conceived notions concerning those parents who, on . Castle View Primary School follows a Values system to teach and encourage children to become successful learners and citizens. We pride ourselves on the personal and social support we can provide for our children, whilst challenging children to work hard and be proud of their work, preparing them for their next stage in learning.
The Richmond Primary School Resource Centre/Library is a continually evolving space, which is enjoyed by the whole school community. It houses a carefully curated selection of books including picture books, non-fiction, teacher resources and various novels and chapter books. Parental Involvement At Orgill Primary School we believe that our pupils benefit most from their educational experience and care here when we work in partnership with parents. Children have two main educators in their lives, their parents and their teachers.
Holy Spirit Catholic Primary School encourages and actively supports a positive, supportive partnership between home and school. The involvement of parents within the school is highly valued. Parents are invited to help in classrooms with activities such as reading, mathematics groups, Computer Technology, Art and Craft activities as well as. Attending class excursions, parent workshops, class concerts or the school P&C Committee meetings Sharing any special skills you may have—eg. carpentry, music, cooking, Volunteering to .
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Mounting workshops for parents to learn about parental involvement Generation of a clear government policy on parental involvement Generation of a clear school policy on parental involvement the participation and support of parents at school and in the home, which directly and positively impacts the educational performance of their children.
It is the provision of curricular and co-curricular support by parents to promote effective learning for their school children. File Size: KB. The Role of Parents in the Implementation of the Curricula.
Author parents and the community in the curricular activities but in the research we will focus on the participation of the parents in the school curriculum. Before exposing the results to which we came, a good part of our study will be analytical presentation of normative Author: Marija Blagoj Kostadinova.
Paul's Church of England Primary school sits at the heart of the Addlestone community offering a safe learning place and a wealth of teaching expertise."/> Church, Christian school, state school in Addlestone, learning in Addlestone, geography, history, sport, science, IT, information technology, faith s.
Different types of primary and intermediate schools. Enrolment Schemes (school zones) Costs and financial assistance.
More about Schooling in NZ» Your child at school. Choosing a school. Making sure your child attends school every day. Moving on from primary school. Stand-downs, suspensions, exclusions, expulsions. School transport assistance. - Explore kimmie's board "Parent Involvement Ideas", followed by people on Pinterest.
See more ideas about Parents as teachers, Teaching and Parent teacher conferences pins. The aim of this study was to investigate the extent to which parents of elementary students (1st to 5th) participate in their children's education with regard to some variables.
The study was designed based on descriptive survey model and comparative and correlational associative models. The sample of the research comprised parents whose children studied at 1st to 5th classes of six Cited by: a 10% increase in school budgets or a 10% increase in parent involvement, he would invest in parent involvement.
What Evidence Exists of the Value of Family Involvement in Education. The evidence is clear. When parents are involved in their child’s schooling, students get better grades, score higher onFile Size: KB. With Building Parent Engagement in Schools, educators can start to develop a hybrid culture between home and school, so that school can serve as a cultural bridge for the students.
Filled with the voices of real educators, students, and parents, the book documents a number of parent-involved efforts to improve low-income communities, gain /5(6). Primary School Students' Parents' Level of Involvement into their Children's Education Article (PDF Available) in Educational Sciences: Theory and Practice 13(2) March with Reads.
Families In Schools (FIS) develops culturally-relevant parent curricular programs from birth to college, designed to engage families in the education of their children. The programs are focused on critical issues that all parents should know in order to support learning and advocate for their children's needs, ranging from quality early education, family literacy to college awareness and.
More than anything, the new school curriculum, which is to be rolled out in a couple of weeks in Kenyan schools, offers parents the opportunity to be involved in their children’s education. Primary education consists of an eight year cycle: junior infants, senior infants, and first to sixth classes.
The primary curriculum aims to provide a broad learning experience and encourages a rich variety of approaches to teaching and learning that cater for the different needs of individual children.
The primary curriculum is designed to. Successful parent involvement can be defined as the active, ongoing participation of a parent or primary caregiver in the education of his or her child.
Parents can demonstrate involvement at home-by reading with their children, helping with homework, and discussing school events-or at school, by attending functions or volunteering in classrooms.
community involvement in curriculum de velopment is in the real and personal con cerns of parents and other persons in relation to a particular school. Whether its students live in the neighborhood or are bussed in from a rural area or across the city, the population is defined and its parents can beFile Size: KB.
establish the types of homework assistance children get from parents, to ascertain the extent of parental involvement in homework and to examine the association between parental involvement in homework and school academic performance.
All teachers, head teachers, pupils and parents in public primary schools were Size: KB. Parent Involvement At Sacred Heart Primary School we welcome parent involvement, believing that strong links between home and school foster student learning and community engagement.
We have an open-door policy and plenty of opportunities for parents to assist and be part of their child’s learning. Country Day is more than a school; it is a community committed to providing children the best educational experience in Central Louisiana. As a Country Day parent, your involvement and engagement is vital to the success of Country Day.
Anne Henderson and Nancy Berla best summed it up in their book, A New Generation of Evidence: The Family Is Critical to Student Achievement- “When parents are.
Abstract: The study sought to explore the schools’involvement of parents in their children’s education. It adopted a qualitative case study design. Data were generated from 15 primary school teachers, who were purposively sampled from three primary schools (five teachers per school).
The five teachers from each school formed three focus groups. Activities to Promote Parent Involvement. Research shows that children are more likely to succeed academically and are less likely to engage in violent behavior if their families are involved in their education.
Many parents say, however, that they feel unwelcome or uncomfortable in. Parent Involvement. Parent/Guardian Involvement. Strathfieldsaye Primary School is an open school where parents are welcomed and encouraged to participate in day-to-day activities. The school is an integral part of the local community and feels that there are many people who have something to contribute, either in a classroom, or any other.Parent and Family Involvement in Education: Results from the National Household Education Surveys Program of (NCES ).
U.S. Department of Education. Washington, Percentage of students in kindergarten through grade 12 whose parents reported school-initiated communication practices, by method of communication andFile Size: 1MB.THE ROLE OF KUWAITI PARENTS’ INVOLVEMENT IN DEVELOPING THEIR PRIMARY SCHOOL - CHILDREN’S INTEREST IN READING ENGLISH STORIES Dr.
Anaam Al-Fadley Curriculum & instructions Dept. | <urn:uuid:94938582-143f-4506-b184-e0deaccf99af> | {
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Things You Need To Know About Inpatient and Outpatient coding in Medical Billing
Medical billing and coding is a complex system considering the complexity of the hospital environment. Hundreds of individuals are employed at the healthcare facilities to ensure everything in the billing process to be systematic and well-organized.
Medical billing and coding serve a number of purposes like retrieving information and reporting the same on the basis of diagnosis and procedures involved. More complex than the coding part is the documentation process.
The medical records pertinent to the medical procedure are the foundation for a successful coding process. The documents contain complete information regarding the patient health condition, the history of his treatment, progress so far and the medications that he/she is prescribed with their quantity. It is the role of a certified medical coder to carefully review the medical records and then assign codes to their diagnosis.
Medical coding is a process of assigning codes to the healthcare data elements of outpatient and inpatient care. Therefore, one of the most important aspects of medical coding process is to identify if the patient is inpatient or outpatient.
Inpatient Coding System
A patient who is formally admitted to a hospital upon the orders of the physician for a long period of time. This coding system is used to report patient diagnosis and services based on their extended stay. The ICD 10 HCPCS coding system is utilized for obtaining appropriate reimbursement.
Outpatient Coding System
An outpatient refers to a patient who is being treated but not actually admitted at any healthcare facility for an extended period of time or is released from the hospital within 24 hours. Outpatient coding is based over ICD 9 or ICD 10 diagnostic codes but uses CPT or HCPCS system to report medical procedures.
Comparison between Inpatient and Outpatient Coding
Outpatient coding is based on a detailed diagnosis report in which the patient is generally treated in one visit, whereas an inpatient billing and coding system is used to report diagnosis and treatment procedures based on a patient’s extended stay.
The inpatient system is based on the assignment of ICD 9/10 CM diagnosis and procedure codes for billing and claim reimbursement. It is a standard coding system used by physicians and other medical healthcare providers for classification and coding for all the diagnoses.
The principal diagnosis is defined as the condition established initially after the checkup and is described as the only reason for admitting the patient under the care of a hospital. During coding, the principal diagnosis is placed first. The correct assignment of principal diagnosis code is important as it determines whether the payment will be made or not. Failure to use it as required may invite unnecessary denials. This method is generally used in cases of outpatient services.
For inpatient services, an (IPPS) Inpatient Prospective Payment system is used as the reimbursement methodology by health insurance payers to provide reimbursements.
In the nutshell, the groundwork remains the same but the coders need to keep up with the changing hospital coding guidelines. The hospital facilities offer a host of settings the involve submitting claims for the services without any sort of error. Inpatient coding becomes different from the outpatient facility in terms of approach, guidelines, and payment system etc.
Bikham Healthcare is a leader in providing the most efficient medical billing and coding services at the most competitive rates. Being 100% HIPAA compliant, we make sure that sensitive patient health information is kept secure at all times. Visit www.bikham.com to know more about our services. | <urn:uuid:91747167-71d1-45eb-9666-773afa396fbd> | {
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Acute pancreatitis is loosely defined as an acute inflammatory condition of the pancreas. It is one of the most common diseases of the gastrointestinal tract and in 2009 was the most common gastroenterology discharge diagnosis. Common causes include ampullary obstruction, excess consumption of alcohol, hypertriglyceridemia, hypercalcemia, infection, medication, and trauma.
Severity ranges widely. In mild cases, pancreatitis may be subclinical and not even come to medical attention, or it can be severe, sometimes necrotizing, and associated with high mortality. Primary infection is unusual, but necrosis may lead to secondary infection, abscess formation, and subsequent sepsis. Chronic complications like pseudocyst, chronic pancreatitis, or pancreatic insufficiency are not infrequent and may create a predisposition to pancreatic cancer.
Establishing the diagnosis should be straightforward. According to the American College of Gastroenterology (ACG)'s 2013 guideline on management of acute pancreatitis, acute pancreatitis is identified by the presence of at least two of the three following criteria:
- abdominal pain consistent with pancreatitis pain,
- serum amylase and/or lipase levels greater than three times the upper limit of the reference range, or
- characteristic findings from contrast-enhanced computed tomography (CECT) and/or MRI.
ACG also recommends abdominal ultrasonography to help establish the cause of pancreatitis, but pancreatic findings from ultrasound are not part of the diagnostic standard. According to the American College of Radiology's Appropriateness Criteria, the main role of ultrasound is to identify gallstones, biliary dilation, and/or choledocholithiasis, but it is not recommended for the diagnosis of pancreatitis.
Unfortunately, clinicians may not be fully aware of these ACG diagnostic criteria or may not exactly know how to interpret and apply them, causing problems down the line with coding, billing, reimbursement, compliance, and recovery auditors.
The pain associated with acute pancreatitis has very specific characteristics. It is typically epigastric or left upper quadrant in location and is usually described as constant and severe in nature, with radiation to the back, chest, or flank. From a diagnostic standpoint, clinicians should keep in mind that, as the ACG points out, pain described as dull, colicky, or located in the lower abdomen is not consistent with acute pancreatitis and suggests an alternative cause.
Clinicians also commonly hold the mistaken impression that elevation of amylase or lipase levels above the normal reference range is indicative of pancreatitis when the actual diagnostic criterion is greater than three times the upper limit. Many extrapancreatic abdominal diseases are associated with lesser degrees of elevation of these two pancreatic enzymes, including appendicitis, cholecystitis, bowel obstruction or ischemia, peptic ulcer, and gynecological disorders.
ACG's guideline recommends that CECT and MRI of the pancreas “should be reserved for patients in whom the diagnosis is unclear or who fail to improve clinically within the first 48-72 hours after hospital admission.”
Sometimes a clinician may be convinced that a patient with a marked elevation of pancreatic enzymes (greater than three times upper limit) but without significant pain and negative CECT or MRI actually has “subclinical” pancreatitis. In this situation, the clinician should document his/her reasoning, acknowledging that only one ACG diagnostic criterion is present but noting that in this particular case the patient's condition and circumstances are clinically convincing based on professional judgment.
Correct coding and billing of acute pancreatitis require an accurate diagnosis that can be clinically substantiated according to ACG guidelines, clear and consistent documentation, and specification of the cause if possible.
Diagnostic substantiation is an important regulatory, contractual, compliance, and reimbursement concept. Payers often do not accept that a patient actually has a coded condition documented by a clinician unless it can be substantiated by other qualified health care professionals based on authoritative consensus criteria, professional guidelines, evidence-based medical literature, or recognized diagnostic standards of practice that are widely accepted by the medical profession. This is why the ACG guideline diagnostic standard is so important to documentation of pancreatitis.
The International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM), provides multiple codes for acute pancreatitis that allow identification of some of the specific causes: biliary, alcoholic, drug-induced, idiopathic, a code for unspecified cause, and a catch-all code (“Other”) for any other cause specified by the clinician.
All of these codes also require identification of whether pancreatitis is associated with what ICD-10 identifies as infected necrosis, uninfected necrosis, or no associated necrosis or infection. There is no code to describe infection without necrosis, presumably because infection (including abscess) is unusual without necrosis.
Acute pancreatitis codes are all found in category K95 with fourth and fifth digits identifying the cause and the necrosis/infection distinction, respectively. To illustrate, the codes for alcoholic pancreatitis are listed in the Table. The other codes follow the same pattern with a different fourth digit to describe the cause.
Incidentally, chronic pancreatitis without any acute component has only two codes: K86.0 (alcohol-related) and K86.1 (unspecified and other specified causes or types).
In summary, the correct and compliant coding of acute pancreatitis requires clear and consistent documentation of the diagnosis that can be “clinically validated” by other qualified health care professionals. The cause is also an important diagnostic consideration to document, as well as any complicating necrosis or infection/abscess. | <urn:uuid:e70e68ce-1632-4eb0-a409-54fb0acd7bca> | {
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With the implementation of ICD 10 in 2015, we are now going to use these codes in future. Since, we were using ICD-9 CM codes for long time we always like to compare with ICD-10 codes. There are not many changes as long as the guidelines are considered. Yes, with the number of codes and use of alphanumeric codes, there is certainly a major difference between ICD-9 and ICD-10 diagnosis codes. So, we will checkout the basic differences between these two versions of diagnosis codes. Checkout my previous post on coding ICD 10 for unilateral and bilateral diagnosis codes to learn more about new codes.
Read also: CPC preparing and Clearing Tips
Basic about ICD-9 CM diagnosis codes
If we put is short, they are only 3-5 digits codes. Only E or V alphabets used in ICD-9 alphanumeric codes. Only first digit was used for alphabet if required, otherwise all other digits from 2-5 are numeric. The decimal was used only after the third digit or character.
Examples: 486– Pneumonia
786.50– Chest Pain, Unspecified
V22.2– Pregnancy state Incidental
Basics about ICD-10 Diagnosis Codes
The new diagnosis codes will be 3-7 digits long. The 1st digit will be alpha, 2nd digit will be numeric and 3-7 digit will be either alpha or numeric. Here also, the decimal is used after 3 rd character.
Example: A78 – Q fever
A69.21 – Meningitis due to Lyme disease
S52.131A – Displaced fracture of neck of right radius, initial encounter for closed fracture.
The Diabetes Loophole Please Click Here!
The first three character denotes the CATEGORY
Example M84 disorder of continuity of bone
4,5 and 6 character (if applicable) denotes the etiology, anatomic and severity.
An Extension character is used for 7th digit.
M84.311A: stress fracture, right shoulder; initial
Read also: Breast Tomosynthesis cpt codes 2015
New feature in ICD-10 CM
A Placeholder X character is used at few codes to allow future expansion. When the placeholder exists, the X must be used in order to consider the code as valid code. An example of this is at the poisoning, adverse effect and under dosing codes, categories T36-T50.
H40.11X1 Mild stage primary open-angle glaucoma
Applicable 7th character in ICD-10
When there is an applicable seventh character, it should be always on the 7th digit. The applicable 7th character is always required for all codes within some category. If there is no character in before 7th digit then we can go ahead and use placeholder X to fill the gap and use applicable 7th character on 7th digit.
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ICD-10 Articles: Coding Corner
ICD-9-CM only has one excludes note. The ICD-9-CM Official Guidelines for Coding and Reporting state that an excludes note under a code indicates that the terms excluded from the code are to be coded elsewhere. In some cases, the codes for the excluded terms should not be used in conjunction with the code from which it is excluded. The guidelines provide the example of a congenital condition excluded from an acquired form of the same condition. In other cases, the excluded terms may be used together with an excluded code if documentation supports the use of both codes.
ICD-10-CM has two types of excludes note and each note has a different definition for use. They are both similar in that they indicate that codes excluded from each other are independent of each other. In contrast to ICD-9-CM coding, the ICD-10-CM guidelines are clearly distinguished to eliminate confusion as to the meaning of the exclusion.
ICD-10-CM Draft Official Guidelines for Coding and Reporting 2013 defines Excludes Notes as follows:
A type 1 Excludes note is a pure excludes note. It means "NOT CODED HERE!” An Excludes 1 note indicates that the code excluded should never be used at the same time as the code above the Excludes 1 note. An Excludes 1 is used when two conditions cannot occur together, such as a congenital form versus an acquired form of the same condition.
A type 2 Excludes note represents "Not included here". An Excludes 2 note indicates that the condition excluded is not part of the condition represented by the code, but a patient may have both conditions at the same time. When an Excludes 2 note appears under a code, it is acceptable to use both the code and the excluded code together, when appropriate. | <urn:uuid:a0e106f5-9b6d-4bbb-96a8-ae30033c9a47> | {
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Webinar: Sarcopenia -Definitions & How to Diagnose
The 1st webinar was held at 9am PST on November 28, 2017 via a webinar portal of Sarcopenia -Education Series for Clinicians-, focusing on the latest knowledge about sarcopenia.
In the 1st webinar, Dr. John Morley, Professor and Division Chief of Geriatric Medicine and Endocrinology, Saint Louis University School of Medicine, who is a key opinion leader in an academic discussion about sarcopenia, had a talk on definitions of and practical diagnosis of sarcopenia. The video is now on SarcopeniaHelp.com.
To access the webcast at SarcopeniaHelp.com
Inquiry about the webinar program Dan Mueller, GM, AstaMed: email@example.com
Sarcopenia is a disease that leads to the progressive loss of skeletal muscle. In Sarcopenia, muscle mass decreases beyond the normal aging process because of inadequate lifestyle and other issues leading to decrease in muscle strength and/or physical performance, negatively impacting Quality of Life, mobility and independence, and even resulting in mortality. It has long been considered a part of aging that cannot be managed, even though it is estimated that sarcopenia affects approximately 45% of the U.S. senior population and exceeds $18 billion dollars in direct healthcare costs annually. Beginning October 1, 2016, sarcopenia was coded in the International Classification of Disease, Tenth Revision, Clinical Modification (ICD-10-CM) under the code of M62.84. | <urn:uuid:ac520f76-1a2c-4106-9656-65a06a788419> | {
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Cervicalgia is the term which is used for neck pain that does not radiate outward. However, It is different from normal neck pain and radiculopathy. This pain is caused generally by other than nerve compression in the neck. The muscles in the neck are under continual pressure to maintain posture and hold up the considerable weight of the skull and brain which averages around 10lbs.
As we move our head forward, with every inch, force on the neck becomes double. The consistent strain on the cervical spinal muscles can take its toll over time, leading to fatigue in the muscles, spasms, cramps, stiffness, and cervicalgia. The muscles of the neck may become tight and inflexible, which can lead to tearing upon sharp movement and acute neck pain. Cervicalgia can occur due to inflammatory joint disorder such as rheumatoid arthritis, persistent stress and tension causing muscles in the neck to become tight, and acute injuries from sports, or whiplash.
Another possible cause of Cervicalgia is fibromyalgia. In many patients, those with tender points between the shoulders and in the neck causing constant pain. A large number of such patients have it temporarily as it is often caused by simply sleeping at an awkward angle, slouching over a desk, or standing or sitting in same position for longer. In some cases there may be a physical abnormality causing the neck pain, such as ligaments calcification, cervical arthritis, spinal curvature, or torticollis (wry neck) which causes the head to tilt to one side due to shortened muscles in the neck.
Cervicalgia ICD 9 Code
Below you can find the symptoms, treatment as well as the ICD 9 code for Cervicalgia. There may a number of different causes, why a patient suffer from it, as discussed above. But if you are suffering from it than you must know its symptoms and available treatment.
Symptoms of Cervicalgia
Following are some symptoms that indicates that patient is suffering from Cervicalgia. These may include:
- both sharp neck pain and chronic pain in the neck.
- pain is always accompanied by aching, tenderness, tension, pain upon rotating the head, stiffness of the neck, and even headaches.
In some cases the neck pain associated with cervicalgia may be short-lived and improve with rest, however in some others, cervicalgia may remain constant, or even progress leading to degeneration of the cervical spine and the development of other symptoms such as radiculopathy or myelopathy.
Treatment of Cervicalgia
Treatment for cervicalgia are usually conservative. It include different methods of relieving inflammation where it is evident. Such as:
- Applying ice to the area is a good way of relieving pain and swelling and is often advised where a muscle tear is suspected. Heat is contraindicated in such a situation as this is likely to make the problem worse by increasing blood flow to the area.
- If the cervicalgia is due to muscle tension rather than an injury then thermotherapy can be effective in aiding relaxation of the muscle and relieving neck pain.
- Adequate rest and the temporary use of a supportive neck collar is also helpful in some cases of cervicalgia. Don’t use a collar for longer as this may itself lead to muscle weakness in the neck.
- Anti-inflammatory medications, including prescribed drugs, over-the-counter remedies, and natural supplements to lower inflammation and pain are also used as cervicalgia treatment.
- Physical therapy, including neck stretches and strengthening exercises, is a good idea for anyone who suffers from chronic neck pain.
ICD 9 Code for Cervicalgia
ICD-9-CM 723.1 is a billable medical code that is used for Cervicalgia. However, 723.1 should only be used for claims with a date of service on or before September 30, 2015. For claims with a date of service on or after October 1, 2015, use an equivalent ICD-10-CM code (or codes).
On converting ICD 9 to ICD-10-CM, 723.1 changes directly to ICD-10-CM M54.2
It is a disorder characterized by marked discomfort sensation in the neck area. Following is a list of approximate synonyms which may also used this code. These include:
Acute neck pain < 3 months
Cervical spine pain
Cervical spine pain greater than 3 months, chronic
Cervical spine pain, less than 3 months, acute
Cervical spine problem, chronic, > 3 months
Chronic disorder of cervical spine greater than three months
Chronic neck pain
Chronic neck pain > 3 months
Chronic neck pain for greater than 3 months
Chronic neck pain greater than 3 months
Neck pain less than 3 months, acute
Neck pain, chronic
Pain in cervical spine for less than 3 months
Pain in cervical spine for more than 3 months
Pain, cervical (neck) spine, acute less than 3 months
Pain, cervical (neck), chronic, more than 3 months
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Get prepared by finding out exactly what you'll learn in your medical billing classes...
No matter which medical billing program you choose, the basics of learning medical billing remain the same.
Although this isn't a representation of actual medical billing programs or a course of study, your medical billing classes should all contain the fundamental elements of learning how to be a medical biller and work in a medical office setting.
Even if you aren't going to be coding yourself, medical billing requires an understanding of the essential elements of coding.
In a typical medical setting there are three standardised code sets (ICD-9, CPT, and HCPCS Level II). These translate the patient visit into numbers, which are sent to patient insurance companies in claims for payment.
ICD-9 codes are the diagnosis codes, and contain from three to five numbers. In 2013, this entire code set is scheduled to change to the ICD-10 code set, which includes a more detailed and specific set of diagnosis codes.
CPT codes represent the procedures performed by the provider to the patient, on the date of service. They are typically five numbers long. These include everything from the physical examination to surgeries, and everything in between.
HCPCS Level II codes represent the supplies and services used in performing medical procedures. They are five digits long, and include one letter and four numbers. These include durable medical equipment, medicine codes, and ambulance or transportation codes.
If you're a medical biller, you'll not have to assign these codes. But you'll still need to understand them to make sure your claims are billed correctly.
It's important to understand that there are many different types of providers. It's not technically correct to use the term "doctor" in every case - often patients aren't seen by doctors, but by mid-level providers.
This distinction is necessary because insurance companies usually pay less for care provided by Physician Assistants (PA) and Nurse Practitioners (NP).
Billing for NPs and PAs depends on your local state requirements. This is why you'll generally see the term "provider" or "practitioner" rather than "doctor."
In your medical billing classes, you'll also learn that not all patients pay for their medical services the same way...
Self-pay patients: Patients without medical insurance are considered self-pay patients. They usually pay up front for their medical services, or work out a payment arrangement with the billing office.
This is where medical billers come in.
Many times, medical offices will help self-pay patients by giving them special discounts or extended payment plans, depending on the amount of money owed and procedures performed.
Commercial Insurance: The majority of patients in the medical industry have some sort of commercial insurance. This means that they pay a monthly premium to a private health insurance carrier, in return for payment on their medical claims.
Learn how commercial health insurance companies calculate their premium prices and make money.
Providers send claims to insurance companies, who review the claim and determine if it meets all the necessary requirements to make a payment.
Many commercial plans require some sort of patient co-payment, co-insurance, or deductible, which is a type of cost-sharing. In this case, the insurance company requires a small payment from the patient in addition to sending their payment on the claim.
Government Insurance: The United States government provides medical insurance to specified portions of the population, depending on their age and income level. There are different types of government insurance, the largest of which is Medicare.
Medicare is administered through the Centers for Medicare and Medicaid Services (CMS), which sets the standard for most insurance practices throughout the country, both government and commercial.
There are different types of Medicare, ranging from Type A to Type D. Each type includes coverage for specific types of medical claims. These range from coverage for prescription only, to doctor visits only, and to doctor plus hospital coverage. Medicaid is a type of Medicare that covers eligible children only.
You may have the option of taking medical billing classes on specific types of government coverage, which will help you learn more about this complicated topic.
Medicare payments for medical services are standardized using a scale of the typical work involved in medical treatments. This scale takes into account:
These three factors are then multiplied by a scale which takes the provider's geographic location into account. This may increase or decrease the payment amount.
Although the RBRVS is implemented and developed by Medicare, many commercial payers also refer to the scale to regulate payment on procedure and supply codes.
This scale is updated regularly, to take into account increasing overhead and malpractice insurance costs as well as changes in geographic elements.
HIPAA, or the Health Insurance Portability and Accountability Act of 1996, was implemented to maintain the privacy and security of patient and insurance data in the electronic age.
Your medical billing classes should teach you the fundamental elements of HIPAA, and how they impact the daily workings of a medical practice.
An essential element of understanding medical billing is knowing what constitutes fraud and abuse.
The majority of fraud is begun on the medical coding side of the equation. It includes using elevated codes to get higher payment from the insurance carrier as well as billing for services that weren't rendered by the provider.
Fraud and abuse is a very serious concern, which is investigated by the government.
Click for more information on medical billing fraud and abuse.
Your medical billing classes will (likely) teach you how to remain in compliance with all insurance and coding requirements.
This includes the implementation of a compliance plan, developed by you and your employer or doctor, which states how your office is going to stay compliant with these many regulations.
Your medical billing and coding classes should also teach you about the essential elements of medical records, and how periodic internal audits work.
Your own office performs these internal audits. They check random patient charts to make sure al the required elements are included and that the claims were billed correctly.
There are many more elements involved in learning what it's really like to be a medical biller. Your medical billing classes will all include different aspects of the medical billing profession.
This is only a small sampling of understanding the many responsibilities of medical billers, and is the tip of the iceberg of what you need to know to be able to do your job correctly!
We also recommend the ebook The Basics of Medical Billing for getting a good grasp of the industry.
If you found this page useful, please click "Like"! Thanks. | <urn:uuid:4ebf43be-e5e4-45ca-b23e-7a833bbfd1a1> | {
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Meme, as cultural replicating unit ...
(Dawkins coined the word in 1976 in his book "The Selfish Gene" as a correlate of genes, using the examples, I think, of a novel or a pretty summer dress, and more particularly of the rabies' virus, which jumps from bodymind to bodymind, due to the parasitical nature of this rabies' form of life).
How is it considered or engaged in the fields of
psychiatry and psychology?
Memes in psychiatry are a very helpful idea explaining a lot.
'Ideas' are another word for memes.
Is it considered at all in psychiatry, for example, in the new or old DSM, or in its mostly European parallel ...?
Diagnosing Psychiatric Disorders: The Synchronization of DSM-5 and ICD-10-CM
"DSM-5 Overview: The Future Manual"
"International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM)"
I was asking these questions of a friend at San Francisco Friends' Meeting this past Sunday, before heading into Quaker Meeting ... My friend replied that memes are 'ideas.'
Meme, as a concept, explains a lot, and emerges only due to Darwin and evolutionary biological thinking to explain cultural phenomena, acting in somewhat parallel ways to genes, which replicate themselves fundamentally ... with 3-100 million species on earth going back 3.5 billion years.
Religion, (like Quakerism, for example), is very memetic. But memes, for example, aren't always helpful or good (sometimes they can be harmful or even deadly, for example), and it can take a Copernicus, and conflict, to change religious memes.
Youtube is a very far reaching 'meme-machine,' in my interpretation.
On the other hand, new memes emerge with time, which can be very therapeutic, such as watsu - water shiatsu - done in warm pools (and which originated at Harbin Hot Springs).
There's an arbitrary aspect to memes.
Here are some wiki subjects about this, where we can add related ideas:
Evolutionary Biology -
Social Science -
Wendell Berry's talk at Yale is on, in many ways, non-harming or care, vis-a-vis sustainable farming and industrialism ...
Yale 2013 Chubb Lecture with Wendell Berry
I'm posting this video here because I'd like to share these ideas or memes by Wendell Berry.
How to cultivate replicating non-harming or care memes, especially given we human primates' common chimpanzee tendencies, in my interpretation, relative to Bonobo chimpanzees, for example? In listening closely and in reading between the lines to Wendell Berry's talk with his interviewers, I wonder if they are examining some aspects or concerns about this, as well.
I found a helpful definition of 'meme' today in the Apple 2.x dictionary ...
an element of a culture or system of behavior that may be considered to be passed from one individual to another by nongenetic means, esp. imitation.
ORIGIN 1970s: from Greek mimēma ‘that which is imitated,’ on the pattern of gene. | <urn:uuid:49de8870-f7de-4e7d-b537-e3a835170ae0> | {
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Symbols and Naming Conventions
Netter Anatomy Plates
Part I: Introduction
ICD-10-CM Official Guidelines for Coding and Reporting 2011
Part II: Alphabetic Index
Index to Diseases and Injuries
Table of Neoplasms
Table of Drugs and Chemicals
External Cause Index
Part III: Tabular List of Diseases and Injuries
1. Certain Infectious and Parasitic Diseases (A00-B99)
2. Neoplasms (C00-D49)
3. Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism (D50-D89)
4. Endocrine, Nutritional, and Metabolic Diseases (E00-E90)
5. Mental and Behavioral Disorders (F01-F99)
6. Diseases of Nervous System (G00-G99)
7. Diseases of Eye and Adnexa (H00-IH59)
8. Diseases of Ear and Mastoid Process (H60-H59)
9. Diseases of Circulatory System (I00-I99)
10. Diseases of Respiratory System (J00-J99)
11. Diseases of Digestive System (K00-K94)
12. Diseases of Skin and Subcutaneous Tissue (L00-L99)
13. Diseases of the Musculoskeletal System and Connective Tissue (M00-M99)
14. Diseases of Genitourinary System (N00-N99)
15. Pregnancy, Childbirth, and the Puerperium (O00-O99)
16. Certain Conditions Originating in the Perinatal Period (P00-P96)
17. Congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99)
18. Symptoms, signs, and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99)
19. Injury, poisoning, and certain other consequences of external causes (S00-T88)
20. External Causes of Morbidity (V01-Y95)
21. Factors influencing health status and contact with health services (Z00-Z99)
Code more efficiently and effectively with Carol J. Buck's 2014 ICD-10-CM Draft Edition. Designed by coders for coders, this reference combines Netter's Anatomy illustrations and the Official Guidelines for Coding and Reporting. It simplifies ICD-10 diagnosis to ensure the most accurate billing and optimal reimbursement for outpatient medical services. Full-color images and clear explanations of A&P, pathology, and medical terminology make it easy to develop the knowledge needed to assign the appropriate ICD-10-CM codes.
- At-a-glance Guide to the Updates lists all new and revised codes, providing quick access to the annual changes.
- Official Guidelines for Coding and Reporting (OGCRs) are listed and also integrated within the code set, providing fast, easy access to the official coding rules.
- Unique! Full-color Netter’s anatomy art is cross-referenced within the Tabular List to help you understand anatomy and how it will affect choosing codes.
- More than 150 full-color illustrations provide visual orientation and help you understand difficult terminology, diseases/conditions, or coding in a specific category.
- Additional elements within specific codes define terms and supply additional coding instruction to aid in understanding difficult terminology, diseases and conditions, or coding in a specific category.
- Symbols and highlights show which codes are an Unacceptable Principle Diagnosis and identify codes that call for the use of additional character(s).
- eBook ISBN:
- eBook ISBN:
- eBook ISBN:
Former Program Director, Medical Secretarial Programs, Northwest Technical College, East Grand Forks, MN | <urn:uuid:00508920-eb7d-4395-a910-c4bc730865b3> | {
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Dating 9's and 10's worksheet answers
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Drugs: Use, Abuse and Addiction - Lesson Plan (Grades 9 & 10
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Numeric Patterns - Teach-nology
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merits attention. Cubital tunnel syndrome may happen when a person frequently bends the elbows, leans on their elbow a lot, or has an injury to the area. (Noun) The skin covering the elbow over the funny bone. os sesamoideum tricipitale - patella cubiti. Synonyms and Keywords. The thumb is distal to the wrist. (T OR F) Dorsal and posterior are synonyms for spinal side of the body. The anterior is the front (or towards the front) of a person's body.
Define elbow. Numbness, feeling of weakness, tingling sensation in the elbow joint may be observed, if the surrounding nerves are pinched. sentences. need for attention. The answer is d, posterior. Structually, the joint is classed as a synovial joint, and functionally as a hinge joint. Distal refers to sites located away from a specific area, most often the center of the body. In conjunction with the shoulder joint and wrist, the elbow gives the arm much of its versatility, as well as structure and durability. The arm is then adducted 10-15 degrees across the body. 'He nudged her with his elbow, reminding her gently, 'Some girls go for older guys.''. Cubital tunnel syndrome is a problem with the ulnar nerve, which passes through the inside of the elbow.
Deltoid - curve of shoulder formed by large deltoid muscle. Definitions by the largest Idiom Dictionary.
There are several synovial folds of the elbow. This is the midline. Cookies allow us to analyze and store information such as the characteristics of your device as well as certain personal data (e.g., IP addresses, navigation, usage or geolocation data, unique identifiers). (Adult / Slang) (Noun) The stretchy skin on the elbow.
Elbow joint Articulatio cubiti 1/5 The elbow joint is a synovial joint found in the upper limb between the arm and the forearm. Rapidly raise the forearm of the child towards arm and flex the elbow >90 degrees. Antonyms for elbows. verb (used without object) to elbow one's way: He elbowed through the crowd.
elbow . Define at elbow.
Synonyms arm sleeve 6. elbow noun. noun. Classic Thesaurus. Decreased range of motion of the elbow. An angular body resembling a flexed elbow. The region of the upper limb between arm and forearm surrounding the elbow joint, especially posteriorly. ; Physiotherapy - can use a variety of treatments.
Noun Emotional or mental shock or distress, which may lead to long-term neurosis shock stress distress pain suffering strain upheaval upset anguish disturbance misery torture worry agony jolt ordeal grief heartache sorrow disorder heartbreak trial tribulation trouble adversity anxiety burden hardship nightmare blow collapse confusion derangement Some of the muscles in your forearm attach to the bone on the outside of your elbow.
Just a transient diaphragmatic spasm. elbow grease phrase.
'people jostled against us'. 1. the bone that connects your shoulder to your elbow. 3. weenis rate.
Transient Diaphragmatic Spasm. . 2 n-uncount If there is enough elbow room in a place or vehicle, it is not too small or too crowded. More example sentences. elbow 90 angle elbow with female threads at both ends n. 1. a.
The 2022 edition of ICD-10-CM M67.823 became effective on October 1, 2021. Inability to bend or straighten the elbow. [with object] 1 Push, elbow, or bump against (someone) roughly, typically in a crowd.
antonyms. ; Pain relief - in the form of ice, creams/gels, tablets or patches. Noun Plural for the joint between the forearm and the upper arm ancones crazy bones funny bones ulnar nerves "The sleeves ended between her elbow and her shoulder, and the overall effect was stunning." Noun Plural for something resembling an elbow, in particular, something bent through, or at, an angle joints bends curves angles corners crooks
c. Distal. ['lbo'] the part of a sleeve that covers the elbow joint. Diagnosis is made clinically with a decrease in internal rotation, increase in external rotation, with a decrease in . Show Sources . Rest, ice, compression and elevation are the best treatment for tennis elbow, followed up with specific exercise and physical therapy. Find 28 ways to say FLARE, along with antonyms, related words, and example sentences at Thesaurus.com, the world's most trusted free thesaurus. something bent like an elbow, as a sharp turn in a road or river, or a piece of pipe bent at an angle. medico See definition of medico on Dictionary.com as in doctor synonyms for medico Compare Synonyms expert physician professor scientist specialist surgeon MD bones doc healer intern medic quack general practitioner medical person antonyms for medico MOST RELEVANT patient
EMT chapter 5- Medical Terminology. in need of treatment. Typically, lateral refers to the outer side of the body part, but it is also used to refer to the side of a body part.
Definition of ulna 1 n-uncount Elbow room is the freedom to do what you want to do or need to do in a particular situation. Medial tennis elbow, or medial epicondylitis, is caused by forceful, repetitive contractions from muscles located on the inside of the forearm. 9 letter words. UK / hjumrs / Word Forms +-singular: humerus: plural: humeri: DEFINITIONS 1. 2. verb. Dr. Andrew Dixon demonstrates how to treat a pulled elbow. Posterior is another word for a person's backside. Learn more. Synonyms for elbows in Free Thesaurus. At home, put ice on the elbow. elbow room.
Saeb Mestrihi, the head of the medical team who performed the operations, said that "we performed a bone calcification operation on a patient who could not move his elbow joint due to an accident." The . elbow definition: 1. the part in the middle of the arm where it bends, or the part of a piece of clothing that covers. In conjunction with the shoulder joint and wrist, the elbow gives the arm much of its versatility, as well as structure and durability.
'people were nudging each other and pointing at me'. . Synonyms of elbowed to force one's way the sort of greedy person who is always the first to elbow to the front of the buffet table at every party Synonyms for elbowed bored, bulldozed, bulled, crashed, jammed, jostled, muscled, pressed, pushed, shouldered, squeezed See the Dictionary Definition Test Your Vocabulary Name That Food Cubital tunnel syndrome may happen when a person frequently bends the elbows, leans on their elbow a lot, or has an injury to the area. 1515 E. Woodfield Road, Suite 345 Schaumburg, IL 60173 P: (847) 698-1629 | F: (847) 698-9499 | firstname.lastname@example.org American Shoulder And Elbow Surgeons weenis rate. All of the forearm muscles are involved in tennis serves, when combined motions of the elbow and wrist are employed.
24 other terms for behavioural disturbances- words and phrases with similar meaning. An elbow dislocation is a serious injury that needs medical care. Define elbow joint. to make (one's way) by so pushing. The patient lost so much weight his _______ were sunken in. The joint between the arm and the forearm. thesaurus. The elbow joint is classified structurally as a synovial joint. The elbow is the joint connecting the proper arm to the forearm. (=leeway) His speech was designed to give himself more political elbow room. Reviewed on 3/29/2021. There are six options for the management of tennis elbow:. 3. Lateral: 1. Log in. Synonyms of elbows to force one's way the sort of greedy person who is always the first to elbow to the front of the buffet table at every party Synonyms for elbows bores, bulldozes, bulls, crashes, jams, jostles, muscles, presses, pushes, shoulders, squeezes See the Dictionary Definition Test Your Vocabulary Great Words for Scrabble os subepicondylare mediale. synonyms. This helps to reduce wrist pressure and maintain better posture and mobility control. Arthritis is a term that describes around 200 conditions that cause pain in the joints and the tissues surrounding the joints. Posterior Body Landmark. This overuse injury is common between ages 20 and 40. ; Supports - usually in the form of a supportive strap. Nursemaid elbow is thought to be secondary to the likelihood of . wrist. 'On it, you're . at elbow synonyms, at elbow pronunciation, at elbow translation, English dictionary definition of at elbow.
This information is intended for medical education, and does not create any doctor-patient . Olecranal - posterior surface of elbow. Lateral elbow tendinopathy, commonly known as tennis elbow, is a condition that can cause significant functional impairment in working-age patients. fractured elbow, injured elbow, swollen elbow, elbow trauma, broken elbow. Changing your activities - rest and/or changing the way you use your arm. elbow synonyms, elbow pronunciation, elbow translation, English dictionary definition of elbow. Verb The actor's bodyguards rudely elbowed everyone out of the way. In this . Medicine is a discipline full of prefixes that show location.
Distal is the opposite of proximal.
The part of the muscle that attaches to a bone is called a tendon. Synonyms of elbow to force one's way the sort of greedy person who is always the first to elbowto the front of the buffet table at every party Synonyms for elbow bore, bull, bulldoze, crash, jam, jostle, muscle, press, push, shoulder, squeeze Words Related to elbow ram, It causes pain that feels a lot like the pain you feel when you hit the "funny bone" in your elbow. Nice work! [with object] 1 Prod (someone) gently with one's elbow in order to attract attention. Nice work! Lists.
Your tonsils can get swollen when you have a sore. The . ; Steroid injection. . Medial means towards the midline, lateral means away from the midline. Over time, the tendon cannot heal, and this leads to irritation and pain where the tendon is attached to the bone. ALLOWANCE - APARTMENT - CLEARANCE - ELBOW ROOM - ELBOWROOM - ENTERTAIN - FAIR FIELD - FREE SCOPE - FREEBOARD - FULL SCOPE - FULL SWING - HAIR SPACE - HALF SPACE - OPEN SPACE - PARTITION - SPARE ROOM - TOLERANCE - WIDE BERTH. elbow 90 angle elbow with female threads at both ends n. 1. a. Here, we address 11 myths about chronic obstructive pulmonary disease (COPD). It causes pain that feels a lot like the pain you feel when you hit the "funny bone" in your elbow. os subepicondylare laterale - paratrochlear bone. The volume of the joint capsule is 24-30 mL 9.
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By American College of Sports Medicine
Read Online or Download ACSM's Resource Manual for Guidelines for Exercise Testing and Prescription (Ascms Resource Manual for Guidlies for Exercise Testing and Prescription) PDF
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Choose prognosis codes correctly with Carol J. Buck's 2016 ICD-10-CM for Physicians: expert version. Designed by way of coders for coders, this full-color handbook contains the entire ICD-10 codes wanted for today’s outpatient and physician-based coding. As coders desire extra huge wisdom to paintings with ICD-10-CM — and to select from the hundreds of thousands of attainable codes — this variation presents a necessary heritage in A&P, pathology, and scientific terminology, besides colourful Netter’s Anatomy illustrations and transparent directions for utilizing the ebook.
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Additional resources for ACSM's Resource Manual for Guidelines for Exercise Testing and Prescription (Ascms Resource Manual for Guidlies for Exercise Testing and Prescription)
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Information for Patients
Also called: Food Poisoning
Each year, around 48 million people in the United States get sick from contaminated food. Common causes include bacteria and viruses. Less often, the cause may be a parasite or a harmful chemical, such as a high amount of pesticides. Symptoms of foodborne illness depend on the cause. They can be mild or serious. They usually include
- Upset stomach
- Abdominal cramps
- Nausea and vomiting
Most foodborne illnesses are acute. This means that they happen suddenly and last a short time.
It takes several steps to get food from the farm or fishery to your dining table. Contamination can happen during any of these steps. For example, it can happen to
- Raw meat during slaughter
- Fruits and vegetables when they are growing or when they are processed
- Refrigerated foods when they are left on a loading dock in warm weather
But it can also happen in your kitchen if you leave food out for more than 2 hours at room temperature. Handling food safely can help prevent foodborne illnesses.
Most people with foodborne illness get better on their own. It is important to replace lost fluids and electrolytes to prevent dehydration. If your health care provider can diagnose the specific cause, you may get medicines such as antibiotics to treat it. For more serious illness, you may need treatment at a hospital.
NIH: National Institute of Diabetes and Digestive and Kidney Diseases
- Food poisoning (Medical Encyclopedia)
- Foodborne Illness-Causing Organisms in the U.S.: What You Need to Know (Food and Drug Administration)
- Gastritis (Medical Encyclopedia)
- Poisoning - fish and shellfish (Medical Encyclopedia)
- Shigellosis (Medical Encyclopedia)
General Equivalence Map Definitions
The ICD-10 and ICD-9 GEMs are used to facilitate linking between the diagnosis codes in ICD-9-CM and the new ICD-10-CM code set. The GEMs are the raw material from which providers, health information vendors and payers can derive specific applied mappings to meet their needs.
- Approximate Flag - The approximate flag is on, indicating that the relationship between the code in the source system and the code in the target system is an approximate equivalent.
- No Map Flag - The no map flag indicates that a code in the source system is not linked to any code in the target system.
- Combination Flag - The combination flag indicates that more than one code in the target system is required to satisfy the full equivalent meaning of a code in the source system. | <urn:uuid:7ea79bc0-9bcf-42ef-bf5f-cf2fcaa4cf5f> | {
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New York City is one of the top twenty “Asthma Capitals” in the United States, a designation based on asthma prevalence, asthma-related emergency visits, and asthma-related fatalities.i The City also has the third highest rate of asthma-related deaths in the country.ii
Data on provider documentation practices can inform new population health and clinical approaches to improving patient outcomes. The Evaluation, Research and Analysis team at the Primary Care Information Project (PCIP) reviewed the documentation of asthma severity in pediatric and adult patients. The findings present an opportunity to improve asthma severity documentation, which is important for patient treatment, targeted interventions, and claims reporting.
Using data from aggregate electronic health records (EHR), the team reviewed the use of ICD-10 codes to document the specificity of a patient’s asthma condition. Under the expanded ICD-10, coding allows for asthma diagnoses to be classified by severity with greater specificity. Aggregated data were limited to the number of patients who visited a provider in 2016 and had an ICD-10 asthma code in their problem list or assessment. A total of 619 practices, accounting for 1.7 million patients, contributed data.
The most commonly selected asthma diagnosis codes were “unspecified” and “other.” These two codes were used twice as often as any of the more specific ICD-10 severity codes. Of the patients, 7.2 percent had an asthma diagnosis, but only half of those patients had a diagnosis that specified the severity of their condition. The findings show that severity codes were used less for adult patients than for pediatric patients, even though asthma is typically more severe in adults (adults are four times more likely than children to die from asthmaiii). “Mild intermittent” was the most commonly used severity code across all practice types and patient demographics. Pediatric practices were more likely to use severity codes than other practice types.
The data show a similar pattern to previous findings on the distribution of asthma in New York City: the South Bronx (16.4%) and East Harlem (10.8%) are asthma hotspots, and children aged 5 to 11 had the highest prevalence of any age group (12.8%).
Detailed documentation of asthma severity may lead to improved patient outcomes. Knowing the severity of asthma is an important indicator for treatment and management. Using ICD-10 severity codes can help better manage patients’ asthma and prevent avoidable hospitalizations and emergency room visits.iv Communicating this information to patients helps them understand their own condition, and documenting severity is useful to other care providers who may be unfamiliar with a patient’s medical history. The use of severity codes can also help identify patients with severe or poorly managed asthma and, in turn, public health or health systems can develop more targeted, effective population-based interventions.
The codes used in documentation for disease severity impact provider’s evaluation of care and related reimbursements. The use of unspecified codes may result in payment delays and unnecessary claim denials by the Centers for Medicare & Medicaid Services (CMS) and other payers. CMS requires the use of 5th or 6th character placement to report the highest level of specificity (for asthma and for other conditions).v
Aggregated information from over 600 practices suggests that the low usage of ICD-10 severity codes may be the result of issues accessing codes in EHR systems. For example, several providers did not know to use the severity codes because their EHR system was not fully updated.
The table to the right lists ICD-10 codes available for specifying asthma severity. Providers should be able to see all of these codes and select any of them in their EHR. If not, providers should contact their EHR vendor.
Consider taking a few minutes to review clinical documentation and ensure codes align with the severity documented in the patient’s health record.
For a step-by-step guide to updating and mapping ICD, CPT, and LOINC codes in eClinicalWorks, watch the Electronic Health Record Tips & Tricks webinar on the NYC REACH resource library at www.nycreach.org (Electronic Health Record Assistance folder).
Please contact email@example.com for further assistance.
Contributing Research Staff
Emily Martinez, MPH; Jenny Smolen, MPH; Charlene Ngamwajasat, MD; Katherine Kaye, MD; Sachin Jain, MD, MPH; Samantha De Leon, PhD; Sarah Shih, MPH.
i. Asthma Capitals 2018. Asthma and Allergy Foundation of America. http://www.aafa.org/media/AAFA-2018-Asthma-Capitals-Report.pdf. Accessed November 2018.
ii. Asthma Capitals 2018. Asthma and Allergy Foundation of America. http://www.aafa.org/media/AAFA-2018-Asthma-Capitals-Report.pdf. Accessed November 2018.
iii. Asthma Facts and Figures. Asthma and Allergy Foundation of America. http://www.aafa.org/page/asthma-facts.aspx. Accessed November 2018.
iv. Asthma Care Quick Reference. U.S. Department of Health and Human Services, National Institutes of Health, National Heart, Lung, and Blood Institute. https://www.nhlbi.nih.gov/files/docs/guidelines/asthma_qrg.pdf. Accessed November 2018.
v. 2019 ICD-10-CM. Centers for Medicare & Medicaid Services https://www.cms.gov/Medicare/Coding/ICD10/2019-ICD-10-CM.html . Accessed November 2018.
vi. Asthma Care Quick Reference: Diagnosing and Managing Asthma. U.S. Department of Health and Human Services, National Institutes of Health, National Heart, Lung, and Blood Institute. https://www.nhlbi.nih.gov/files/docs/guidelines/asthma_qrg.pdf. Accessed November 2018. | <urn:uuid:7ff43319-156c-4b8e-ab1d-97f1d487b1c6> | {
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Information for Patients
Fetal Health and Development
A normal pregnancy lasts nine months. Each three-month period of pregnancy is called a trimester. During each trimester, the fetus grows and develops. Regular medical checkups and prenatal tests are very important. They can
- Help keep you and your baby healthy
- Spot problems with your baby (if there are any). In some cases, health care professionals can treat the problem before your baby is born. But even when they cannot, it can still be helpful to know about the problem early on. That gives you time to learn about your baby's condition and prepare for any challenges you may face after the baby is born.
- Prevent problems during delivery. For example, if your baby is breech (bottom first or feet first, instead of head first), you may need to have a Cesarean section to avoid complications.
Besides getting medical care, there are other things you can do to keep your baby as healthy as possible. It's important not to drink or smoke. Try to eat a healthy diet and make sure to take care of any health problems you have during pregnancy.
- Fetal development (Medical Encyclopedia)
- Intrauterine growth restriction (Medical Encyclopedia)
Infections and Pregnancy
During pregnancy, some common infections like the common cold or a skin infection do not usually cause serious problems. But other infections can be dangerous to you, your baby, or both. Some infections may lead to preterm birth and low birth weight babies. Others can cause serious illness, birth defects, and lifelong disabilities, such as hearing loss or learning problems.
Some of the infections that can be dangerous during pregnancy include
- Bacterial vaginosis (BV)
- Group B strep (GBS)
- Sexually transmitted diseases
- Urinary tract infections
- Yeast infections
- Zika virus
To try to prevent infections,
- Don't eat raw or undercooked meat
- Don't share food or drinks with other people
- Wash your hands frequently
- Don't empty cat litter. Cats can transmit toxoplasmosis.
If you do get an infection during pregnancy, contact your health care provider about how best to protect you and your baby. Only some medicines are safe during pregnancy.
- Group B streptococcal septicemia of the newborn (Medical Encyclopedia)
- Group B streptococcus - pregnancy (Medical Encyclopedia)
- Immunization and Pregnancy (Centers for Disease Control and Prevention)
- Pregnancy and the flu (Medical Encyclopedia)
- Pregnant Women Need a Flu Shot (Centers for Disease Control and Prevention)
- Protect Your Baby for Life: When a Pregnant Woman Has Hepatitis B (Centers for Disease Control and Prevention)
- Toxoplasmosis: An Important Message for Women (Centers for Disease Control and Prevention)
General Equivalence Map Definitions
The ICD-10 and ICD-9 GEMs are used to facilitate linking between the diagnosis codes in ICD-9-CM and the new ICD-10-CM code set. The GEMs are the raw material from which providers, health information vendors and payers can derive specific applied mappings to meet their needs.
- Approximate Flag - The approximate flag is on, indicating that the relationship between the code in the source system and the code in the target system is an approximate equivalent.
- No Map Flag - The no map flag indicates that a code in the source system is not linked to any code in the target system.
- Combination Flag - The combination flag indicates that more than one code in the target system is required to satisfy the full equivalent meaning of a code in the source system. | <urn:uuid:6e0b2913-0e25-46ab-ab15-20111cdbcf91> | {
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Information for Patients
Optic Nerve Disorders
The optic nerve is a bundle of more than 1 million nerve fibers that carry visual messages. You have one connecting the back of each eye (your retina) to your brain. Damage to an optic nerve can cause vision loss. The type of vision loss and how severe it is depends on where the damage occurs. It may affect one or both eyes.
There are many different types of optic nerve disorders, including:
- Glaucoma is a group of diseases that are the leading cause of blindness in the United States. Glaucoma usually happens when the fluid pressure inside the eyes slowly rises and damages the optic nerve.
- Optic neuritis is an inflammation of the optic nerve. Causes include infections and immune-related illnesses such as multiple sclerosis. Sometimes the cause is unknown.
- Optic nerve atrophy is damage to the optic nerve. Causes include poor blood flow to the eye, disease, trauma, or exposure to toxic substances.
- Optic nerve head drusen are pockets of protein and calcium salts that build up in the optic nerve over time
Contact your health care provider if you are having vision problems. Tests for optic nerve disorders may include eye exams, ophthalmoscopy (an examination of the back of your eye), and imaging tests. Treatment depends on which disorder that you have. With some optic nerve disorders, you may get your vision back. With others, there is no treatment, or treatment may only prevent further vision loss.
- Optic glioma (Medical Encyclopedia)
- Optic nerve atrophy (Medical Encyclopedia)
- Optic neuritis (Medical Encyclopedia)
Syphilis is a sexually transmitted disease caused by bacteria. It infects the genital area, lips, mouth, or anus of both men and women. You usually get syphilis from sexual contact with someone who has it. It can also pass from mother to baby during pregnancy.
The early stage of syphilis usually causes a single, small, painless sore. Sometimes it causes swelling in nearby lymph nodes. If you do not treat it, syphilis usually causes a non-itchy skin rash, often on your hands and feet. Many people do not notice symptoms for years. Symptoms can go away and come back.
The sores caused by syphilis make it easier to get or give someone HIV during sex. If you are pregnant, syphilis can cause complications, or you could lose your baby. In rare cases, syphilis causes serious health problems and even death.
Syphilis is easy to cure with antibiotics if you catch it early. Correct usage of latex condoms greatly reduces, but does not completely eliminate, the risk of catching or spreading syphilis. The most reliable way to avoid infection is to not have anal, vaginal, or oral sex.
Centers for Disease Control and Prevention
- Condom Fact Sheet in Brief (Centers for Disease Control and Prevention)
- Congenital syphilis (Medical Encyclopedia)
- CSF-VDRL test (Medical Encyclopedia)
- FTA-ABS test (Medical Encyclopedia)
- Neurosyphilis (Medical Encyclopedia)
- RPR test (Medical Encyclopedia)
- Syphilis (Centers for Disease Control and Prevention)
- Syphilis - primary (Medical Encyclopedia)
- Syphilis and MSM (Men Who Have Sex with Men) (Centers for Disease Control and Prevention)
- VDRL test (Medical Encyclopedia)
General Equivalence Map Definitions
The ICD-10 and ICD-9 GEMs are used to facilitate linking between the diagnosis codes in ICD-9-CM and the new ICD-10-CM code set. The GEMs are the raw material from which providers, health information vendors and payers can derive specific applied mappings to meet their needs.
- Approximate Flag - The approximate flag is on, indicating that the relationship between the code in the source system and the code in the target system is an approximate equivalent.
- No Map Flag - The no map flag indicates that a code in the source system is not linked to any code in the target system.
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The Complexity of Eating disorder response Recovery in the Digital Age
Through this week’s Learning Resources, you become aware not only of the prevalence of factors involved in the treatment of eating disorders, but also the societal, medical, and cultural influences that help individuals develop and sustain the unhealthy behaviors related to an eating disorder. These behaviors have drastic impacts on health. In clinical practice, social workers need to know about the resources available to clients living with an eating disorder and be comfortable developing interdisciplinary, individualized treatment plans for recovery that incorporate medical and other specialists.
For this Discussion, you focus on guiding clients through treatment and recovery.
- Review the Learning Resources on experiences of living with an eating disorder, as well as social and cultural influences on the disorder.
- Read the case provided by your instructor for this week’s Discussion.
address the following:
- Provide the full DSM-5 diagnosis for the client. Remember, a full diagnosis should include the name of the disorder, ICD-10-CM code, specifiers, severity, and the Z codes (other conditions that may be a focus of clinical attention). Keep in mind a diagnosis covers the most recent 12 months.
- Explain the diagnosis by matching the symptoms identified in the case to the specific criteria for the diagnosis.
- Explain why it is important to use an interprofessional approach in treatment. Identity specific professionals you would recommend for the team, and describe how you might best utilize or focus their services.
- Explain how you would use the client’s family to support recovery. Include specific behavioral examples.
- Select and explain an evidence-based, focused treatment approach that you might use in your part of the overall treatment plan.
- Explain how culture and diversity influence these disorders. Consider how gender, age, socioeconomic status, sexual orientation, and/or ethnicity/race affect the experience of living with an eating disorder.
Post a 300- to 500-word response
Psychiatry Online | DSM Library
A narrative review of binge eating disorder in adolescence: prevalence, impact, and psychological treatment strategies – DOAJ
Starving for the Good: An Anorexic’s Search for Meaning & Perfection | Elisabeth Huh | TEDxUChicag | <urn:uuid:998c8f46-9735-42cf-87c3-13ad4bb7f39f> | {
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In the Veterans Affairs (VA) population, roughly the same percentage of women and men are Hispanic or missing race and ethnic information, while more women are non-Hispanic black compared with men (15%-27% for women over time v. 10%-16% for men) and correspondingly a greater fraction of men are non-Hispanic whites than women.
Chart Explanation: The chart shows the distribution of race/ethnicity by year, by age, and by year and gender. The y-axis (vertical line) shows the percentage of patients. The x-axis (horizontal line) shows the race groups by either year, age groups, or year and gender.
The VA data presented are from a national sample of health care visits to the VA Health System by eligible U. S. veterans. During any given year, ~ 70% of the outpatient population receives a serum creatinine test. While the demographics of VA Health System users are distinct from the general U.S. population, the VA data allow a ‘snapshot’ of clinical practices across the nation.
National VA data were examined for veterans with at least one outpatient visit during the federal fiscal year. To estimate prevalence of CKD, outpatient serum creatinine laboratory results (averaged if a patient had more than one test during the fiscal year) were used to calculate an estimated glomerular filtration rate (eGFR) for each patient using the CKD-EPI equation, excluding dialysis and transplant patients. Estimated GFR (kidney function) was classified into five CKD categories (eGFR =90, eGFR 60-89, stage 3=eGFR 30-59, stage 4=eGFR 15 to 29, and stage 5 without dialysis=eGFR<15 ml/min/1.73 m² and “eGFR Unmeasured” for those patients without serum creatinine testing. Inpatient serum creatinine data were not used as they would be affected by the presence of acute illnesses. Due to the infrequency of testing, albuminuria was not included in the definition of CKD. Dialysis patients were defined by clinic stop-codes (602-611), outpatient procedure codes for dialysis (CPT4: 90921 and 90925), outpatient diagnosis codes (ICD-9-CM: 585.6, V56, V45.1 and E87.91 and ICD-10-CM: N186, Y841, Z4931, Z4901, Z4902, Z4931, Z4932, and Z4933) to indicate dialysis. Kidney transplant patients were identified by inpatient and outpatient ICD-9-CM diagnosis code V420, 99681, ICD-10 CM diagnosis code T86X, Z4822 and Z940, and inpatient procedure and surgery codes (55.69).
This material is the result of work supported with resources and the use of facilities at the VA Ann Arbor Health Care System, Ann Arbor, Michigan.
|Description of Measure||Race/ethnicity within gender|
|Type of Data Source||Administrative|
|Data Set||VA National Data, using the MedSAS data files|
|Health Care System Data||Yes|
|Regional or National?||National|
|Demographic Group||Patients in VA health plan|
|Numerator||Patients in denominator of each race/ethnicity group |
|Denominator||Patients >20 years old and who had outpatient visit of specified gender (i.e., male or female)|
|Primary Data Source Indicator||Race/Ethnicity|
|Primary Indicator Method of Measurement||Outpatient and inpatient visits|
|Secondary (1) Variable||Gender: Sex|
|Secondary (1) Indicator Method of Measurement||Outpatient visit|
|Frequency of Measurement (Primary)||Multiple measurements per patient|
|U.S. Region Covered by Primary Variable||All|
|Period Currently Available||2005–2018|
|Analytical Considerations||Race and ethnicity must be examined separately| | <urn:uuid:865f3523-df89-4315-999e-0a5b91b1308e> | {
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- Acute Conditions –
The medical conditions characterized by sudden onset, severe
change, and/or short duration.
- Additional Diagnosis –
The secondary diagnosis code used, if available, to provide
a more complete picture of the primary diagnosis.
- Bilateral – For bilateral
sites, the final character of the codes in the ICD-10-CM
indicates laterality. An unspecified side code is also provided
should the side not be identified in the medical record.
If no bilateral code is provided and the condition is bilateral,
assign separate codes for both the left and right side.
- Category – The three-digit
diagnosis code classifications that broadly define each
condition (e.g., 250 for diabetes mellitus).
- Centers for Disease Control and Prevention
(CDC) – A federal health data organization
that helps maintain several code sets included in the HIPAA
standards, including the ICD-9-CM codes. A division of the
Department of Health and Human Services responsible for
monitoring, researching and developing public health policies
for the prevention of disease, injury and disability and
the promotion of healthy behaviors. The National Center
for Health Statistics is the part of the CDC that maintains
health related statistics including the coordination with
World Health Organization (WHO) on use of International
Classification of Diseases (ICD) in North America.
- Chronic Conditions –
Medical conditions characterized by long duration, frequent
recurrence over a long period of time, and/or slow progression
- Combination Codes –
A single code used to classify any of the following: two
diagnoses; a diagnosis with an associated secondary process
(manifestation); or a diagnosis with an associated complication.
- Conventions of ICD-10 –
The general rules for use of the classification independent
of guidelines. These conventions are incorporated within
the Index and Tabular of the ICD-10-CM as instructional
notes. Possible conventions to include with code are:
• Notes – Extra information to
define or clarify code choice.
• Includes Notes – This note appears
immediately under a three character code title to further
define, or give examples of, the content of the category.
• Not otherwise specified (NOS) –
This abbreviation is the equivalent of unspecified.
• Excludes Notes – A type 1 Excludes
note is a pure excludes note. It means “NOT CODED
HERE!” An Excludes1 note indicates that the code excluded
should never be used at the same time as the code above
the Excludes1 note. An Excludes1 is used when two conditions
cannot occur together, such as a congenital form versus
an acquired form of the same condition. A type 2 excludes
note represents “Not included here.” An excludes2
note indicates that the condition excluded is not part of
the condition represented by the code, but a patient may
have both conditions at the same time. When an Excludes2
note appears under a code, it is acceptable to use both
the code and the excluded code together, when appropriate.
• Not elsewhere classifiable (NEC) –
This abbreviation in the Tabular List represents “other
specified.” When a specific code is not available
for a condition the Tabular List includes an NEC entry under
a code to identify the code as the “other specified”
- Crosswalk/mapping –
A new test is determined to be similar to an existing test,
multiple existing test codes, or a portion of an existing
test code. The new test code is then assigned to the related
existing local fee schedule amounts and resulting national
limitation amount. In some instances, a test may only equate
to a portion of a test, and, in those instances, payment
at an appropriate percentage of the payment for the existing
test is assigned.
- Centers for Medicare & Medicaid
Services (CMS) – The federal agency that
runs the Medicare program. In addition, CMS works with the
States to run the Medicaid program. CMS works to make sure
that the beneficiaries in these programs are able to get
high quality healthcare.
- Current Procedural Terminology (CPT
)Codes – This is the procedural coding system
that is currently used in America primarily to report physician
professional services. Frequently called “CPT”,
the Current Procedural Terminology, is a code set, developed
in 1966 and maintained by the American Medical Association
(AMA), used to describe what healthcare professional services
were provided or utilized by healthcare professionals. CPT
codes are also known as “Level I” codes. Additional
codes to describe use of healthcare facilities and services
provided by healthcare professionals are known as “Level
II” or “Healthcare Common Procedure Coding System”
(HCPCS). Level II codes were developed are maintained by
- Federal Register –
The “Federal Register” is the official daily
publication for rules, proposed rules and notices of federal
agencies and organizations, as well as Executive Orders
and other Presidential documents.
- GEMs - This reference mapping
attempts to include all valid relationships between the
codes in the ICD-9-CM diagnosis classification and the ICD-10-CM
- Healthcare Common Procedure Coding
System (HCPCS) – A medical code set that
identifies healthcare procedures, equipment, and supplies
for claim submission purposes. It has been selected for
use in the HIPAA transactions. HCPCS Level I contains numeric
CPT codes which are maintained by the AMA. HCPCS Level II
contains alphanumeric codes used to identify various items
and services that are not included in the CPT medical code
set. These are maintained by Health Care Financing Administration
(HCFA), Blue Cross and Blue Shield Association (BCBSA),
and the Health Insurance Association of America (HIAA).
HCPCS Level III contains alphanumeric codes that are assigned
by Medicaid state agencies to identify additional items
and services not included in levels I or II. These are usually
called "local codes", and must have "W",
"X", "Y", or "Z" in the first
position. HCPCS Procedure Modifier Codes can be used with
all three levels, with the WA - ZY range used for locally
assigned procedure modifiers.
- Health Insurance Portability &
Accountability Act (HIPAA) – A law passed
in 1996 which is also sometimes called the “Kassebaum-Kennedy”
law. This law expands healthcare coverage for patients who
have lost or changed jobs, or have pre-existing conditions.
HIPAA does not replace the states' roles as primary regulators
of insurance. The HIPAA legislation has the following broad
goals, to provide: 1) a way to uniquely identify providers,
employers and health plans, 2) a uniform level of protection
of health information, known as the "Security Rule,"
3) a uniform level of protection of the privacy of health
data associated with patients, known as the "Privacy
Rule" and 4) a simpler healthcare electronic transaction
process by describing standards by which all healthcare
administrative entities would use, which is known as the
“Transactions and Code Sets Rule”.
- HIPAA 4010 – The original
healthcare transactions version of HIPAA (officially known
as Version 004010 of the ASC X12 transaction implementation
guides) named as part of HIPAA’s Electronic Transaction
Standards regulation. Version 4010 was required to be used
by HIPAA covered healthcare entities by Oct. 16, 2003.
- HIPAA 5010 – Required
by Jan. 1, 2012 to be the new version of the HIPAA healthcare
transactions. Officially known as Version 005010 of the
ASC X12 transaction Technical Report Type 3. This new version
was required as a result of Department of Health and Human
Services (HHS) final rules published on Jan. 6, 2009.
- International Classification of Diseases
(ICD) – A medical code set maintained by
the World Health Organization (WHO). The primary purpose
of this code set is to classify both causes of death or
mortality and diseases or morbidity. A U.S. extension, known
as ICD-CM, “Clinical Modification,” is maintained
by the NCHS within the CDC to more precisely define ICD
use in the U.S.
- ICD-9 – The mortality
and morbidity classification coding system that is currently
used throughout most of the world, including the United
States. The ICD-9 classification of death and disease is
based a series of classifications systems first adopted
- ICD-9-CM – The “clinical
modification” to the ICD-9 code set that is currently
used in America to report medical diagnoses. The “Clinical
Modification” refers to the base WHO defined ICD-9
code set that has been defined for use in United State by
the National Center for Health Statistics (NCHS) division
of the Centers for Disease Control (CDC).
- ICD-9-PCS – The procedural
coding system currently used in America primarily for hospital
inpatient services. It is contained in Volume 3 of ICD-9-CM.
- ICD-10 – The mortality
and morbidity classification coding system implemented by
WHO in 1993 to replace ICD-9.
- ICD-10-CM – The updated
version of the clinical modification coding set defined
by the National Center for Health Statistics that will replace
ICD-9-CM no sooner than Oct. 1, 2015.
- ICD-10-PCS – The updated
procedural coding system defined by CMS that will replace
Volume 3 of ICD-9-CM for hospital inpatient services.
- Index (to diseases) –
The ICD-10-CM is divided into the Alphabetic Index, an alphabetical
list of terms and their corresponding code, and the Tabular
List, a chronological list of codes divided into chapters
based on body system or condition. The Alphabetic Index
consists of the following parts: the Index of Diseases and
Injury, the Index of External Causes of Injury, the Table
of Neoplasms and the Table of Drugs and Chemicals.
- Manifestation Codes –
Certain conditions have both an underlying etiology and
multiple body system manifestations due to the underlying
etiology. For such conditions, the ICD-10-CM has a coding
convention that requires the underlying condition be sequenced
first followed by the manifestation. Wherever such a combination
exists, there is a “use additional code” note
at the etiology code, and a “code first” note
at the manifestation code. These instructional notes indicate
the proper sequencing order of the codes, etiology followed
- Medical Necessity –
Services or supplies that: are proper and needed for the
diagnosis or treatment of a medical condition; are provided
for the diagnosis, direct care, and treatment of a medical
condition; meet the standards of good medical practice in
the local area; and are not mainly for the convenience of
the patient or doctor.
- Morbidity – Term refers
to the disease rate or number of cases of a particular disease
in a given age range, gender, occupation, or other relevant
population based grouping.
- Mortality –Term refers
to the death rate reflected by the population in a given
region, age range, or other relevant statistical grouping
- National Center for Health Statistics
(NCHS) – A federal organization within the
CDC that collects, analyzes, and distributes healthcare
statistics. The NCHS helps maintain the ICD-CM codes.
- Principle Diagnosis –
First-listed/primary diagnosis code. The code sequenced
first on a medical record defines the primary reason for
the encounter as determined at the end of the encounter.
- Signs/Symptoms – Codes
that describe symptoms and signs, as opposed to diagnoses,
are acceptable for reporting purposes when a related definitive
diagnosis has not been established (confirmed) by the provider.
- Sequelae – A late
effect is the residual effect (condition produced) after
the acute phase of an illness or injury has terminated.
There is no time limit on when a late effect code can be
used. The residual may be apparent early, such as in cerebral
infarction, or it may occur months or years later, such
as that due to a previous injury.
- Tabular List – It
is essential to use both the Alphabetic Index and Tabular
List when locating and assigning a code. The Alphabetic
Index does not always provide the full code. Selection of
the full code, including laterality and any applicable 7th
character can only be done in the Tabular List. A dash (-)
at the end of an Alphabetic Index entry indicates that additional
characters are required. Even if a dash is not included
at the Alphabetic Index entry, it is necessary to refer
to the Tabular List to verify that no 7th character is required.
- Uniform Hospital Discharge Data Set
(UHDDS) – The UHDDS definitions are used
by hospitals to report inpatient data elements in a standardized
manner. These data elements and their definitions can be
found in the July 31, 1985, Federal Register (Vol. 50, No,
147), pp. 31038-40.
- Volume I – The detailed,
tabular list of diagnosis codes in the ICD-9-CM manual.
- Volume II – The alphabetical
index to diseases in the ICD-9-CM diagnosis coding manual.
- Volume III – The ICD-9/ICD-10
list of procedure codes, used in inpatient settings.
- World Health Organization (WHO)
– An organization that maintains the International
Classification of Diseases (ICD) medical code set.
2011 Official Draft Coding Guidelines – http://www.cdc.gov/nchs/icd/icd10cm.htm#10update
Centers for Medicare & Medicaid Services
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If you prefer clerical tasks over clinical duties, becoming a medical coder is a great way to get involved in the healthcare industry, especially since there are increasing opportunities for employment. The primary duties of a medical coder are to translate medical records into industry standard code. These medical codes are then sent to insurance agencies, government programs, and other organizations. Coding accurately helps healthcare organizations be reimbursed for services they perform, while failing to code adequately will greatly defect institutions’ financial stability.
In order to begin a career in medical coding the first thing to do is to become certified. Some certifications require different coding experience, others require some form of college education, while some certifications have no requirements for eligibility. Medical Coding Certifications
The best medical coding certification programs will usually include:
- Training on HIPAA
- Medical Terminology
- Anatomy and Physiology
- ICD-10 (diagnostic coding)
- CPT (procedural coding)
- Coding Software Programs
- Healthcare reimbursement methodologies
Topics: Medical Coding
The world of healthcare is currently undergoing many changes. One of them being the switch to value based care. Below are some trends successful organizations have implemented to keep up with it all.
Merging healthcare organizations has become and will continue to be a popular choice for many organizations. The healthcare world is all about acquiring patients. One of the best methods to increase a hospitals patient base is to be involved in a merger. Bigger hospitals are more likely to be successful by providing patients with more affordable services. Small organizations will likely stay in a fragile state.
- Technology Advancements
Technology is always advancing. Even though most organizations have implemented different types of technology into their systems, there will always be improving systems that arise. Below are some new technology trends that will be affecting the healthcare world in 2016.
Health Monitoring Devices
It has become quite a popular trend for the public to monitor aspects of personal health by wearing Fit Bits or other similar devices. This can greatly impact and improve patient care. Hopefully people using these devices will be able to pay more attention to their health, and the limitations their body has. When patients are familiar with their vitals, exercising habits, and sleep patterns it may help doctors come up with more accurate diagnoses.
The United States was one of the last countries that transitioned into the ICD-10 code set, which carries a high volume of codes allowing provider’s to be much more detailed in their medical records when compared to ICD-9.
With this new pool of codes, many healthcare experts predicted the transition to ICD-10 would cause quite a bit of disruption for the industry’s profitability. Surprisingly enough, these expectations have not panned out. In fact, those studying the effects of ICD 10 have found minimal effects.
The average productivity decline for the year is 14%, which is much lower than to be expected. Some of this decline in productivity may not even be contributed to the switch to ICD-10. Researchers noted that a new computer-assisted coding technology was introduced around the same time, which could account for some of the decline in productivity.
Levels of patient engagement have increased dramatically over the last decade or so. Easy Access to information has encouraged transparency, and because of this, patients no longer choose hospitals simply based off location. Hospitals that have high satisfaction ratings and easy access to care over ones that don’t, will attract the majority of patients.
Measure Patient Satisfaction
One way to gauge patient satisfaction is to measure their loyalty. Patients may vary in the engagement spectrum. Some patients come in for their first visit and then never return. Some patients may be somewhat disengaged in your healthcare organization by having contact with only one specialist. Loyal patients will interact with the hospital across multiple services lines. Hospitals marketing departments tend to focus on acquiring as many new patients as possible. Hospitals think this is where the revenue is, when in reality loyal patients are five times more valuable. It is much more efficient for marketing departments to use their budget to invest in loyalty, rather than spending their resources to acquire more patients.
How hospitals incorporate the revenue cycle into their organization will largely affect its overall prosperity. Studies have found several consistencies among successful hospitals. Most of these similarities are directly associated with the revenue cycle. There are 3 key areas in which high-performing organizations thrive.
Employees heavily influence the functionality of the revenue cycle, and successful hospitals have taken notice. Most of these hospitals will take the time to hire the right employees. Usually ones that are passionate, go above and beyond, and have a fitting personality. These hospitals make sure that their hiring managers are putting their employees in the most suitable positions. In order to attract these kinds of employees these hospitals will provide competitive compensation or performance incentives.
High performing hospitals don’t stop there. They are fervent on continuing education for their employees. They will continue to extensively train new and existing employees to make certain they will be competent in the demands of their positions.
In today’s economy, several hospitals may be struggling to stay afloat, especially when it comes to smaller rural practices. No matter the size of your facility, there are still steps that can be taken to improve all financial situations.
- Add new services that have a good return
One of the most valuable tactics to increase revenue is to add new service lines your organization doesn’t currently offer. Do your research before you add new lines of service. Study the population that surrounds your organization. What types of services is the population in need of? Research the demographics of your area to get a better understanding of the types of service you should be offering. Do a comparative analysis on the competing hospitals near by. Check into the services they provide their patients to see how your hospital needs to improve. Go a step further and start offering services other hospitals are not offering. This way you don’t have to compete for patients.
- Improve your Organizations Reputation
It’s extremely important that your healthcare organization is maintaining a positive reputation. A 2012 World Economic Study found on average that more than 25% of a company’s market value is directly correlated to its reputation. What opinion does your community hold when it comes to your hospital? Try sending out a community engagement survey to find out how the locals view you. It’s likely your hospital won’t get perfect reviews, so try and use the negative results to improve in those areas.
If you are considering having a serious career in medical coding, the first thing you need to do to gain credibility is to get certified. There are several different types of certifications for medical coders so make sure you know which one would be best for you. The certifications are split into two different levels: entry- level certifications and advanced certifications. Here are some of the most popular certifications:
Certified Coding Associate (CCA)
This is offered through AHIMA and is one of the most basic certifications that they offer. The program is designed to give medical coders a general understanding of coding principles. It will create coding competency in both hospitals and physician practices.
- High School Diploma
- 6 months of medical coding experience
- Completion of an AHIMA approved coding program
These days, it’s easy to feel stretched for time with all of the things going on in healthcare. That’s why it’s extremely important that healthcare professionals are helping manage your practice’s time in the best way possible. Time management will affect the number of patients you see, how many medical claims you send out, and the overall effectiveness of your practice. Here are a few tips to help your practice manage its time properly.
- Set Goals for Your Practice
Make sure your practice has short and long term goals put in place. If you don’t know what you want for the future of your practice it will be difficult to be successful. Each goal you set should be a SMART goal: Specific, Measurable, Attainable, Relevant and Time Bound. Make sure the goals you set are written down, and reviewed frequently. Help maintain accountability by letting your staff know about the goals for the practice. Perhaps even give incentives to your staff if certain long-term goals are reached.
- Stay on Track with Patient Appointments
Your practice will experience revenue leakage starting the moment a patient schedules an appointment with you. Some of these leaks typically start out small but overtime they will make large dents within your practice. Below are some tips to help improve your rev cycle management system and prevent those leaks.
- Patient Information: Acquiring accurate patient information will help reduce claim rejections due to ineligibility, patient not found, or service not authorized. Implement a checklist at your practices registration office to help insure accuracy. The staff member registering a patient should verify the patient’s information, take a photocopy of the patient’s insurance card, and review the patient’s insurance (optimally, this would be done before the physician sees the patient in order to avoid performing services that are not covered).
E/M coding has become the most frequently billed physician service, and auditors are taking notice of its popularity. There is a fine line to walk when it comes to Medical coding. Frequent E/M coding errors occur when medical practices are either upcoding or undercoding. Upcoding increases the risk of audits. Coding too conservatively doesn’t protect your practice from audits, and it severely decreases your level of reimbursement. Here are some tips to help you stay on the straight and narrow:
- Sending out Claims Under the Wrong Provider: Popular medical coding errors occur when nurse practitioners and physician assistants report services improperly. Often times NP’s or PA’s will send out claims under the physician’s name and National Provider Identifier, but if the patient was treated solely by the NP or PA, the claim should be billed under the mid-level practitioner’s name and NPI. | <urn:uuid:60c8a8c5-6e7f-4759-bf39-72f72c6e4fa9> | {
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Purpose: Diagnose and classify mental disorders
The new edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5) defines and classifies mental disorders in order to improve diagnoses, treatment, and research. It is the product of more than over 10 years of effort by hundreds of international experts in all aspects of mental health.
The criteria are concise and explicit, intended to facilitate an objective assessment of symptom presentations in a variety of clinical settings—inpatient, outpatient, partial hospital, consultation-liaison, clinical, private practice, and primary care.
The DSM-5 is the most comprehensive, current, and critical resource for clinical practice available to today's mental health clinicians and researchers. The information contained in the manual is also valuable to other physicians and health professionals, including psychologists, counsellors, nurses, occupational and rehabilitation therapists, as well as social workers and forensic and legal specialists.
New Features and Enhancements
- Chapter organisation reflects a lifespan approach, with disorders typically diagnosed in childhood (such as neurodevelopmental disorders) at the beginning of the manual, and those more typical of older adults (such as neurocognitive disorders) placed at the end
- Latest findings in neuroimaging and genetics have been integrated into each disorder along with gender and cultural considerations
- Recognises symptoms that span multiple diagnostic categories, providing new clinical insight in diagnosis
- Specific criteria have been streamlined, consolidated and clarified to be consistent with clinical practice including:
- Consolidation of autism disorder, asperger’s syndrome, and pervasive developmental disorder into autism spectrum disorder
- Classification of bipolar and depressive disorders
- Restructuring of substance use disorders for consistency and clarity
- Enhanced specificity for major and mild neurocognitive disorders
- Dimensional assessments for research and validation of clinical results have been provided
- Both ICD-9-CM and ICD-10-CM codes are included for each disorder and the organisational structure is consistent with the new ICD-11 in development
Essential Companion Guides to the DSM-5 are also available. | <urn:uuid:8b00cae3-2bb9-466c-91f0-ba884016fd4e> | {
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Preparing for ICD-10 includes more than just codes!
With ICD-10, coders may need to probe deeper into the patient’s medical record and/or query the physician more often to obtain the level of specificity required by the ICD-10-CM codes. As a result, coders will need to fully understand anatomy and physiology (not only the structure and location of organs and body parts, but also how they function), medical terminology, disease process, surgical procedures, and drugs and pharmaceuticals.
ICD-10-CM includes many combination codes that require the underlying condition, as well as one or more manifestations, complications, or associated conditions. Often one will need to first identify the diseases and disorders in the medical record documentation, and then find the ICD-10-CM code that best represents the patient’s documented condition.
For example, ICD-10-CM defines a ‘minor contusion of the kidney’ (S37.01-) as being less than 2 centimeters. A different category will be used if the contusion is more than 2 centimeters and therefore considered a ‘major contusion of the kidney’ (S37.02-). Physician documentation must include this information, and the coder should be able to differentiate between the clinical conditions to assign the proper code. | <urn:uuid:f0f2f70c-c94f-4f45-8fd3-8c88e25faa22> | {
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So…EXACTLY what’s medical coding?
It’s part-playing detective, part-searching through doctor notes, and part hand-holding. However, the biggest part is explaining to the insurance exactly what happened at the doctor’s visit or what happened in surgery. This is done by giving tons of information in the form of codes to the insurance provider, so the doctor or surgeon gets reimbursed. Before 2015, these codes were all numerical. Starting October 2015, they were adjusted to specific alphanumeric terms. These new codes allow for more details and make it easier for the insurance computers to process claims quick and efficient.
Medical coding is a system of number and letters that are unique for each diagnosis, symptom, and cause of death. Medical coding can involve one or more of the following types of codes: ICD codes, CPT codes, HCPCS codes, HCC codes, DRG codes, and modifiers. All of these coding sets are important for communication and billing purposes. Accurate medical coding is necessary for billing and tracking statistics of disease and medical treatment.
Diagnosis codes are used to analyze disease patterns in societies for national and regional health and death statistics. Member countries of the World Health Organization can then benefit from needed resources to combat widespread health issues, to educate the populace on prevention and treatment, and to ensure the future health and well-being for their citizens.
Not only is coding important in disease tracking, but it is also financially critical for medical providers. Medical coding is one of the most significant factors in obtaining insurance reimbursement as well as maintaining patient records. Coding claims accurately lets the insurance payer know the illness or injury of the patient and the method of treatment. Commercial payers such as insurance companies, Medicare and Medicaid will not pay a claim if it’s not submitted with the acceptable codes. Let’s break down each medical coding system by type necessary for a payable claim:
The International Statistical Classification of Diseases (ICD-10) is the medical coding system specific to diagnoses, symptoms, and causes of death in humans. The World Health Organization (WHO) creates, copyrights, and oversees these classifications, and they are standard and thereby recognizable by every medical facility and practitioner worldwide. In the United States, the National Center for Health Statistics (which is a part of the Centers for Medicare and Medicaid Services) manages any amendments to the ICD-10 codes alongside the WHO. These diagnosis codes start the claim process.
CPT & HCPCS Level II Codes
Healthcare Common Procedure Coding System (HCPCS) codes have three levels:
- Level I Current Procedural Terminology (CPT) codes are made up of 5 digit numbers and managed by the American Medical Association (AMA). CPT codes are used to identify medical procedures and services ordered by physicians or other licensed professionals.
- Level II HCPCS are alphanumeric codes consisting of one alphabetical letter followed by four numbers and are managed by the Centers for Medicare and Medicaid Services (CMS). These codes identify non-physician services such as ambulance, durable medical equipment, and some pharmacy products.
- Level III codes are miscellaneous (otherwise known as “local codes”) alphanumeric codes used when there is no discernible Level I or II code. They have W, X, Y, or Z followed by a four-digit numeric code.
Level I are numeric CPT procedure codes. Level II HCPCS are alphanumeric codes which are used to identify products, supplies, and services not included in the CPT codes.
Some CPT codes required the use of modifiers. They consist of two digit number, letters or combination of both. Modifiers provide additional information about the service or procedure performed. They can be used to identify the area of the body of a performed procedure, multiple procedures in the same session, or indicate a procedure was started but discontinued.
What are HCCs? CMS uses HCCs to reimburse Medicare Advantage plans based on the health of their members. It pays accurately for the predicted cost expenditures of patients by adjusting those payments based on demographic information and patient health status. The risk assessment data used is based on the diagnosis information pulled from claims and medical records which are collected by physician offices, hospital inpatient visits and in outpatient settings.
Diagnosis-related grouping codes are only used on inpatient claims. Many insurers pay according to the DRG. Therefore, the accuracy of all components is essential to proper claim reimbursement.
Education in Medical Coding
Many colleges and trade schools offer in-person classes on medical billing and coding. There are also online medical coding courses available through the AAPC or independent instructors. These courses or degree plans educate students on medical terminology, proper coding and billing techniques. Keep in mind, whichever education option you choose, ultimately you will have to pass the certification exam to be hired.
Education and continuing education in a clinic or doctor’s office are imperative to a coder’s success; staying abreast of the changes in coding and billing practices, as well as governing regulations, is essential in this fast-paced digital system in which we all work and live. The more you invest with continuing education, the more you find fascinating things like medical advances that will blow you away, new technology and better ways for performing surgery.
Coding and Billing
Coding and billing are often mentioned together because these are two facets of the medical office are linked to one another. The staff member(s) who complete your medical coding and billing should work closely together to ensure accurate and prompt payment of all medical claims and correct and complete medical records. The billing department cannot exist without medical codes to inform the insurance what happened during the doctor visit or the procedure.
Resources such as up-to-date code books and current software for coding or billing are imperative to the billing and coding staff in order to ensure accurate filing. Insurance companies like Blue Cross Blue Shield, Aetna, Humana, United Healthcare, Medicare, Medicaid pay the doctors and surgeons when accurate diagnosis and medical records are in place. In addition to the initial filing of patient claims, the coder and biller may be responsible for following up on appealing denied claims by auditing the patient’s chart, re-filing the claim, submitting coding guidelines, or taking other steps to ensure the accuracy of the records.
Given that medical billing staffs are responsible for the accuracy of your medical records by state and federal regulations, the importance of competent billers and coders is a must-have. A successful medical facility must have well trained, organized, proficient, medical billers and medical coders. The Medical Coders and Billers are the lifeblood of a well-run office.
As a Medical Coder, I can honestly say without reservation or beyond a shadow of a doubt that taking training for medical coding was one of the best decisions I have ever made in my life. Being a medical coder has been the adventure of a lifetime. No day is ever the same. I promise you will never be bored. I love what I do for a living and career.
Are you ready for the adventure of a lifetime? Look into taking a Medical Coding course and embark on a quest you never dreamed possible. Join us! | <urn:uuid:9d705461-99db-467d-aa93-bb2556022cc1> | {
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- 1 What is the branch of medicine that deals with design production and use of artificial body parts?
- 2 What does the CMS Hcpcs workgroup maintain?
- 3 Are prosthetics considered durable medical equipment?
- 4 Which of the following key terms is defined by Medicare as equipment that can withstand repeated use?
- 5 What is the difference between prosthetic and prosthesis?
- 6 What are the benefits of bionic limbs?
- 7 What is the difference between HCPCS and CPT?
- 8 What are G codes used to identify?
- 9 What are permanent national codes?
- 10 Do Orthotics fall under DME?
- 11 What are some examples of durable medical equipment?
- 12 Is a hearing aid considered medical equipment?
- 13 How many types of presenting problems does CPT recognize?
- 14 What are the four types of HCPCS codes?
- 15 What do J codes refer to?
What is the branch of medicine that deals with design production and use of artificial body parts?
prosthetics. The branch of medicine or surgery that deals with the production and application of artificial body parts.
What does the CMS Hcpcs workgroup maintain?
National HCPCS Level II codes are maintained by CMS. CMS is responsible for making decisions about additions, revisions, and deletions to the national alpha-numeric codes. This workgroup informs CMS’ decisions.
Are prosthetics considered durable medical equipment?
Durable medical equipment includes medial products, surgical supplies, equipment such as wheelchairs, prosthetic and orthotic devices, and hearing aide services when ordered by a physician as medically necessary in the treatment of a specific medical condition.
Which of the following key terms is defined by Medicare as equipment that can withstand repeated use?
The term DME is further defined in Medicare regulations at 42 CFR § 414.202 to mean equipment furnished by a supplier or home health agency that: can withstand repeated use; has an expected life of at least 3 years; is primarily and customarily used to serve a medical purpose; generally is not useful to an individual
What is the difference between prosthetic and prosthesis?
The term “prosthetic” is also used as an adjective to describe items. Prosthesis: While prosthetics refers to the science of creating artificial body parts, the artificial parts themselves are called prosthesis. One piece is called a prosthesis, but multiple pieces are called prostheses.
What are the benefits of bionic limbs?
The direct connection between the prosthesis and bone has several advantages:
- It provides greater stability and control, and can reduce the amount of energy expended.
- It does not require suction for suspension, which makes it easier and more comfortable for the user.
What is the difference between HCPCS and CPT?
CPT is a code set to describe medical, surgical,and diagnostic services; HCPCS are codes based on the CPT to provide standardized coding when healthcare is delivered.
What are G codes used to identify?
The G codes are used to identify professional health care procedures and services that would otherwise be coded in CPT but for which there are no CPT codes.
What are permanent national codes?
What is a HCPCS level II code?
- Permanent national codes – these cover the bulk of the healthcare procedures and services reimbursable under OPPS; updated annually and effective January 1st.
- Dental codes – starts with a D; these are from the Current Dental Terminology (CDT), owned and maintained by the.
Do Orthotics fall under DME?
Covered items include: DME; ▪ Medical supplies; ▪ Home dialysis supplies and equipment; ▪ Therapeutic shoes; ▪ Parenteral and enteral nutrient, equipment and supplies; ▪ Transfusion medicine; and ▪ Prosthetic devices, prosthetics, and orthotics.
What are some examples of durable medical equipment?
Durable medical equipment (DME) coverage
- Blood sugar meters.
- Blood sugar test strips.
- Commode chairs.
- Continuous passive motion devices.
- Continuous Positive Airway Pressure (CPAP) devices.
- Hospital beds.
Is a hearing aid considered medical equipment?
While the FDA regulates hearing aids, which are medical devices, it does not consider sound amplifiers to be medical devices when labeled for recreational or other use by individuals with normal hearing. However, certain safety regulations related to sound output levels still apply to these products.
How many types of presenting problems does CPT recognize?
What are the 5 types of presenting problems are recognized? Minimal, self-limited or minor, low severity, moderate severity, and high severity.
What are the four types of HCPCS codes?
5.20: CPC Exam: HCPCS Level II
- A-codes: Transportation, Medical and Surgical Supplies, Miscellaneous and Experimental.
- B-codes: Enteral and Parenteral Therapy.
- C-codes: Temporary Hospital Outpatient Prospective Payment System.
- D-codes: Dental codes.
- E-codes: Durable Medical Equipment.
What do J codes refer to?
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The International Classification of Diseases (ICD) is a medical coding system created by the World Health Organization (WHO) and is used by payers and providers to identify diagnoses and procedures. ICD-9 is the current system used in the United States and was widely adopted in the world in 1978. Today, there are many limitations to continuing to use ICD-9 codes. Over 130 countries have transitioned to ICD-10 diagnosis and procedure coding, and the United States is set to transition to ICD-10 on 10/1/2015.
The transition to ICD-10 is occurring because ICD-9 produces limited data about patients’ medical conditions and hospital inpatient procedures. ICD-9 is 30 years old, has outdated terms, and is inconsistent with advancements in medical technology and knowledge. Also, the structure of ICD-9 limits the number of new codes that can be created, and many ICD-9 categories are full. For example, new cardiac disease codes may be assigned to the chapter for diseases of the eye because of lack of available codes.
ICD-10-CM/PCS (International Classification of Diseases, 10th Edition, Clinical Modification/Procedure Coding System) consists of two parts:
- ICD-10-CM for diagnosis coding
- ICD-10-PCS for inpatient procedure coding
ICD-10-CM is for use in all U.S. health care settings. Diagnosis coding under ICD-10-CM uses three to seven alphanumeric digits instead of the three to five alphanumeric digits used with ICD-9-CM, but the format of the code sets is similar. ICD-10-PCS is for use in U.S. inpatient hospital settings only. ICD-10-PCS uses 7 alphanumeric digits instead of the 3 or 4 numeric digits used under ICD-9-CM procedure coding. Coding under ICD-10-PCS is much more specific and substantially different from ICD-9-CM procedure coding.
California Health & Wellness will be ICD-10 compliant by 10/1/2015. California Health & Wellness will be able to process (send/receive) transactions and perform internal functions using ICD-10 diagnosis and procedure codes. Providers must submit claims with codes that align with CMS and state guidelines:
The following information applies to paper, web, and standard electronic (837 X12) claims.
- Claims may not contain a combination of ICD-9 and ICD-10 codes.
- Claims must be submitted with ICD-10 codes if the date of discharge / date of service is on or after the ICD-10 compliance date of 10/1/2015.
- Claims must not be submitted with ICD-10 codes if the date of discharge / date of service is prior to the compliance date of 10/1/2015.
- For some claims which span the ICD-10 compliance date, the admit date on the claim can be prior to the ICD-10 compliance date and the claim can still contain ICD-10 codes. For other claims which span the ICD-10 compliance date, a splitting of the claim into two separate claims is necessary. CMS has outlined guidance on which claims will need to be split in this claims processing document (SE1408 (PDF))
- CMS uses the “bill type” on an institutional claim for determining whether the claim should be split. In general, inpatient claims can have dates of service which span the compliance date and contain ICD-10 codes. Outpatient and professional claims cannot have dates of service which span the compliance date and have ICD-10 codes. For outpatient and professional claims, providers must split claims into two separate claims (one claim with a date of discharge on 9/30/15 and another claim with an admit date of 10/1/15).
- Interim bills for long hospital stays (TOB: 112, 113, 114) are expected to follow the same rules as other claims. If a provider submits a replacement claim (TOB: 117) to cover all interim stays, it is expected that the provider must re-code all diagnoses / procedures to ICD-10 since the replacement claim will have a discharge / through date post-compliance.
- All first-time claims and adjustments for pre-10/1/2015 service dates must include ICD-9 codes, even if claims are submitted post-10/1/2015. Claims with pre-10/1/2015 service dates can be submitted with ICD-9 codes for as long as contracts and provider manuals specify.
- Reiteration: Claim submission date does not determine whether ICD-9/10 codes should be used. All ICD-9/10 claims submission rules outlined by CMS are based on patient discharge date, or date of service for outpatient/professional services.
Claims will be reimbursed according to state reimbursement guidelines. Claims will be adjudicated natively in ICD-9 for dates of service prior to 10/1/2015 and natively in ICD-10 for dates of service on and after 10/1/2015, consistent with CMS requirements.
ICD-10 diagnosis codes will be accepted on prior authorization requests submitted 7/1/15 or later for services with a start date on or after the ICD-10 compliance date. ICD-9 codes will no longer be accepted on prior authorization requests submitted on the ICD-10 compliance date or later except in the case of retro authorizations for services with a start date on or before 9/30/15. ICD-9 procedure codes are not used on authorizations and ICD-10 procedure codes will not be used on authorizations.
ICD-10 Implementation and Testing
Our ICD-10 implementation approach aligns with CMS guidance and recommended timeframes.
An ICD-10 assessment was completed in 2011-2012 and HIPAA compliance testing with providers, clearinghouses, vendors and state agencies began on July 2013. Transactional-level testing is available today to any provider interested in participating and will continue to be available through the ICD-10 compliance date. As part of this testing effort, providers who register in Ramp Manager (application used for all testing efforts) and submit 837 X12 test claims will receive TA1, 999, 277CA, and 271 eligibility responses.
Providers or clearinghouses who are interested in transactional-level testing can contact the EDI service desk at 1-800-225-2573, ext. 25525 or firstname.lastname@example.org for further instructions.
Providers or clearinghouses who are interested in testing must be direct electronic claim submitters (837 X12 claims).
A spectrum of claims test cases were tested internally among IT systems. Based on the successful passing of claims test cases during internal end-to-end testing, external end-to-end testing with providers was initiated.
The objective of external end-to-end testing was to demonstrate the ability to process ICD-10 claims from end-to-end successfully. Providers were instructed to submit electronic claim files (837 files), which were sent through claims processing systems and an electronic remittance file (835 files or suitable replacement) was generated. The results of testing reaffirmed that the claims processing systems were ICD-10 capable and ready.
Testing was coordinated by our parent company, Centene Corporation. Forty-six provider groups and clearinghouses participated and 1,648 claims were processed.
Another end-to-end testing exercise will not be conducted due to the success of the completed testing initiative. While it would be advantageous to test with all providers, clearinghouses, and vendors, California Health & Wellness believes the incremental benefits of conducting further testing are outweighed by the costs of execution. To successfully prepare for submitting claims with ICD-10 codes, entities should conduct “claims format” testing through Centene’s Ramp Manager application, which is self-service and available for us from now until the ICD-10 transition. This testing will help to ensure that claims are not rejected upon submission and are billed properly. | <urn:uuid:2f38e478-2312-47bf-b0fc-b0ed9c9db9a0> | {
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Hematopoietic Stem Cell Transplantation
Hematopoietic stem-cell transplantation (HSCT) refers to a procedure in which hematopoietic stem cells are infused to restore bone marrow function in cancer patients who receive bone-marrow-toxic doses of cytotoxic drugs, with or without whole-body radiotherapy. Hematopoietic stem cells may be obtained from the transplant recipient (i.e., autologous HSCT) or from a donor (i.e., allogeneic HSCT). They can be harvested from bone marrow, peripheral blood, or umbilical cord blood shortly after delivery of neonates. Although cord blood is an allogeneic source, the stem cells in it are antigenically “naïve” and thus are associated with a lower incidence of rejection or graft vs. host disease. Cord blood is discussed in greater detail in the Placental and Umbilical Cord Blood as a Source of Stem Cells policy.
Immunologic compatibility between infused stem cells and the recipient is not an issue in autologous HSCT. However, immunologic compatibility between donor and patient is a critical factor for achieving a good outcome of allogeneic HSCT. Compatibility is established by typing of human leukocyte antigens (HLA) using cellular, serologic, or molecular techniques. HLA refers to the tissue type expressed at the class I and class II loci on chromosome 6. Depending on the disease being treated, an acceptable donor will match the patient at all or most of the HLA loci (with the exception of umbilical cord blood).
Conventional Preparative Conditioning for Hematopoietic Stem-Cell Transplantation
The success of autologous HSCT is predicated on the ability of cytotoxic chemotherapy with or without radiation to eradicate cancerous cells from the blood and bone marrow. This permits subsequent engraftment and repopulation of bone marrow space with presumably normal hematopoietic stem cells obtained from the patient prior to undergoing bone marrow ablation. As a consequence, autologous HSCT is typically performed as consolidation therapy when the patient’s disease is in complete remission. Patients who undergo autologous HSCT are susceptible to chemotherapy-related toxicities and opportunistic infections prior to engraftment, but not GVHD.
The conventional (“classical”) practice of allogeneic HSCT involves administration of cytotoxic agents (e.g., cyclophosphamide, busulfan) with or without total-body irradiation at doses sufficient to destroy endogenous hematopoietic capability in the recipient. The beneficial treatment effect in this procedure is due to a combination of initial eradication of malignant cells and subsequent graft-versus-malignancy (GVM) effect mediated by nonself immunologic effector cells that develop after engraftment of allogeneic stem cells within the patient’s bone marrow space. While the slower GVM effect is considered to be the potentially curative component, it may be overwhelmed by extant disease without the use of pretransplant conditioning. However, intense conditioning regimens are limited to patients who are sufficiently fit medically to tolerate substantial adverse effects that include pre-engraftment opportunistic infections secondary to loss of endogenous bone marrow function and organ damage and failure caused by the cytotoxic drugs. Furthermore, in any allogeneic HSCT, immune suppressant drugs are required to minimize graft rejection and GVHD, which also increases susceptibility of the patient to opportunistic infections.
Reduced-Intensity Conditioning for Allogeneic Hematopoietic Stem-Cell Transplantation
Reduced-intensity conditioning (RIC) refers to the pretransplant use of lower doses or less intense regimens of cytotoxic drugs or radiation than are used in traditional full-dose myeloablative conditioning treatments. The goal of RIC is to reduce disease burden, but also to minimize as much as possible associated treatment-related morbidity and nonrelapse mortality (NRM) in the period during which the beneficial GVM effect of allogeneic transplantation develops. Although the definition of RIC remains arbitrary, with numerous versions employed, all seek to balance the competing effects of NRM and relapse due to residual disease. RIC regimens can be viewed as a continuum in effects, from nearly totally myeloablative, to minimally myeloablative with lymphoablation, with intensity tailored to specific diseases and patient condition. Patients who undergo RIC with allogeneic HSCT initially demonstrate donor cell engraftment and bone marrow mixed chimerism. Most will subsequently convert to full-donor chimerism, which may be supplemented with donor lymphocyte infusions to eradicate residual malignant cells.
For the purposes of this Policy, the term “reduced-intensity conditioning” will refer to all conditioning regimens intended to be nonmyeloablative, as opposed to fully myeloablative (traditional) regimens.
Non-Hodgkin’s Lymphomas (NHL)
A heterogeneous group of lymphoproliferative malignancies, NHL usually originates in lymphoid tissue. Historically, uniform treatment of patients with NHL was hampered by the lack of a uniform classification system. In 1982, the Working Formulation (WF) was developed to unify different classification systems into one. The WF divided NHL into low-, intermediate-, and high-grade, with subgroups based on histologic cell type. Since our understanding of NHL has improved, the diagnosis has become more sophisticated and includes the incorporation of new immunophenotyping and genetic techniques. As a result, the WF has become outdated.
European and American pathologists proposed a new classification, the Revised European American Lymphoma (REAL) Classification, and an updated version of the REAL system, the new World Health Organization (WHO) classification. The WHO/REAL classification recognizes 3 major categories of lymphoid malignancies based on morphology and cell lineage: B-cell neoplasms, T-cell/natural killer (NK)-cell neoplasms, and Hodgkin lymphoma. Hodgkin lymphoma and SCT is addressed in the Hematopoietic Stem Cell Transplantation for Hodgkin Lymphoma policy.
Updated WHO Classification
Mature B-cell neoplasms
Mature T-cell and NK-cell neoplasms
*These represent provisional entities or provisional subtypes of other neoplasms.
In the United States, B-cell lymphomas represent 80–85% of cases of NHL and T-cell lymphomas 15–20%. NK lymphomas are relatively rare.
The International Lymphoma Classification Project identified the most common NHL subtypes as follows: diffuse large B-cell lymphoma (DLBCL) 31%, follicular lymphoma (FL) 22%, small lymphocytic lymphoma/chronic lymphocytic leukemia (SLL/CLL) 6%, mantle cell lymphoma (MCL) 6%, peripheral T-cell lymphoma (PTCL) 6%, and marginal zone B-cell lymphoma/mucosa-associated lymphoid tissue (MALT) lymphoma 5%. All other subtypes each represent less than 2% of cases of NHL.
In general, the NHL can be divided into two prognostic groups, indolent and aggressive. Indolent NHL has a relatively good prognosis, with a median survival of 10 years; however, they it is not curable in advanced clinical stages. Early stage indolent NHL (stage 1 or 2) may be effectively treated with radiation alone. Although indolent NHL is responsive to radiation and chemotherapy, a continuous rate of relapse is seen in advanced stages. These patients can often be retreated if their disease remains of the indolent type. Indolent NHL may transform into a more aggressive form, which is generally treated with regimens that are used for aggressive, recurrent NHL. Histologic transformation to higher grade lymphoma occurs in up to 70% of patients with low-grade lymphomas, and median survival with conventional chemotherapy is 1 year or less.
FL is the most common indolent NHL (70–80% of cases), and often the terms indolent lymphoma and FL are used synonymously. Also included in the indolent NHL are SLL/CLL, lymphoplasmacytoid lymphoma, marginal zone lymphomas, and cutaneous T-cell lymphomas.
Aggressive NHL has a shorter natural history; however, 30–60% of these patients can be cured with intensive combination chemotherapy regimens. Aggressive lymphomas include DLBCL, MCL, PTCL, anaplastic large cell lymphoma, and Burkitt’s lymphoma.
Oncologists developed a clinical tool to aid in predicting the prognosis of patients with aggressive NHL (specifically DLBCL), referred to as the International Prognostic Index (IPI). Prior to the development of IPI in 1993, prognosis was predominantly based upon disease stage.
Based on the number of risk factors present and adjusted for patient age, the IPI defines 4 risk groups: low, low intermediate, high intermediate, and high risk, based upon 5 significant risk factors prognostic of overall survivial (OS):
Risk groups are stratified according to the number of adverse factors as follows: 0 or 1 is low risk, 2 is low intermediate, 3 is high intermediate, and 4 or 5 are high risk.
Patients with two or more risk factors have a less than 50% chance of relapse-free survival and OS at 5 years. Age-adjusted IPI and stage-adjusted modifications of this IPI are used for younger patients with localized disease.
Adverse risk factors for age-adjusted IPI include stage III or IV disease, elevated LDH and ECOG performance status >2, and can be calculated as follows: 0 is low risk, 1 is low intermediate, 2 is high intermediate, and 3 is high risk.
With the success of the IPI, a separate prognostic index was developed for FL, which has multiple independent risk factors for relapse after a first complete remission. The proposed and validated Follicular Lymphoma International Prognostic Index (FLIPI) contains 5 adverse prognostic factors:
These 5 factors are used to stratify patients into 3 categories of risk: low (0-1 risk factor), intermediate (2 risk factors), or poor (more than 3 risk factors).
Mantle Cell Lymphoma
Mantle cell lymphoma (MCL) comprises approximately 65-68% of NHL and has been recognized within the past 15 years as a unique lymphoma subtype with a particularly aggressive course. MCL is characterized by a chromosomal translocation t(11;14) and the term “mantle cell lymphoma” was proposed in 1992 by Banks et al. The number of therapeutic trials are not as numerous as for other NHL as it was not widely recognized until the REAL classification. MCL shows a strong predilection for elderly males, and the majority of cases (70%) present with disseminated (stage 4) disease and extranodal involvement is common. Localized MCL is quite rare. MCL has a median survival of approximately 2 - 4 years, and although most patients achieve remission with first line therapy, relapse inevitably occurs, often within 12-18 months. MCL is rarely, if ever, cured with conventional therapy, and no standardized therapeutic approach to MCL is used.
There had been no generally established prognostic index for patients with MCL. Application of the IPI or FLIPI system to patients with MCL showed serious limitations, which included no separation of some important risk groups. In addition, some of the individual IPI and FLIPI risk factors, including number of extranodal sites and number of involved nodal areas showed no prognostic relevance, and hemoglobin showed no independent prognostic relevance in patients with MCL. Therefore, a new prognostic index for patients with MCL was developed, and should prove useful in comparing clinical trial results for MCL.
MCL international prognostic index (MIPI):
MIPI allows separation of 3 groups with significantly different prognoses:
Peripheral T-cell Lymphomas (PTCL)
The majority of peripheral T-cell lymphomas are aggressive and fall into the category of PTCL, unspecified (PTCL-u) or not otherwise specified (PTCL-NOS), angioimmunoblastic or anaplastic large cell which, combined make up approximately 60–70% of T-cell lymphomas. PTCLs are less responsive to standard chemotherapy than DLBCLs and carry a worse prognosis than aggressive B-cell counterparts. Survival rates at 5 years with standard chemotherapy regimens range from 20–35%. The poor results with conventional chemotherapy have prompted exploration of the role of HSCT as therapy.
The Ann Arbor staging classification is commonly used for the staging of lymphomas and is the scheme defined in the AJCC Manual for Staging Cancer. Originally developed for Hodgkin's disease, this staging scheme was later expanded to include non-Hodgkin's lymphoma.
Ann Arbor Classification
Involvement of a single lymph node region (I) or of a single extralymphatic organ or site (IE)
Involvement of 2 or more lymph node regions on the same side of the diaphragm (II) or localized involvement of extralymphatic organ or site and of one or more lymph node regions on the same side of the diaphragm (IIE).
Involvement of lymph node regions on both sides of the diaphragm (III), which may also be accompanied by localized involvement of extralymphatic organ or site (IIIE) or by involvement of the spleen (IIIS) or both (IIISE) .
Diffuse or disseminated involvement of one or more extralymphatic organs or tissues with or without associated lymph node enlargement.
Note: Small lymphocytic lymphoma may be considered a node-based variant of chronic lymphocytic leukemia (CLL). Therefore, SLL is considered along with CLL in the Hematopoietic Stem-Cell Transplantation for Chronic Lymphocytic Leukemia and Small Lymphocytic Lymphoma policy.
No benefits will be provided for a covered transplant procedure unless the Member receives prior authorization through Case Management from Blue Cross & Blue Shield of Mississippi.
For patients with non-Hodgkin lymphoma (NHL) B-cell subtypes considered aggressive (except mantle cell lymphoma), either allogeneic hematopoietic stem cell transplantation (HSCT) using a myeloablative conditioning regimen or autologous HSCT may be considered medically necessary:
For patients with mantle cell lymphoma:
For patients with NHL B-cell subtypes considered indolent, either allogeneic HSCT using a myeloablative conditioning regimen or autologous HSCT may be considered medically necessary:
Reduced-intensity conditioning allogeneic HSCT may be considered medically necessary as a treatment of NHL in patients who meet criteria above for an allogeneic HSCT but who do not qualify for a myeloablative allogeneic HSCT.
Either autologous HSCT or allogeneic HSCT is considered investigational:
Tandem transplants are considered investigational to treat patients with any stage, grade, or subtype of NHL.
For patients with mature T-cell or NK-cell (peripheral T-cell) neoplasms:
Note: Small lymphocytic lymphoma may be considered a node-based variant of chronic lymphocytic leukemia (CLL). Therefore, SLL is considered along with CLL in the Hematopoietic Stem-Cell Transplantation for Chronic Lymphocytic Leukemia and Small Lymphocytic Lymphoma policy. Lymphoplasmacytic lymphoma/Waldenstrom macroglobulinemia is considered in the Hematopoietic Stem-Cell Transplantation for Primary Amyloidosis or Waldenstrom's Macroglobulinemia policy.
For Federal Employee Program (FEP) subscribers, the Service Benefit Plan includes specific conditions in which autologous or allogeneic blood or marrow stem cell transplants would be considered eligible for coverage.
For State and School Employee subscribers, all bone marrow/stem cell transplants must be certified as medically necessary by the Plan’s Utilization Review Vendor. No benefits will be provided for any transplant procedure unless prior approval for the transplant is obtained.
Reduced-intensity conditioning (RIC) would be considered an option in patients who meet criteria for an allogeneic hematopoietic stem-cell transplant (SCT) but whose age (typically older than 55 years) or comorbidities (e.g., liver or kidney dysfunction, generalized debilitation, prior intensive chemotherapy) preclude use of a standard conditioning regimen.
In patients who qualify for a myeloablative allogeneic hematopoietic SCT on the basis of overall health and disease status, allogeneic HSCT using either myeloablative or RIC may be considered. However, a myeloablative conditioning regimen with allogeneic HSCT may benefit younger patients with good performance status and minimal comorbidities more than allogeneic HSCT with RIC.
A chemosensitive relapse is defined as relapsed NHL that does not progress during or immediately after standard-dose induction chemotherapy (i.e., achieves stable disease or a partial response).
Transformation describes a lymphoma whose histologic pattern has evolved to a higher-grade lymphoma. Transformed lymphomas typically evolve from a nodular pattern to a diffuse pattern.
Tandem transplants usually are defined as the planned administration of two (2) successive cycles of high-dose myeloablative chemotherapy, each followed by infusion of autologous hematopoietic stem cells, whether or not there is evidence of persistent disease following the first treatment cycle. Sometimes, the second cycle may use non-myeloablative immunosuppressive conditioning followed by infusion of allogeneic stem cells.
The term salvage therapy describes therapy given to patients with refractory or relapsed disease. For patients with PTCL, salvage therapy includes patients who do not achieve a CR (eg, achieve only a partial response (PR), have no response, or have progressive disease) with first-line induction chemotherapy (refractory disease) or who relapse after achieving a CR with first-line induction chemotherapy. For mantle cell lymphoma, salvage therapy includes patients with progressive disease with first-line induction chemotherapy (refractory disease) or in patients who relapse after a CR or PR after initial induction chemotherapy, or patients who fail a previous autologous HSCT.
High-risk (aggressive) T-cell and natural killer (NK)‒cell neoplasms: the T-cell and NK-cell neoplasms are a clinically heterogeneous group of rare disorders, most of which have an aggressive clinical course and poor prognosis. The exception includes the following subtypes, which typically have a relatively indolent and protracted course: T-cell large granulocyte leukemia (T-LGL), chronic lymphoproliferative disorder of NK cells, early-stage mycosis fungoides, primary cutaneous anaplastic large-cell lymphoma (ALCL), and ALK+ ALCL.
Medically Necessary is defined as those services, treatments, procedures, equipment, drugs, devices, items or supplies furnished by a covered Provider that are required to identify or treat a Member's illness, injury or Nervous/Mental Conditions, and which Company determines are covered under this Benefit Plan based on the criteria as follows in A through D:
A. consistent with the symptoms or diagnosis and treatment of the Member's condition, illness, or injury; and
B. appropriate with regard to standards of good medical practice; and
C. not solely for the convenience of the Member, his or her Provider; and
D. the most appropriate supply or level of care which can safely be provided to Member. When applied to the care of an Inpatient, it further means that services for the Member's medical symptoms or conditions require that the services cannot be safely provided to the Member as an Outpatient.
For the definition of Medically Necessary, “standards of good medical practice” means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, and physician specialty society recommendations, and the views of medical practitioners practicing in relevant clinical areas and any other relevant factors. BCBSMS makes no payment for services, treatments, procedures, equipment, drugs, devices, items or supplies which are not documented to be Medically Necessary. The fact that a Physician or other Provider has prescribed, ordered, recommended, or approved a service or supply does not in itself, make it Medically Necessary.
Investigative is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized as a generally accepted standard of good medical practice for the treatment of the condition being treated and; therefore, is not considered medically necessary. For the definition of Investigative, “generally accepted standards of medical practice” means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, and physician specialty society recommendations, and the views of medical practitioners practicing in relevant clinical areas and any other relevant factors. In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting.
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language.
3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.20 per approval by Medical Policy Advisory Committee (MPAC)
7/19/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC, “High-dose chemotherapy with allogeneic stem-cell support is considered investigational to treat NHL that progresses or relapses relatively soon after a prior course of high-dose chemotherapy with autologous stem-cell support.” changed to “High-dose chemotherapy with allogeneic stem-cell support may be considered medically necessary to treat NHL that progresses or relapses relatively soon after a prior course of high-dose chemotherapy with autologous stem-cell support.”
7/14/2005: Code Reference section updated, CPT code 38230 added covered codes, HCPCS G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added covered codes, HCPCS J9000-J9999 statement added to HCPCS and all separately listed codes deleted
10/20/2005: Code Reference section updated, ICD9 procedure codes 41.01, 41.02, 41.03, 41.09 added
3/16/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
5/17/2007: Policy reviewed, description updated. Added marginal zone lymphoma with indolent behavior or lymphoma or lymphoplasmacytoid lymphoma medically necessary for patients with NHL subtypes IWF classified as indolent
9/13/2007: Code reference section updated per the annual ICD-9 code updates. ICD-9 codes 200.00-200.28 and 200.80-200.88 added
12/19/2007: Coding updated per 2008 CPT/HCPCS revisions
7/11/2008: Policy description and statements updated. Peripheral T-cell lymphoma added as investigational for either autologous or allogeneic stem-cell support. Allogeneic stem-cell support to treat NHL that progresses or relapses soon after a course of HDC with autologous stem-cell support changed to investigational. Title changed to "Stem-Cell Transplantation" and the terminology "High Dose Chemotherapy" removed
1/6/2009: Policy reviewed, "prior authorization before evaluation" deleted
6/04/2010: Policy description updated to include risk groups and adverse risk factors. Policy statement updated to include medically necessary indications for allogeneic SCT and/or autologous SCT and medically necessary indications for reduced intensity conditioning allogeneic SCT. FEP and State and School Employee verbiage added to Policy Exceptions section. Added new CPT Codes 86825 and 86826 to Covered Codes Table. HCPCS Codes G0265, G0266 and G0267 were removed from covered table due to these codes were deleted as of 12-31-2007.
04/20/2011: Policy description updated regarding disease classification, prevalence, and treatment approaches. Policy statement revised to break out mantle cell lymphoma; investigational statements added for autologous as salvage therapy and allogeneic to consolidate a first remission and medically necessary statement added for allogeneic as salvage therapy. Also revised the policy statement to break out peripheral T-cell lymphoma; added statements as medically necessary for autologous to consolidate first remission in specific situations and autologous and allogeneic as salvage therapy, and as investigational regarding allogeneic HSCT to consolidate a first complete remission. Policy guidelines updated regarding high-risk peripheral T-cell lymphoma.
05/08/2012: Policy statement regarding peripheral T-cell lymphomas revised to clarify that this includes mature T-cell and NK-cell neoplasms.
04/16/2013: Policy reviewed; no changes.
04/01/2014: Policy reviewed; description updated regarding Mature T-cell and NK-cell neoplasms and Mantle Cell Lymphoma.
03/13/2015: Policy reviewed; description updated. "Stem-cell transplantation" changed to "hematopoietic stem-cell transplantation" throughout policy. Investigational statement criteria for autologous and allogeneic HSCT updated to change "NHL subtypes" to "NHL B-cell subtypes." In first medically necessary statement for patients with mature T-cell or NK-cell (peripheral T-cell) neoplasms, "high-risk peripheral T-cell lymphoma" changed to "high-risk subtypes." Policy guidelines updated to add information regarding salvage therapy and high-risk (aggressive) T-cell and natural killer cell neoplasms.
08/27/2015: Code Reference section updated to add ICD-10 codes, updated the code descriptions for 38240 and 38241; removed deleted HCPCS code G0363, and removed deleted code CPT 96445 and replaced with CPT code 96446.
05/25/2016: Policy number added. Policy Guidelines updated to add medically necessary and investigative definitions.
09/30/2016: Code Reference section updated to add the following new ICD-10 procedure codes: 30230G2, 30233G2, 30240G2, 30243G2, 30230G3, 30233G3, 30240G3, 30243G3, 30230G4, 30233G4, 30240G4, 30243G4, 30230Y2, 30233Y2, 30240Y2, 30243Y2, 30230Y3, 30233Y3, 30240Y3, 30243Y3, 30230Y4, 30233Y4, 30240Y4, and 30243Y4.
Blue Cross Blue Shield Association Policy # 8.01.20
This may not be a comprehensive list of procedure codes applicable to this policy.
The code(s) listed below are ONLY medically necessary if the procedure is performed according to the "Policy" section of this document. | <urn:uuid:c05632f8-ac98-40cc-9214-faba2f1be5c9> | {
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In the United States, colorectal cancer (CRC) is the fourth most common cancer diagnosed among men and women and the second leading cause of death from cancer.1 The majority of cases of CRC can be prevented by the detection and removal of noncancerous adenomatous polyps (adenomas).2 As in other types of cancer, survival is significantly better when CRC is diagnosed early, while the disease is still localized.2
Since 2002, the United States Preventive Services Task Force (USPSTF) has recommended routine CRC screening of asymptomatic average-risk adults aged 50 to 75 years.3 In 2018, the American Cancer Society (ACS) lowered the starting age for CRC screening to age 45 years for people with average risk.4 CRC screening has been a Healthcare Effectiveness Data and Information Set (HEDIS) quality-of-care measure since 2004 and is widely promoted as lifesaving.5
Commercial payers (not Medicare or Medicaid) provide insurance to 75% of the approximately 61 million US adults aged 50 to 64 years,6 the ages that are appropriate for CRC screening. From 2000 to 2010, CRC screening rates improved from approximately 35% to almost 60%.7 However, in recent years, this increase has slowed dramatically, with the most recent estimate of 62.4% of men and women aged ≥50 years who report CRC testing that is consistent with the guideline recommendations.7 This results in a gap of approximately 18 million commercially insured adults aged 50 to 64 years who are noncompliant with the USPSTF’s screening guidelines.3 Noncompliance may be related to access to screening, because noncompliant patients are disproportionately from rural areas.8
Although optical colonoscopy has been the dominant method for CRC screening in the United States to date, other methods that are also recommended by established guidelines include computed tomography (CT) colonography, guaiac-based fecal occult blood test, fecal immunochemical test, fecal immunochemical test-DNA (ie, Cologuard), flexible sigmoidoscopy, and flexible sigmoidoscopy with fecal immunochemical test.9,10 Offering patients choices for CRC screening appears to lead to higher screening rates and better screening compliance.10
In 2008, the ACS, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology recommended that clinicians make patients aware of the full range of CRC screening options, including CT colonography.11 The new recommendation for screening from the ACS regarding a starting age of 45 years is not reflected in this combined statement.4,11 In June 2016, the USPSTF recommended CRC screening by any of the methods mentioned above, including CT colonography.3 As a result, nongrandfathered Affordable Care Act (ACA) health plans must cover CT colonography, with no patient cost-sharing, and CT colonography screening is now incorporated into the HEDIS CRC screening quality-of-care measure.12-14
Optical colonoscopy and CT colonography are the only CRC screening methods that visualize the entire colon; for this reason, they have the highest sensitivity for the detection of precancerous and cancerous adenomas.15,16 Optical colonoscopy and CT colonography allow for the detection and subsequent removal of precancerous adenomas, which can prevent long-term and interscreening interval cancers. Patients who have a CT colonography screening that reveals a nondiminutive polyp (>6 mm) are referred to colonoscopy (and subsequent polypectomy). Although there is discussion about whether polypectomy is necessary for low-risk patients who present with small polyps (6-9 mm),15 Pickhardt and colleagues suggest that active surveillance of these otherwise healthy patients would be cost-effective and preferable to the patient.17
CT colonography also offers patient-centered advantages relative to optical colonoscopy and other CRC screening methods.16 Most optical colonoscopies include sedation and anesthesia, neither of which is routinely used for CT colonography. Because of anesthesia, patients who have had an optical colonoscopy must be accompanied home and will be absent from work the remainder of the day of the procedure, neither of which is required for patients who have CT colonography.18 The potential for less lost work time with CT colonography versus other testing methods may be especially important to the working-age population and to employers.
Moreover, CT colonography is less invasive than optical colonoscopy and has fewer complications.19 CT colonography can be performed by a radiology technologist with the scan interpreted by a radiologist at another site, which can be advantageous to patients in underserved areas. In addition, ethnic groups who are at high risk for CRC and who remain underscreened because of cultural objections to optical colonoscopy may prefer CT colonography.20
CT colonography is an abdominal CT scan that can detect abnormalities outside of the colon; it always exposes a patient to radiation. Experts have been unable to quantify patient harm from the reporting of extracolonic abnormalities or the radiation. Extracolonic reporting is beneficial if knowledge of the abnormality allows for timely intervention for conditions that are detrimental to a patient’s health, and is harmful if the exploration of insignificant findings results in unnecessary patient stress, intervention, and costs.
The CT Colonography Reporting & Data System was established in 2005 as a mechanism of classifying CRC and extracolonic findings of CT colonography screenings, and consistent use of this system may reduce the reporting of nonsignificant extracolonic findings.21 In 2016, the USPSTF found insufficient evidence to assess the population consequences of reporting extracolonic findings.22 The task force also examined radiation exposure risk and concluded that ionizing radiation from a single CT colonography examination (1-5 mSv) repeated every 5 years is low compared with radiation from background sources (3 mSv annually).22 Furthermore, a 2017 American Association of Physicists in Medicine policy states that there is no convincing epidemiologic evidence of increased cancer incidence or mortality from low radiation doses (ie, <100 mSv).23
Our primary interest in this study is the cost of CT colonography screening. Because optical colonoscopy is considered a gold standard of CRC screening, and because the literature24 supports equivalent clinical outcomes for CT colonography and optical colonoscopy,3 we chose optical colonoscopy as the reference for this analysis of CT colonography cost. In published modeling of the Medicare population, the cost of CT colonography compares favorably to optical colonoscopy, but the comparison has not been made for the commercial population.25 The use of anesthesia in optical colonoscopy (but not in CT colonography) is a significant source of costs and, as such, is an important consideration for medical and pharmacy directors.
For historical cost and use patterns, we used the 4th quarter of the 2016 Truven Health MarketScan Commercial Database (hereafter MarketScan), which includes health plan membership and claims data for 2016 for approximately 28 million US employees and their dependents covered under fully insured and self-funded employer-sponsored health insurance. We also used the Medicare physician fee schedule for 2016.
Because the screening intervals for CT colonography and optical colonoscopy differ, we developed a cost-per-screening-year metric to compare the 2 services. We defined “cost per screening year” as the total cost of a screening service, divided by the interval years between screenings. This allowed a direct comparison of the cost of screening methods that have different screening intervals.
Our methodology had 3 steps. First, we estimated the cost per screening for optical colonoscopy using MarketScan 2016 US commercial claims data. Second, as a result of sparse commercial claims experience for CT colonography screening, we estimated CT colonography cost per screening using several fee scenarios. Finally, we converted optical colonoscopy and CT colonography costs per screening to respective costs per screening year using real-world screening intervals obtained from the literature.26-29
The cost data include the screening service and ancillary services. For example, a patient who had an optical colonoscopy may have several pathology services for biopsies performed during the colonoscopy. For cost, we used the allowed charges paid by the payer, which would also include any patient cost-sharing.
Optical Colonoscopy Cost per Screening
We restricted the optical colonoscopy cost data analysis to plan members who had medical and prescription drug coverage, as reported in the MarketScan database; members’ age had to be between 45 years and <65 years. We included patients who were aged 45 to 49 years, because the US Multi-Society Task Force on Colorectal Cancer suggests that routine screening for people in this age range is appropriate for African Americans.30
We identified members with 1 facility or professional optical colonoscopy claim (service) that had either a Healthcare Common Procedure Coding System (HCPCS) code that indicates that the optical colonoscopy was for a screening procedure for an average-risk member, or, if the HCPCS code was ambiguous for screening, had an International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnosis code for the screening of an average-risk member. These HCPCS and ICD-10-CM code criteria avoided capturing screenings for high-risk individuals (such as those with a history of CRC) who are not candidates for CT colonography. We excluded optical colonoscopies with codes that indicate an incomplete colonoscopy or if an upper endoscopy was performed the same day. The latter exclusion is because we could not easily distinguish the additional costs related to the upper endoscopy.
For the remaining optical colonoscopies, we identified other same-day optical colonoscopy–related services and costs for the member. We summarized the optical colonoscopy–related costs, including anesthesia and pathology services that occurred on the same day, and categorized the costs as screening (ie, professional and facility services for the screening itself), anesthesia, or pathology.
For the bowel preparation costs, we identified the prescription drug costs for laxatives in the 30 days before the optical colonoscopy. We did not include nonprescription bowel preparation agents in our cost estimates.
Finally, we identified optical colonoscopy complication claim costs for the day of the procedure and the 30 days after the procedure by summing the costs with diagnosis codes that may be attributable to complications. We based the list of diagnosis codes on the article by Levin and colleagues (see Appendix Table A.1 for all codes and descriptions).31
We divided the total costs for each service category by the number of screenings with any cost in the category to get the unit cost for each service category. In addition, we divided the costs by the number of unique screenings to get the cost per screening for each service category and for all services.
CT Colonography Cost per Screening
Nationally, fewer than 1% of CRC screenings in 2015 were a CT colonography.32 Within the MarketScan claims data, less than 0.1% of CRC screenings in 2015 were by CT colonography, which is an insufficient quantity for a credible claims analysis. We instead used data from several sources to construct our cost scenarios. The scenarios included assumptions as to whether the service is performed in an outpatient hospital department, because the outpatient hospital site of service is associated with significantly higher commercial cost.
We constructed 4 scenarios for the average cost per screening year for CT colonography. These scenarios varied the screening fee by setting (ie, hospital outpatient or non–hospital outpatient) and the distribution of screenings by setting (ie, outpatient hospital or non–outpatient hospital). In developing the fee scenarios, we considered Medicare fees for diagnostic CT colonography, because Medicare does not cover screening CT colonography, and we tested various ratios of commercial to Medicare fees. Commercial reimbursement for imaging is variable, with radiology benefit managers’ fees being proximate to Medicare’s, but hospital outpatient–based imaging is much higher. Therefore, there could be different scenarios to determine the cost of CT colonography. Nevertheless, we believe that our scenarios are a fair way to bracket the range of future commercial fees.
For the first scenario, we assumed that commercial screening CT colonography fees were higher than Medicare’s diagnostic CT colonography by the ratio of commercial-to-Medicare diagnostic abdominal CT fees and that the portion of CT colonographies performed in the hospital outpatient and non–hospital outpatient settings would be the same as for commercial, nonemergency abdominal CTs.
For the second scenario, we used the same fees as the first scenario and the same observed site-of-service distribution as for commercial screening mammograms (the only widely adopted radiologic screening).
For the third scenario, we assumed that the commercial CT colonography fee has the same fee relativity to the Medicare CT colonography fee as commercial-to-Medicare screening mammograms and the same site-of-service distribution as commercial screening mammograms.
For the fourth scenario, we assumed that the commercial screening CT colonography fee is 200% of Medicare’s diagnostic CT colonography fee, regardless of the site of service (Table 1).
We calculated the commercial fees for diagnostic abdominal CTs and mammograms using the same MarketScan data and restrictions as for optical colonoscopies (Appendix Table A.1). We obtained the 2015 Medicare fees from the Centers for Medicare & Medicaid Services website.
We assumed that the unit costs for bowel preparation, complications, and follow-up were the same for CT colonography and optical colonoscopy; therefore, we used the unit costs from the optical colonoscopy analysis, except that for follow-up optical colonoscopy screening we assumed that everyone would have a pathology service. We also assumed that the percent of patients with prescription bowel preparation would be the same for CT colonography and for optical colonoscopy. We relied on published estimates of the percent of CT colonographies that require follow-up (ie, 14.5%)26,33 and for the frequency of optical colonoscopy complications (ie, 0.4%).31,34 We multiplied the unit costs for each service by the frequency of each service to calculate the average cost by CT colonography.
Cost per Screening Year
Optical colonoscopy and CT colonography have different screening intervals. To compare the costs of optical colonoscopy with CT colonography, we divided our estimates of the cost of optical colonoscopy and CT colonography screenings by the estimated real-world screening intervals to calculate each cost per screening year.
People who have had an optical colonoscopy return for screening, on average, in 6 years (see Appendix Table A.2).27 This is earlier than is suggested by national optical colonoscopy guidelines, which recommend that people without adenomas (approximately 75% of people) should return in 10 years for their next screening and that the remaining 25% of people should return in 3 or 5 years, unless they have cancer.27-29 Studies suggest that approximately 75% of average-risk people who have an optical colonoscopy will have no adenomas, so the average screening return time when following the screening recommendations should be approximately 8.6 years.27-29
For CT colonography, we assumed that people will return, on average, in 4.9 years. The American College of Gastroenterology recommends a 5-year screening interval for people who have had a CT colonography and did not have a follow-up optical colonoscopy, and a 3-year screening interval for the approximately 6% of those who have had an optical colonoscopy after which a high-risk adenoma was found11,26,30,35 (see also Appendix Table A.2). We did not find evidence suggesting that the real-world return interval is less than 4.9 years, which differs from a study by Pickhardt and colleagues.26
All data analyses were performed using SAS version 9.4 (SAS Institute Inc; Cary, NC). The fee scenario models were created in Microsoft Excel 2016.
We identified 798,143 optical colonoscopies, of which (in order of exclusion) 300,362 were coded as diagnostic or high-risk; 60,764 were coded as incomplete; 54,027 were in plan members who had an upper endoscopy the same day; and 30,949 were for people aged <45 years or >65 years, which resulted in 406,068 screening optical colonoscopies for analysis (Figure).
We found that in 2016, the average screening optical colonoscopy cost was $2033. The cost of the screening itself was $1425, which is approximately 66% of the total fee associated with all screening services. Approximately 46% of the people had prescription drug bowel preparation costs that averaged $103; approximately 81% of the people had anesthesia fees that averaged $410; approximately 64% of the members had pathology fees that averaged $226; and approximately 1 of 270 people had optical colonoscopy–related complications that averaged approximately $22,400 (Table 2).
Combining the screening cost and ancillary costs, and dividing by the average return time of 6 years results in an optical colonoscopy cost of $340 per screening year (Table 2).
The non–CT colonography services associated with CT colonography, which were averaged per the screened members, include $48 for prescription bowel preparation (46.6% frequency), $4 for complications (0.02% frequency), and $307 for referral to colonoscopy (14.5% frequency; Table 3). The cost for the CT colonography itself ranged from $330 to $1081, depending on the scenario and the site of service; the total cost is inclusive of non–CT colonography services, referrals from CT colonography to optical colonoscopy, and complications, and ranged from $689 to $1440 (Table 4).
Using the CT colonography screening interval of 4.9 years resulted in CT colonography costs of $265, $249, $153, and $170 per screening year for scenarios 1 to 4, respectively, and savings of 22%, 27%, 55%, and 50%, respectively, compared with optical colonoscopy (Table 4).
Our optical colonoscopy–related cost estimates and the high portion (ie, approximately 33%) of optical colonoscopy costs associated with ancillary services are consistent with numbers reported in the literature.36 In recent years, there have been increases in the use of anesthesia services, higher polyp detection rates, and, as a consequence, an increased use of pathology services.36 The increase in polyp detection rate is likely a result of the implementation of optical colonoscopy quality measures based on polyp detection rates and adenoma detection rates.37 The anesthesia and polypectomy trends may not necessarily be in the best interest of plan members, because anesthesia and polypectomies increase the risk for complications and add to the cost of optical colonoscopy that is paid by commercial payers.
The ACA, which requires coverage without cost-sharing of all USPSTF-recommended services, was followed by rules that also likely increased the cost to payers, including a 2010 requirement that CRC screening procedures that are initially coded as screening optical colonoscopies remain classified as screening optical colonoscopies even when polyps are found,38 and a 2016 ACA requirement that anesthesia be covered for all optical colonoscopies.39 Before 2016, some payers classified screening optical colonoscopies with polyps as diagnostic and did not cover anesthesia.39
Now that it is endorsed by the USPSTF, CT colonography has the potential to become a high-volume screening procedure. We present 4 commercial CT colonography fee scenarios to estimate the commercial costs for CT colonography screenings, and each scenario compares favorably to optical colonoscopy. We developed the CT colonography fee scenarios using the 2016 commercial fees for other radiology services that are similar to CT colonography, relative to Medicare fees for the same services.
In preparing the scenarios, we observed that commercial fees associated with the radiology procedures varied based on the site of service and volume. High-volume screening procedures performed in freestanding facilities have the lowest fees relative to Medicare, and lower-volume diagnostic procedures performed in hospital outpatient departments have the highest fees relative to Medicare. These dynamics suggest that expanding the use of screening CT colonographies can be attractive to payers and to providers.
Our 4 scenarios show that commercial CT colonography screening is 22% to 55% less expensive than optical colonoscopy per screening year. We anticipate that as awareness of and demand for CT colonography screening increases, fees will decline and more non–hospital outpatient sites will offer CT colonography. An increased availability of CT colonography procedures in non–hospital outpatient sites may be particularly attractive to people for their relative geographic convenience.
The potential for CT colonography expansion is large: if half of the 18 million guideline-nonadherent US adults aged 50 to 65 years with commercial health insurance use CT colonography for screening, there would be more than 1.8 million additional CT colonographies each year. An optical colonoscopy expansion could accompany a CT colonography expansion as well, because the current 60% compliance rate can accommodate increases for all methods of screening.
We noted several advantages for people to use CT colonography rather than optical colonoscopy, including convenience, time-savings, and fewer complications thanks to the screening technique itself and avoiding anesthesia. Offering CT colonography as a screening choice for CRC is a clear win on all 3 dimensions of the Triple Aim, including (1) CRC screening by any method improves the health of populations; (2) CT colonography improves the person’s experience of care relative to optical colonoscopy; and (3) CT colonography offers cost advantages relative to optical colonoscopy. We suggest that payers and health systems that wish to improve population health and their CT colonography screening HEDIS scores should consider expanding the availability of CT colonography.
Our model assumes the USPSTF and other organizations’ recommendation that screening begin at age 50 years. We did not comprehensively model the ACS’s recent recommendation of a starting age of 45 years, although our testing shows that CT colonography’s cost relativities would be preserved.11
This study has several limitations. Our analysis compares CT colonography with optical colonoscopy, but we did not compare other methods. A comparison across all CRC screening methods for commercial payers would be useful and would need to consider the full follow-up required for a suspicious or indeterminate finding, which often involves optical colonoscopy. Such a comparison would need to account for the cost-benefit of the nondetection of earlier precancerous adenomas, which is not available for stool-based methods, such as the fecal occult blood test or fecal immunochemical test.
If optical colonoscopy were performed at recommended intervals instead of more frequently than recommended, the advantages of the CT colonography would be lower than we estimate. However, we are not aware of strong efforts to shift screening intervals to current recommendations. Conversely, if recommendations emerge for longer intervals than 5 years for CT colonography, the cost advantage of CT colonography would increase.
Furthermore, our analysis relies on claims from the 2016 Truven Health MarketScan Database, which is a national insurance database of commercially insured plan members and claims. Other national databases and time periods may potentially produce different results.
In addition, often there are significant regional, provider-specific, and payer-specific variations in costs as a result of differences in service-level fees and practice patterns (eg, the use of anesthesia and prescription bowel preparatory agents). These variations suggest that each care management organization should consider its circumstances in determining whether CT colonography offers cost-savings that are greater than optical colonoscopy. Future reimbursement changes could cause our estimates to be obsolete.
Finally, several areas warrant further research. In our analysis of US commercial claims, we excluded approximately 12% of the screening optical colonoscopies, because those people had a same-day upper endoscopy. This rate is similar to that reported in a 2015 Medicare analysis of CRC screening.36 Upper endoscopies are not recommended as a routine screening examination, and this practice could contribute to the overall invasiveness and potential complications associated with optical colonoscopy.40 More research into the short intervals for repeated optical colonoscopies could be conducted through longitudinal claims data sets. Furthermore, little is known about the potential advantages offered by screening centers that have the capability to perform immediately an optical colonoscopy on people who have had a CT colonography and require additional testing, which avoids delayed or missed follow-up appointments and the burden of additional bowel preparation.41
Our findings suggest that CT colonography for CRC screening offers effective screening, patient-centered advantages, and lower costs compared with optical colonoscopy. Therefore, CT colonography may be particularly appealing to the currently recommended but unscreened population of people who have commercial insurance.
This study was funded by the National Electrical Manufacturers Association.
Author Disclosure Statement
Dr Goss Sawhney was, and Mr Pyenson, Dr Rotter, and Ms Berrios are employees of Milliman, which received funding for this study; Dr Yee has received research/grant support from EchoPixel and Philips.
Dr Goss Sawhney was Healthcare Consultant and Actuary, Milliman, New York, NY; Mr Pyenson is Principal & Consulting Actuary, Milliman, and Commissioner of Medicare Payment Advisory Commission (MedPAC); Dr Rotter is Senior Healthcare Analyst, Milliman; Ms Berrios is Senior Healthcare Analytics Consultant, Milliman; Dr Yee is Chair, Department of Radiology, Montefiore Medical Center, Bronx, NY.
1. National Cancer Institute. Surveillance, Epidemiology and End Results Program. Cancer stat facts: colorectal cancer. https://seer.cancer.gov/statfacts/html/colorect.html. Accessed August 6, 2018.
2. American Society for Gastrointestinal Endoscopy. Colorectal cancer screening: facts about colorectal cancer. www.asge.org/home/about-asge/newsroom/mediabackgrounders-detail/colorectal-cancer-screening. Accessed August 6, 2018.
3. US Preventive Services Task Force. Screening for colorectal cancer: US Preventive Services Task Force Recommendation Statement. JAMA. 2016;315:2564-2575. Errata in: JAMA. 2016;316:545; JAMA. 2017;317:2239.
4. American Cancer Society. American Cancer Society guideline for colorectal cancer screening. Revised May 30, 2018. www.cancer.org/cancer/colon-rectal-cancer/detection-diagnosis-staging/acs-recommendations.html. Accessed May 7, 2018.
5. National Committee for Quality Assurance. Colorectal cancer screening. www.ncqa.org/report-cards/health-plans/state-of-health-care-quality/2017-table-of-contents/colorectal-cancer. Accessed August 6, 2018.
6. United States Census Bureau. B27002 – Private health insurance status by sex by age. Universe: civilian noninstitutionalized population. 2016 version. 2012-2016 American Community Survey 5-year estimates. https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_16_5YR_
B27002&prodType=table. Accessed January 18, 2018.
7. White A, Thompson TD, White MC, et al. Cancer screening test use—United States, 2015. MMWR Morb Mortal Wkly Rep. 2017;66:201-206.
8. Cole AM, Jackson JE, Doescher M. Urban–rural disparities in colorectal cancer screening: cross-sectional analysis of 1998–2005 data from the Centers for Disease Control’s Behavioral Risk Factor Surveillance study. Cancer Med. 2012;1:350-356.
9. Subramanian S, Amonkar MM, Hunt TL. Use of colonoscopy for colorectal cancer screening: evidence from the 2000 National Health Interview Survey. Cancer Epidemiol Biomarkers Prev. 2005;14:409-416.
10. Stoop EM, de Haan MC, de Wijkerslooth TR, et al. Participation and yield of colonoscopy versus non-cathartic CT colonography in population-based screening for colorectal cancer: a randomised controlled trial. Lancet Oncol. 2012;13:55-64.
11. Levin B, Lieberman DA, McFarland B, et al. Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. Gastroenterology. 2008;134:1570-1595.
12. Centers for Medicare & Medicaid Services. Affordable Care Act implementation FAQs - set 12. www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/aca_implementation_faqs12.html. Accessed January 8, 2018.
13. US Preventive Services Task Force. Screening for colorectal cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2008;149:627-637.
14. National Committee for Quality Assurance. Colorectal cancer screening (COL). www.ncqa.org/hedis/measures/colorectal-cancer-screening/. Accessed September 18, 2018.
15. Pickhardt PJ, Hassan C, Laghi A, et al. Small and diminutive polyps detected at screening CT colonography: a decision analysis for referral to colonoscopy. AJR Am J Roentgenol. 2008;190:136-144.
16. Pickhardt PJ, Hassan C, Halligan S, Marmo R. Colorectal cancer: CT colonography and colonoscopy for detection—systematic review and meta-analysis. Radiology. 2011;259:393-405.
17. Pickhardt PJ, Hassan C, Laghi A, et al. Clinical management of small (6- to 9-mm) polyps detected at screening CT colonography: a cost-effectiveness analysis. AJR Am J Roentgenol. 2008;191:1509-1516.
18. Pickhardt PJ. CT colonography for population screening: ready for prime time? Dig Dis Sci. 2015;60:647-659.
19. Kim DH, Pickhardt PJ, Hanson ME, Hinshaw JL. CT colonography: performance and program outcome measures in an older screening population. Radiology. 2010;254:493-500.
20. Bass SB, Gordon TF, Ruzek SB, et al. Perceptions of colorectal cancer screening in urban African American clinic patients: differences by gender and screening status. J Cancer Educ. 2011;26:121-128.
21. Pooler BD, Kim DH, Lam VP, et al. CT Colonography Reporting and Data System (C-RADS): benchmark values from a clinical screening program. AJR Am J Roentgenol. 2014;202:1232-1237.
22. Lin JS, Piper MA, Perdue LA, et al. Screening for colorectal cancer: updated evidence report and systematic review for the US Preventive Services Task Force. JAMA. 2016;315:2576-2594. Errata in: JAMA. 2016;316:545; JAMA. 2016;316:1412.
23. American Association of Physicists in Medicine. AAPM Position Statement on Radiation Risks from Medical Imaging Procedures. PP 25-C. April 10, 2018. www.aapm.org/org/policies/details.asp?id=318&type=PP¤t=true. Accessed August 13, 2018.
24. Geiger TM, Ricciardi R. Screening options and recommendations for colorectal cancer. Clin Colon Rectal Surg. 2009;22:209-217.
25. Pickhardt PJ, Hassan C, Laghi A, Kim DH. CT colonography to screen for colorectal cancer and aortic aneurysm in the Medicare population: cost-effectiveness analysis. AJR Am J Roentgenol. 2009;192:1332-1340.
26. Pickhardt PJ, Pooler BD, Mbah I, et al. Colorectal findings at repeat CT colonography screening after initial CT colonography screening negative for polyps larger than 5 mm. Radiology. 2017;282:139-148.
27. Kruse GR, Khan SM, Zaslavsky AM, et al. Overuse of colonoscopy for colorectal cancer screening and surveillance. J Gen Intern Med. 2015;30:277-283.
28. Schoen RE, Pinsky PF, Weissfeld JL, et al. Utilization of surveillance colonoscopy in community practice. Gastroenterology. 2010;138:73-81.
29. Murphy CC, Sandler RS, Grubber JM, et al. Underuse and overuse of colonoscopy for repeat screening and surveillance in the Veterans Health Administration. Clin Gastroenterol Hepatol. 2016;14:436-444.e1.
30. Rex DK, Johnson DA, Anderson JC, et al. American College of Gastroenterology guidelines for colorectal cancer screening 2009. Am J Gastroenterol. 2009;104:739-750. Erratum in: Am J Gastroenterol. 2009;104:1613.
31. Levin TR, Zhao W, Conell C, et al. Complications of colonoscopy in an integrated health care delivery system. Ann Intern Med. 2006;145:880-886.
32. American Cancer Society. Colorectal Cancer Facts & Figures 2017-2019. 2017. www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/colorectal-cancer-facts-and-figures/colorectal-cancer-facts-and-figures-2017-2019.pdf. Accessed February 15, 2018.
33. Edwards JT, Mendelson RM, Fritschi L, et al. Colorectal neoplasia screening with CT colonography in average-risk asymptomatic subjects: community-based study. Radiology. 2004;230:459-464.
34. Berrington de Gonzalez A, Kim KP, Yee J. CT colonography: perforation rates and potential radiation risks. Gastrointest Endosc Clin N Am. 2010;20:279-291.
35. Cash BD, Riddle MS, Bhattacharya I, et al. CT colonography of a Medicare-aged population: outcomes observed in an analysis of more than 1400 patients. AJR Am J Roentgenol. 2012;199:W27-W34.
36. Pyenson B, Pickhardt PJ, Sawhney TG, Berrios M. Medicare cost of colorectal cancer screening: CT colonography vs. optical colonoscopy. Abdom Imaging. 2015;40:2966-2976.
37. Williams JE, Le TD, Faigel DO. Polypectomy rate as a quality measure for colonoscopy. Gastrointest Endosc. 2011;73:498-506.
38. Centers for Medicare & Medicaid Services Medicare Learning Network. Coding for polypectomy performed during screening colonoscopy or flexible sigmoidoscopy. MLN Matters Number SE0746. www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnmattersarticles/downloads/se0746.pdf. Accessed August 9, 2018.
39. The Center for Consumer Information & Insurance Oversight. Affordable Care Act Implementation FAQs-Set 12. February 20, 2013. www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/aca_implementation_faqs12.html. Accessed August 10, 2018.
40. Shaheen NJ, Weinberg DS, Denberg TD, et al; for the Clinical Guidelines Committee of the American College of Physicians. Upper endoscopy for gastroesophageal reflux disease: best practice advice from the Clinical Guidelines Committee of the American College of Physicians. Ann Intern Med. 2012;157:808-816.
41. Mayo Clinic. Virtual colonoscopy. www.mayoclinic.org/tests-procedures/virtual-colonoscopy/about/pac-20385156. Accessed February 15, 2018. | <urn:uuid:24e6a548-1ec9-4fb0-9b82-48087c7755a3> | {
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How Much Salary Does a Surgeon Make Every Month?
Growth Trends for Related Jobs
Surgeons’ salaries depend on many factors, including the location in which they work and the medical specialties they practice. Becoming a surgeon requires years of study and training. Nonetheless, successful surgeons reap the dual rewards of earning a comfortable income while helping their patients live healthier lives.
Anatomy of a Doctor Salary
In the past, many surgeons earned their livings like small-business owners. They charged fees for their services and paid themselves from the profits of their businesses.
Present-day surgeons receive their pay from health care organizations, medical groups and hospitals. In many cases, organizations base the surgeons' pay on limits set by a code system called the Medicare Physician Fee Schedule (MPFS).
The MPFS, established by the U.S. Centers for Medicare and Medicaid Services and the American Medical Association, itemizes medical tasks and sets fees based on the number of minutes a physician typically needs to complete each task. For example, a surgeon might submit a bill for a 30-minute diagnosis, two hours of surgery and 15 minutes of postoperative patient evaluation.
The payment provider, which may be a private insurance company or Medicare, then decides the amount it to pay the surgeon for the time billed. In some cases, the surgeon receives payment for the time the payer decides is needed to complete the task, not the actual time the doctor spends performing the task.
The MPFS is the predominant method by which payers determine doctors’ pay.
To work as a surgeon, you must complete many years of education and training. First, you must complete a bachelor’s degree program to qualify for medical school admission. Some aspiring surgeons also earn a master’s degree before applying to medical school.
Medical schools employ a rigorous, competitive admissions process. To qualify, you must earn good grades in your undergraduate and graduate studies. Schools also require applicants to submit letters of recommendation and undergo interviews with admissions committees.
After graduating from medical school, you must complete a residency or internship program at a hospital, clinic or in a private practice. These programs give you the opportunity to explore the medical specialty you plan to practice and gain experience working with, diagnosing and treating patients. Typically, internships and residency programs take three to seven years to complete.
Surgeon Licensing and Certification
After completing a residency or internship program, you must pass the Medical Licensing Examination and obtain a license before you can practice. You also might decide to earn certifications in the specialty you practice, which can boost your career.
Surgeon Salary Per Year
Surgeons earn a median annual salary of about $252,000 per year or $21,000 per month, according to the U.S. Bureau of Labor Statistics (BLS). The median salary represents the income in the middle of the surgeons’ pay scale.
The BLS median salary does not paint a complete salary picture. Surgeons earn varying amounts of income according to the type of medicine they practice. According to a 2018 study produced by Merritt Hawkins, a physician-recruiting firm, plastic surgeons earn $387,000 to $588,000. An orthopedic surgeon salary comes in much higher, about $500,000 to $680,000 per year.
The 2018 Physician Compensation Report produced by Doximity, a professional network for doctors and other health care professionals, reported that neurosurgeons earned an average income of around $663,000 in 2017. Vascular surgeons took home around $476,000, while thoracic surgeons earned about $603,000.
Location Makes a Difference
The amount of money a surgeon earns can depend on the location of his practice. A Doximity study of all physicians showed that doctors in Charlotte, North Carolina, earned an average income of about $402,000 in 2017, but their colleagues in Salt Lake City, Utah, made just $370,000.
Gender Pay Gap
Even in the 21st century, a substantial gender pay gap persists in the medical industry. In 2016, female doctors made 25 percent less than their male counterparts. The gender pay gap increased in 2017 to nearly 28 percent.
Job Growth Trend
Surgeons should see a 14 percent increase in employment opportunities from now until 2026, according to BLS estimates. Hospitals and clinics in inner city and rural areas should have the greatest demands for new surgeons.
- U.S. Bureau of Labor Statistics: Physicians and Surgeons: Pay
- U.S. Bureau of Labor Statistics: How to Become a Physician or Surgeon
- U.S. Bureau of Labor Statistics: Physicians and Surgeons: Job Outlook
- Merritt Hawkins: 2018 Compilation of Physician Compensation Surveys
- Doximity: 2018 Physician Compensation Report
- Doximity: Physician Compensation by Medical Specialty
- University of Michigan: Think the System for Paying U.S. Doctors Is Rigged to Favor Surgeons? New Study May Surprise You
- U.S. Centers for Medicare and Medicaid Services: ICD-10-CM, ICD-10-PCS, CPT, AND HCPCS Code Sets
- U.S. Centers for Medicare and Medicaid Services: How to Use the Searchable Medicare Physician Fee Schedule
Michael Evans’ career path has taken many planned and unexpected twists and turns, from TV sports producer to internet project manager to cargo ship deckhand. He has worked in numerous industries, including higher education, government, transportation, finance, manufacturing, journalism and travel. Along the way, he has developed job descriptions, interviewed job applicants and gained insight into the types of education, work experience and personal characteristics employers seek in job candidates. Michael graduated from The University of Memphis, where he studied photography and film production. He began writing professionally while working for an online finance company in San Francisco, California. His writings have appeared in print and online publications, including Fox Business, Yahoo! Finance, Motley Fool and Bankrate. | <urn:uuid:b76ee87c-2c28-4c89-85f6-e1192425b0b7> | {
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AVR is a family of microcontrollers developed since 1996 by Atmel, acquired by Microchip Technology in 2016. These are modified Harvard architecture 8-bit RISC single-chip microcontrollers. AVR was one of the first microcontroller families to use on-chip flash memory for program storage, as opposed to one-time programmable ROM, EPROM, or EEPROM used by other microcontrollers at the time.
AVR microcontrollers find many applications as embedded systems. They are especially common in hobbyist and educational embedded applications, popularized by their inclusion in many of the Arduino line of open hardware development boards.
Atmel says that the name AVR is not an acronym and does not stand for anything in particular. The creators of the AVR give no definitive answer as to what the term "AVR" stands for. However, it is commonly accepted that AVR stands for Alf and Vegard's RISC processor. Note that the use of "AVR" in this article generally refers to the 8-bit RISC line of Atmel AVR microcontrollers.
The original AVR MCU was developed at a local ASIC house in Trondheim, Norway, called Nordic VLSI at the time, now Nordic Semiconductor, where Bogen and Wollan were working as students. It was known as a μRISC (Micro RISC) and was available as silicon IP/building block from Nordic VLSI. When the technology was sold to Atmel from Nordic VLSI, the internal architecture was further developed by Bogen and Wollan at Atmel Norway, a subsidiary of Atmel. The designers worked closely with compiler writers at IAR Systems to ensure that the AVR instruction set provided efficient compilation of high-level languages.
Among the first of the AVR line was the AT90S8515, which in a 40-pin DIP package has the same pinout as an 8051 microcontroller, including the external multiplexed address and data bus. The polarity of the RESET line was opposite (8051's having an active-high RESET, while the AVR has an active-low RESET), but other than that the pinout was identical.
The AVR 8-bit microcontroller architecture was introduced in 1997. By 2003, Atmel had shipped 500 million AVR flash microcontrollers. The Arduino platform, developed for simple electronics projects, was released in 2005 and featured ATmega8 AVR microcontrollers.
The AVR is a modified Harvard architecture machine, where program and data are stored in separate physical memory systems that appear in different address spaces, but having the ability to read data items from program memory using special instructions.
AVRs are generally classified into following:
tinyAVR – the ATtiny series
|0.5–32 kB||1.6–20||6–32-pin package||64–3072 bytes||64–256 bytes||2016|
The ATtiny series features a small package microcontroller with a limited peripheral set available. This does however include:
- Peripherals equal to or exceed megaAVR 0-series
- Event System
- Improved AVRxt instruction set, hardware multiply
megaAVR – the ATmega series
|4–256 kB||1.6–20||28–100-pin package||256–16384 bytes||256–4096 bytes||2016|
The ATmega series features a microcontroller that provides a solid amount of program memory, as well as a wide range of pins available. It does also have functionality such as:
- Extended instruction set (multiply instructions and instructions for handling larger program memories)
- Extensive peripheral set
- Event system
- New peripherals with enhanced functionality
- Improved AVRxt instruction set
AVR Dx – The AVR Dx family is featuring multiple microcontroller series, focused on HCI, analog signal conditioning and functional safety.
|16–128 kB||20–24 at 1.8–5.5 V||14–64-pin package||4–16 KB||512 bytes||2020|
The parts numbers is formatted as AVRffDxpp, where ff is flash size, x is family, and pp is number of pins. Example: AVR128DA64 – 64-pin DA-series with 128k flash. All devices is AVR Dx family include:
- an Async Type D timer that can run fast than CPU
- 12-bit ADC
- 10-bit DAC
- AVR DA-series (early 2020) – The high memory density makes these MCUs well suited for both wired and wireless communication-stack-intensive functions.
- AVR DB-series (mid-late 2020) – inherits many features from the DA-family, while adding its own:
- 2 or 3 on-chip opamps
- MultiVoltage IO (MVIO) on PORTC
- Supports external HF crystal
- AVR DD-series (not yet released as of September 2021) – small package microcontrollers designed to bring real-time control and multi-voltage operation to applications industrial control, home appliance products, automotive, and Internet of Things (IoT).
- MVIO support on 3 or 4 pins
- AVR EA-series (not yet released as of September 2021)
- 8–64k flash
- 28–48-pin package
|16–256 kB||32||44–100-pin package||1–32 KB||512–2048 bytes||—|
the ATxmega series offers a wide variety of peripherals and functionality such as:
- Extended performance features, such as DMA, "Event System", and cryptography support
- Extensive peripheral set with ADCs
- megaAVRs with special features not found on the other members of the AVR family, such as LCD controller, USB controller, advanced PWM, CAN, etc.
FPSLIC (AVR with FPGA)
- FPGA 5k to 40k gates
- SRAM for the AVR program code, unlike all other AVRs
- AVR core can run at up to 50 MHz
- In 2006, Atmel released microcontrollers based on the 32-bit AVR32 architecture. This was a completely different architecture unrelated to the 8-bit AVR, intended to compete with the ARM-based processors. It had a 32-bit data path, SIMD and DSP instructions, along with other audio- and video-processing features. The instruction set was similar to other RISC cores, but it was not compatible with the original AVR (nor any of the various ARM cores). Since then support for AVR32 has been dropped from Linux as of kernel 4.12; compiler support for the architecture in GCC was never mainlined into the compiler's central source-code repository and was available primarily in a vendor-supported fork. At the time that AVR32 was introduced, Atmel had already been a licensee of the ARM architecture, with both ARM7 and ARM9 microcontrollers having been released prior to and concurrently with the AVR32; later Atmel focused most development effort on 32-bit chips with ARM Cortex-M and Cortex-A cores.
Flash, EEPROM, and SRAM are all integrated onto a single chip, removing the need for external memory in most applications. Some devices have a parallel external bus option to allow adding additional data memory or memory-mapped devices. Almost all devices (except the smallest TinyAVR chips) have serial interfaces, which can be used to connect larger serial EEPROMs or flash chips.
The size of the program memory is usually indicated in the naming of the device itself (e.g., the ATmega64x line has 64 KB of flash, while the ATmega32x line has 32 KB).
There is no provision for off-chip program memory; all code executed by the AVR core must reside in the on-chip flash. However, this limitation does not apply to the AT94 FPSLIC AVR/FPGA chips.
Internal data memory
In the tinyAVR and megaAVR variants of the AVR architecture, the working registers are mapped in as the first 32 memory addresses (000016–001F16), followed by 64 I/O registers (002016–005F16). In devices with many peripherals, these registers are followed by 160 “extended I/O” registers, only accessible as memory-mapped I/O (006016–00FF16).
Actual SRAM starts after these register sections, at address 006016 or, in devices with "extended I/O", at 010016.
Even though there are separate addressing schemes and optimized opcodes for accessing the register file and the first 64 I/O registers, all can also be addressed and manipulated as if they were in SRAM.
The very smallest of the tinyAVR variants use a reduced architecture with only 16 registers (r0 through r15 are omitted) which are not addressable as memory locations. I/O memory begins at address 000016, followed by SRAM. In addition, these devices have slight deviations from the standard AVR instruction set. Most notably, the direct load/store instructions (LDS/STS) have been reduced from 2 words (32 bits) to 1 word (16 bits), limiting the total direct addressable memory (the sum of both I/O and SRAM) to 128 bytes. Conversely, the indirect load instruction's (LD) 16-bit address space is expanded to also include non-volatile memory such as Flash and configuration bits; therefore, the Load Program Memory (LPM) instruction is unnecessary and omitted. (For detailed info, see Atmel AVR instruction set.)
In the XMEGA variant, the working register file is not mapped into the data address space; as such, it is not possible to treat any of the XMEGA's working registers as though they were SRAM. Instead, the I/O registers are mapped into the data address space starting at the very beginning of the address space. Additionally, the amount of data address space dedicated to I/O registers has grown substantially to 4096 bytes (000016–0FFF16). As with previous generations, however, the fast I/O manipulation instructions can only reach the first 64 I/O register locations (the first 32 locations for bitwise instructions). Following the I/O registers, the XMEGA series sets aside a 4096 byte range of the data address space, which can be used optionally for mapping the internal EEPROM to the data address space (100016–1FFF16). The actual SRAM is located after these ranges, starting at 200016.
Each GPIO port on a tiny or mega AVR drives up to eight pins and is controlled by three 8-bit registers: DDRx, PORTx and PINx, where x is the port identifier.
- DDRx: Data Direction Register, configures the pins as either inputs or outputs.
- PORTx: Output port register. Sets the output value on pins configured as outputs. Enables or disables the pull-up resistor on pins configured as inputs.
- PINx: Input register, used to read an input signal. On some devices, this register can be used for pin toggling: writing a logic one to a PINx bit toggles the corresponding bit in PORTx, irrespective of the setting of the DDRx bit.
Newer ATtiny AVR's, like ATtiny817 and its siblings, have their port control registers somewhat differently defined. xmegaAVR have additional registers for push/pull, totem-pole and pullup configurations.
Almost all AVR microcontrollers have internal EEPROM for semi-permanent data storage. Like flash memory, EEPROM can maintain its contents when electrical power is removed.
In most variants of the AVR architecture, this internal EEPROM memory is not mapped into the MCU's addressable memory space. It can only be accessed the same way an external peripheral device is, using special pointer registers and read/write instructions, which makes EEPROM access much slower than other internal RAM.
However, some devices in the SecureAVR (AT90SC) family use a special EEPROM mapping to the data or program memory, depending on the configuration. The XMEGA family also allows the EEPROM to be mapped into the data address space.
Since the number of writes to EEPROM is limited – Atmel specifies 100,000 write cycles in their datasheets – a well designed EEPROM write routine should compare the contents of an EEPROM address with desired contents and only perform an actual write if the contents need to be changed.
Atmel's AVRs have a two-stage, single-level pipeline design. This means the next machine instruction is fetched as the current one is executing. Most instructions take just one or two clock cycles, making AVRs relatively fast among eight-bit microcontrollers.
The AVR instruction set is more orthogonal than those of most eight-bit microcontrollers, in particular the 8051 clones and PIC microcontrollers with which AVR competes today. However, it is not completely regular:
- Pointer registers X, Y, and Z have addressing capabilities that are different from each other.
- Register locations R0 to R15 have more limited addressing capabilities than register locations R16 to R31.
- I/O ports 0 to 31 can be bit addressed, unlike I/O ports 32 to 63.
- CLR (clear all bits to zero) affects flags, while SER (set all bits to one) does not, even though they are complementary instructions. (CLR is pseudo-op for EOR R, R; while SER is short for LDI R,$FF. Arithmetic operations such as EOR modify flags, while moves/loads/stores/branches such as LDI do not.)
- Accessing read-only data stored in the program memory (flash) requires special LPM instructions; the flash bus is otherwise reserved for instruction memory.
Additionally, some chip-specific differences affect code generation. Code pointers (including return addresses on the stack) are two bytes long on chips with up to 128 KB of flash memory, but three bytes long on larger chips; not all chips have hardware multipliers; chips with over 8 KB of flash have branch and call instructions with longer ranges; and so forth.
The mostly regular instruction set makes C (and even Ada) compilers fairly straightforward and efficient. GCC has included AVR support for quite some time, and that support is widely used. LLVM also has rudimentary AVR support. In fact, Atmel solicited input from major developers of compilers for small microcontrollers, to determine the instruction set features that were most useful in a compiler for high-level languages.
The AVR line can normally support clock speeds from 0 to 20 MHz, with some devices reaching 32 MHz. Lower-powered operation usually requires a reduced clock speed. All recent (Tiny, Mega, and Xmega, but not 90S) AVRs feature an on-chip oscillator, removing the need for external clocks or resonator circuitry. Some AVRs also have a system clock prescaler that can divide down the system clock by up to 1024. This prescaler can be reconfigured by software during run-time, allowing the clock speed to be optimized.
Since all operations (excluding multiplication and 16-bit add/subtract) on registers R0–R31 are single-cycle, the AVR can achieve up to 1 MIPS per MHz, i.e. an 8 MHz processor can achieve up to 8 MIPS. Loads and stores to/from memory take two cycles, branching takes two cycles. Branches in the latest "3-byte PC" parts such as ATmega2560 are one cycle slower than on previous devices.
AVRs have a large following due to the free and inexpensive development tools available, including reasonably priced development boards and free development software. The AVRs are sold under various names that share the same basic core, but with different peripheral and memory combinations. Compatibility between chips in each family is fairly good, although I/O controller features may vary.
See external links for sites relating to AVR development.
AVRs offer a wide range of features:
- Multifunction, bi-directional general-purpose I/O ports with configurable, built-in pull-up resistors
- Multiple internal oscillators, including RC oscillator without external parts
- Internal, self-programmable instruction flash memory up to 256 KB (384 KB on XMega)
- On-chip debugging (OCD) support through JTAG or debugWIRE on most devices
- The JTAG signals (TMS, TDI, TDO, and TCK) are multiplexed on GPIOs. These pins can be configured to function as JTAG or GPIO depending on the setting of a fuse bit, which can be programmed via ISP or HVSP. By default, AVRs with JTAG come with the JTAG interface enabled.
- debugWIRE uses the /RESET pin as a bi-directional communication channel to access on-chip debug circuitry. It is present on devices with lower pin counts, as it only requires one pin.
- Internal data EEPROM up to 4 KB
- Internal SRAM up to 16 KB (32 KB on XMega)
- External 64 KB little endian data space on certain models, including the Mega8515 and Mega162.
- The external data space is overlaid with the internal data space, such that the full 64 KB address space does not appear on the external bus and accesses to e.g. address 010016 will access internal RAM, not the external bus.
- In certain members of the XMega series, the external data space has been enhanced to support both SRAM and SDRAM. As well, the data addressing modes have been expanded to allow up to 16 MB of data memory to be directly addressed.
- 8-bit and 16-bit timers
- Analog comparator
- 10 or 12-bit A/D converters, with multiplex of up to 16 channels
- 12-bit D/A converters
- A variety of serial interfaces, including
- I²C compatible Two-Wire Interface (TWI)
- Synchronous/asynchronous serial peripherals (UART/USART) (used with RS-232, RS-485, and more)
- Serial Peripheral Interface Bus (SPI)
- Universal Serial Interface (USI): a multi-purpose hardware communication module that can be used to implement an SPI, I2C or UART interface.
- Brownout detection
- Watchdog timer (WDT)
- Multiple power-saving sleep modes
- Lighting and motor control (PWM-specific) controller models
- CAN controller support
- USB controller support
- Ethernet controller support
- LCD controller support
- Low-voltage devices operating down to 1.8 V (to 0.7 V for parts with built-in DC–DC upconverter)
- picoPower devices
- DMA controllers and "event system" peripheral communication.
- Fast cryptography support for AES and DES
There are many means to load program code into an AVR chip. The methods to program AVR chips varies from AVR family to family. Most of the methods described below use the RESET line to enter programming mode. In order to avoid the chip accidentally entering such mode, it is advised to connect a pull-up resistor between the RESET pin and the positive power supply.
The in-system programming (ISP) programming method is functionally performed through SPI, plus some twiddling of the Reset line. As long as the SPI pins of the AVR are not connected to anything disruptive, the AVR chip can stay soldered on a PCB while reprogramming. All that is needed is a 6-pin connector and programming adapter. This is the most common way to develop with an AVR.
The Atmel-ICE device or AVRISP mkII (Legacy device) connects to a computer's USB port and performs in-system programming using Atmel's software.
AVRDUDE (AVR Downloader/UploaDEr) runs on Linux, FreeBSD, Windows, and Mac OS X, and supports a variety of in-system programming hardware, including Atmel AVRISP mkII, Atmel JTAG ICE, older Atmel serial-port based programmers, and various third-party and "do-it-yourself" programmers.
The Program and Debug Interface (PDI) is an Atmel proprietary interface for external programming and on-chip debugging of XMEGA devices. The PDI supports high-speed programming of all non-volatile memory (NVM) spaces; flash, EEPROM, fuses, lock-bits and the User Signature Row. This is done by accessing the XMEGA NVM controller through the PDI interface, and executing NVM controller commands. The PDI is a 2-pin interface using the Reset pin for clock input (PDI_CLK) and a dedicated data pin (PDI_DATA) for input and output.
The Unified Program and Debug Interface (UPDI) is a one-wire interface for external programming and on-chip debugging of newer ATtiny and ATmega devices. The Atmel-ICE and PICkit 4 are capable of programming UPDI chips. It is also possible to use an Arduino thanks to jtag2updi.
High-voltage serial programming (HVSP) is mostly the backup mode on smaller AVRs. An 8-pin AVR package does not leave many unique signal combinations to place the AVR into a programming mode. A 12-volt signal, however, is something the AVR should only see during programming and never during normal operation. The high voltage mode can also be used in some devices where the reset pin has been disabled by fuses.
High-voltage parallel programming (HVPP) is considered the "final resort" and may be the only way to correct bad fuse settings on an AVR chip.
Most AVR models can reserve a bootloader region, 256 bytes to 4 KB, where re-programming code can reside. At reset, the bootloader runs first and does some user-programmed determination whether to re-program or to jump to the main application. The code can re-program through any interface available, or it could read an encrypted binary through an Ethernet adapter like PXE. Atmel has application notes and code pertaining to many bus interfaces.
The AT90SC series of AVRs are available with a factory mask-ROM rather than flash for program memory. Because of the large up-front cost and minimum order quantity, a mask-ROM is only cost-effective for high-production runs.
aWire is a new one-wire debug interface available on the new UC3L AVR32 devices.
The AVR offers several options for debugging, mostly involving on-chip debugging while the chip is in the target system.
debugWIRE is Atmel's solution for providing on-chip debug capabilities via a single microcontroller pin. It is particularly useful for lower pin count parts which cannot provide the four "spare" pins needed for JTAG. The JTAGICE mkII, mkIII and the AVR Dragon support debugWIRE. debugWIRE was developed after the original JTAGICE release, and now clones support it.
The Joint Test Action Group (JTAG) feature provides access to on-chip debugging functionality while the chip is running in the target system. JTAG allows accessing internal memory and registers, setting breakpoints on code, and single-stepping execution to observe system behaviour.
Atmel provides a series of JTAG adapters for the AVR:
- The Atmel-ICE is the latest adapter. It supports JTAG, debugWire, aWire, SPI, TPI, and PDI interfaces.
- The JTAGICE 3 is a midrange debugger in the JTAGICE family (JTAGICE mkIII). It supports JTAG, aWire, SPI, and PDI interfaces.
- The JTAGICE mkII replaces the JTAGICE and is similarly priced. The JTAGICE mkII interfaces to the PC via USB, and supports both JTAG and the newer debugWIRE interface. Numerous third-party clones of the Atmel JTAGICE mkII device started shipping after Atmel released the communication protocol.
- The AVR Dragon is a low-cost (approximately $50) substitute for the JTAGICE mkII for certain target parts. The AVR Dragon provides in-system serial programming, high-voltage serial programming and parallel programming, as well as JTAG or debugWIRE emulation for parts with 32 KB of program memory or less. ATMEL changed the debugging feature of AVR Dragon with the latest firmware of AVR Studio 4 - AVR Studio 5 and now it supports devices over 32 KB of program memory.
- The JTAGICE adapter interfaces to the PC via a standard serial port. Although the JTAGICE adapter has been declared "end-of-life" by Atmel, it is still supported in AVR Studio and other tools.
JTAG can also be used to perform a boundary scan test, which tests the electrical connections between AVRs and other boundary scan capable chips in a system. Boundary scan is well-suited for a production line, while the hobbyist is probably better off testing with a multimeter or oscilloscope.
Development tools and evaluation kits
Official Atmel AVR development tools and evaluation kits contain a number of starter kits and debugging tools with support for most AVR devices:
STK600 starter kit
The STK600 starter kit and development system is an update to the STK500. The STK600 uses a base board, a signal routing board, and a target board.
The base board is similar to the STK500, in that it provides a power supply, clock, in-system programming, an RS-232 port and a CAN (Controller Area Network, an automotive standard) port via DE9 connectors, and stake pins for all of the GPIO signals from the target device.
The signal routing board sits between the base board and the target board, and routes the signals to the proper pin on the device board. There are many different signal routing boards that could be used with a single target board, depending on what device is in the ZIF socket.
The STK600 allows in-system programming from the PC via USB, leaving the RS-232 port available for the target microcontroller. A 4 pin header on the STK600 labeled 'RS-232 spare' can connect any TTL level USART port on the chip to an onboard MAX232 chip to translate the signals to RS-232 levels. The RS-232 signals are connected to the RX, TX, CTS, and RTS pins on the DB-9 connector.
STK500 starter kit
The STK500 starter kit and development system features ISP and high voltage programming (HVP) for all AVR devices, either directly or through extension boards. The board is fitted with DIP sockets for all AVRs available in DIP packages.
STK500 Expansion Modules: Several expansion modules are available for the STK500 board:
- STK501 – Adds support for microcontrollers in 64-pin TQFP packages.
- STK502 – Adds support for LCD AVRs in 64-pin TQFP packages.
- STK503 – Adds support for microcontrollers in 100-pin TQFP packages.
- STK504 – Adds support for LCD AVRs in 100-pin TQFP packages.
- STK505 – Adds support for 14 and 20-pin AVRs.
- STK520 – Adds support for 14 and 20, and 32-pin microcontrollers from the AT90PWM and ATmega family.
- STK524 – Adds support for the ATmega32M1/C1 32-pin CAN/LIN/Motor Control family.
- STK525 – Adds support for the AT90USB microcontrollers in 64-pin TQFP packages.
- STK526 – Adds support for the AT90USB microcontrollers in 32-pin TQFP packages.
STK200 starter kit
The STK200 starter kit and development system has a DIP socket that can host an AVR chip in a 40, 20, or 8-pin package. The board has a 4 MHz clock source, 8 light-emitting diode (LED)s, 8 input buttons, an RS-232 port, a socket for a 32 KB SRAM and numerous general I/O. The chip can be programmed with a dongle connected to the parallel port.
|AT90S1200||1 KB||64 B||0 B||12||PDIP-20|
|AT90S2313||2 KB||128 B||128 B||10||PDIP-20|
|AT90S/LS2323||2 KB||128 B||128 B||10||PDIP-8|
|AT90S/LS2343||2 KB||128 B||128 B||10||PDIP-8|
|AT90S4414||4 KB||256 B||256 B||8||PDIP-40|
|AT90S/LS4434||4 KB||256 B||256 B||8||PDIP-40|
|AT90S8515||8 KB||512 B||512 B||8||PDIP-40|
|AT90S/LS8535||8 KB||512 B||512 B||8||PDIP-40|
AVRISP and AVRISP mkII
The AVRISP and AVRISP mkII are inexpensive tools allowing all AVRs to be programmed via ICSP.
The AVRISP connects to a PC via a serial port and draws power from the target system. The AVRISP allows using either of the "standard" ICSP pinouts, either the 10-pin or 6-pin connector.
The AVRISP mkII connects to a PC via USB and draws power from USB. LEDs visible through the translucent case indicate the state of target power.
As the AVRISP mkII lacks driver/buffer ICs, it can have trouble programming target boards with multiple loads on its SPI lines. In such occurrences, a programmer capable of sourcing greater current is required. Alternatively, the AVRISP mkII can still be used if low-value (~150 ohm) load-limiting resistors can be placed on the SPI lines before each peripheral device.
Both the AVRISP and the AVRISP mkII are now discontinued, with product pages removed from the Microchip website. As of July 2019 the AVRISP mkII is still in stock at a number of distributors. There are also a number of 3rd party clones available.
The Atmel Dragon is an inexpensive tool which connects to a PC via USB. The Dragon can program all AVRs via JTAG, HVP, PDI, or ICSP. The Dragon also allows debugging of all AVRs via JTAG, PDI, or debugWire; a previous limitation to devices with 32 KB or less program memory has been removed in AVR Studio 4.18. The Dragon has a small prototype area which can accommodate an 8, 28, or 40-pin AVR, including connections to power and programming pins. There is no area for any additional circuitry, although this can be provided by a third-party product called the "Dragon Rider".
The JTAG In Circuit Emulator (JTAGICE) debugging tool supports on-chip debugging (OCD) of AVRs with a JTAG interface. The original JTAGICE (sometimes retroactively referred to as JTAGICE mkI) uses an RS-232 interface to a PC and can only program AVR's with a JTAG interface. The JTAGICE mkI is no longer in production, however it has been replaced by the JTAGICE mkII.
The JTAGICE mkII debugging tool supports on-chip debugging (OCD) of AVRs with SPI, JTAG, PDI, and debugWIRE interfaces. The debugWire interface enables debugging using only one pin (the Reset pin), allowing debugging of applications running on low pin-count microcontrollers.
The JTAGICE mkII connects using USB, but there is an alternate connection via a serial port, which requires using a separate power supply. In addition to JTAG, the mkII supports ISP programming (using 6-pin or 10-pin adapters). Both the USB and serial links use a variant of the STK500 protocol.
The JTAGICE3 updates the mkII with more advanced debugging capabilities and faster programming. It connects via USB and supports the JTAG, aWire, SPI, and PDI interfaces. The kit includes several adapters for use with most interface pinouts.
The AVR ONE! is a professional development tool for all Atmel 8-bit and 32-bit AVR devices with On-Chip Debug capability. It supports SPI, JTAG, PDI, and aWire programming modes and debugging using debugWIRE, JTAG, PDI, and aWire interfaces.
Butterfly demonstration board
The very popular AVR Butterfly demonstration board is a self-contained, battery-powered computer running the Atmel AVR ATmega169V microcontroller. It was built to show off the AVR family, especially a then new built-in LCD interface. The board includes the LCD screen, joystick, speaker, serial port, real time clock (RTC), flash memory chip, and both temperature and voltage sensors. Earlier versions of the AVR Butterfly also contained a CdS photoresistor; it is not present on Butterfly boards produced after June 2006 to allow RoHS compliance. The small board has a shirt pin on its back so it can be worn as a name badge.
The AVR Butterfly comes preloaded with software to demonstrate the capabilities of the microcontroller. Factory firmware can scroll your name, display the sensor readings, and show the time. The AVR Butterfly also has a piezoelectric transducer that can be used to reproduce sounds and music.
The AVR Butterfly demonstrates LCD driving by running a 14-segment, six alpha-numeric character display. However, the LCD interface consumes many of the I/O pins.
The Butterfly's ATmega169 CPU is capable of speeds up to 8 MHz, but it is factory set by software to 2 MHz to preserve the button battery life. A pre-installed bootloader program allows the board to be re-programmed via a standard RS-232 serial plug with new programs that users can write with the free Atmel IDE tools.
This small board, about half the size of a business card, is priced at slightly more than an AVR Butterfly. It includes an AT90USB1287 with USB On-The-Go (OTG) support, 16 MB of DataFlash, LEDs, a small joystick, and a temperature sensor. The board includes software, which lets it act as a USB mass storage device (its documentation is shipped on the DataFlash), a USB joystick, and more. To support the USB host capability, it must be operated from a battery, but when running as a USB peripheral, it only needs the power provided over USB.
Only the JTAG port uses conventional 2.54 mm pinout. All the other AVR I/O ports require more compact 1.27 mm headers.
The AVR Dragon can both program and debug since the 32 KB limitation was removed in AVR Studio 4.18, and the JTAGICE mkII is capable of both programming and debugging the processor. The processor can also be programmed through USB from a Windows or Linux host, using the USB "Device Firmware Update" protocols. Atmel ships proprietary (source code included but distribution restricted) example programs and a USB protocol stack with the device.
Raven wireless kit
The RAVEN kit supports wireless development using Atmel's IEEE 802.15.4 chipsets, for ZigBee and other wireless stacks. It resembles a pair of wireless more-powerful Butterfly cards, plus a wireless USBKey; and costing about that much (under $US100). All these boards support JTAG-based development.
The kit includes two AVR Raven boards, each with a 2.4 GHz transceiver supporting IEEE 802.15.4 (and a freely licensed ZigBee stack). The radios are driven with ATmega1284p processors, which are supported by a custom segmented LCD display driven by an ATmega3290p processor. Raven peripherals resemble the Butterfly: piezo speaker, DataFlash (bigger), external EEPROM, sensors, 32 kHz crystal for RTC, and so on. These are intended for use in developing remote sensor nodes, to control relays, or whatever is needed.
The USB stick uses an AT90USB1287 for connections to a USB host and to the 2.4 GHz wireless links. These are intended to monitor and control the remote nodes, relying on host power rather than local batteries.
A wide variety of third-party programming and debugging tools are available for the AVR. These devices use various interfaces, including RS-232, PC parallel port, and USB.
AVRs have been used in various automotive applications such as security, safety, powertrain and entertainment systems. Atmel has recently launched a new publication "Atmel Automotive Compilation" to help developers with automotive applications. Some current usages are in BMW, Daimler-Chrysler and TRW.
The Arduino physical computing platform is based on an ATmega328 microcontroller (ATmega168 or ATmega8 in board versions older than the Diecimila). The ATmega1280 and ATmega2560, with more pinout and memory capabilities, have also been employed to develop the Arduino Mega platform. Arduino boards can be used with its language and IDE, or with more conventional programming environments (C, assembler, etc.) as just standardized and widely available AVR platforms.
USB-based AVRs have been used in the Microsoft Xbox hand controllers. The link between the controllers and Xbox is USB.
Numerous companies produce AVR-based microcontroller boards intended for use by hobbyists, robot builders, experimenters and small system developers including: Cubloc, gnusb, BasicX, Oak Micros, ZX Microcontrollers, and myAVR. There is also a large community of Arduino-compatible boards supporting similar users.
Schneider Electric used to produce the M3000 Motor and Motion Control Chip, incorporating an Atmel AVR Core and an advanced motion controller for use in a variety of motion applications but this has been discontinued.
With the growing popularity of FPGAs among the open source community, people have started developing open source processors compatible with the AVR instruction set. The OpenCores website lists the following major AVR clone projects:
- pAVR, written in VHDL, is aimed at creating the fastest and maximally featured AVR processor, by implementing techniques not found in the original AVR processor such as deeper pipelining.
- avr_core, written in VHDL, is a clone aimed at being as close as possible to the ATmega103.
- Navré, written in Verilog, implements all Classic Core instructions and is aimed at high performance and low resource usage. It does not support interrupts.
- softavrcore, written in Verilog, implements the AVR instruction set up to AVR5, supports interrupts and some interfaces (such as UART, SPI and timers) demonstrating how external peripherals are attached to and configured for this core.
- The opencores project CPU lecture written in VHDL by Dr. Jürgen Sauermann explains in detail how to design a complete AVR-based system on a chip (SoC).
In addition to the chips manufactured by Atmel, clones are available from LogicGreen Technologies. These parts are not exact clones - they have a few features not found in the chips they are "clones" of, and higher maximum clock speeds, but use SWD instead of ISP for programming, so different programming tools must be used.
Microcontrollers using the ATmega architecture are being manufactured by NIIET in Voronezh, Russia, as part of the 1887 series of integrated circuits. This includes an ATmega128 under the designation 1887VE7T (Russian: 1887ВЕ7Т).
- Since 1996, NTH has become part of the Norwegian University of Science and Technology (NTNU)
- alfbogen.com blog
- Archived at Ghostarchive and the Wayback Machine: "The Story of AVR". youtube.com.
- "UNSW School of Computer Science and Engineering - General AVR Info". Cse.unsw.edu.au. Archived from the original on 2012-06-23. Retrieved 2012-09-19.
- An introduction to Atmel and the AVR microcontroller
- "Embedded Systems and Microcontrollers" (PDF). Archived from the original (PDF) on 2004-12-24. Retrieved 2018-10-01.
- Myklebust, Gaute. The AVR Microcontroller and C Compiler Co-Design (PDF). Atmel Norway. CiteSeerX 10.1.1.63.1447. Retrieved 2012-09-19.
- Atmel press release. "Atmel's AVR Microcontroller Ships 500 Million Units".
- Field Programmable System Level Integrated Circuit. Archived 2012-11-27 at the Wayback Machine.
- Atmel Smart Card ICs
- "AVR319: Using the USI module for SPI communication" (PDF). Atmel. 2004. Retrieved 10 June 2014.
- "Atmel AVR310: Using the USI Module as a I2C Master" (PDF). Atmel. 2013. Retrieved 10 June 2014.
- "AVR312: Using the USI module as a I2C slave" (PDF). Atmel. 2005. Retrieved 10 June 2014.
- "AVR307: Half Duplex UART Using the USI Module" (PDF). Atmel. 2003. Retrieved 10 June 2014.
- "AVR Hardware Design Considerations" (PDF) (application note). Atmel Corporation. Jun 2015. p. 5. Retrieved 14 Jun 2015.
The reset line has an internal pull-up resistor, but if the environment is noisy it can be insufficient and reset can therefore occur sporadically.
- "AVRDUDE programmer". Savannah.nongnu.org. Retrieved 2012-09-19.
- "PDI programming driver" (PDF). Retrieved 2012-09-19.
- "GitHub - ElTangas/Jtag2updi: UPDI programmer software for Arduino (Targets Tiny AVR-0/1/2, Mega AVR-0 and AVR-DA/DB MCUs)". GitHub. 17 December 2021.
- "HVSP_Description". Support.atmel.no. Archived from the original on 2009-10-12. Retrieved 2012-09-19.
- "DES-encrypted AVR Bootloader" (PDF). Retrieved 2012-09-19.
- "AES-encrypted AVR Bootloader" (PDF). Retrieved 2012-09-19.
- "XMEGA Bootloader" (PDF). Retrieved 2012-09-19.
- "AVR USB Bootloader" (PDF). Retrieved 2012-09-19.
- "Atmel's Self-Programming Flash Microcontrollers" (PDF). Retrieved 12 March 2020.
- "Guide to understanding JTAG and security fuses on the AVR". Retrieved 2012-09-19.
- "Atmel-ICE - Atmel Corporation". Atmel.com. Retrieved 2015-09-11.
- "JTAGICE 3- Atmel Corporation". Atmel.com. Retrieved 2012-09-19.
- "AVR JTAGICE mkII". Atmel. Archived from the original on 15 February 2013. Retrieved 13 January 2013.
- "JTAGICE mkII Communication Protocol" (PDF). Retrieved 2012-09-19.
- "AVR Dragon". Atmel. Retrieved 13 January 2013.
- "AVR JTAGICE mkII User's Guide" (PDF). microchip.com. Retrieved 25 March 2020.
- JTAGICE Press Release, 2004. Archived 2011-07-07 at the Wayback Machine
- "STK600". Atmel. Archived from the original on 15 February 2013. Retrieved 13 January 2013.
- "AVRISP mkII Disassembled". Archived from the original on 2014-11-08. Retrieved 2014-11-08.
- "AVR1005: Getting started with XMEGA, page 7" (PDF). Atmel. Retrieved 7 November 2011.
- "AVR Studio v4.18 Release Notes". Retrieved 2012-09-19.
- "ECROS Technology - Dragon Rider". Ecrostech.com. 2008-03-02. Retrieved 2012-09-19.
- JTAGICE3 Product Page
- AVR ONE! Product Page
- AVR Butterfly
- "LUFA (Formerly MyUSB)". Four Walled Cubicle. Retrieved 2012-09-19.
- See avrffreaks.net for a comprehensive list.
- "Comfile Technology". Comfile Technology, Inc. Retrieved 13 January 2013.
- "gnusb: Open Source USB Sensor Box". Retrieved 13 January 2013.
- "BasicX". NetMedia, Inc. Archived from the original on 23 May 2013. Retrieved 13 January 2013.
- "Welcome to Oak Micros". Oak Micros. Oak Micros. Archived from the original on 2012-10-25. Retrieved 13 January 2013.
- "ZBasic". Retrieved 13 January 2013.
- "myAVR". Laser & Co. Solutions GmbH. Retrieved 13 January 2013.
- "M3000 Motion controller on a chip". imshome.com. Schneider Electric Motion USA. Archived from the original on 2009-12-02. Retrieved 2011-08-02.
- "pAVR :: Overview". OpenCores. Retrieved 2012-09-19.
- "AVR Core :: Overview". OpenCores. Retrieved 2012-09-19.
- "Navré AVR clone (8-bit RISC) Overview". OpenCores. Retrieved 2012-09-19.
- "Soft AVR Core + Interfaces Overview". OpenCores. Retrieved 2020-06-16.
- "CPU lecture". OpenCores. Retrieved 2015-02-16.
- "LGT8F88A FLASH Microcontroller". LogicGreen Technologies. Archived from the original on 2017-08-29. Retrieved 2019-01-18, a clone of the ATmega88.
- "Микроконтроллеры" [Microcontrollers] (in Russian). Voronezh: OAO "NIIET". Archived from the original on 22 August 2017. Retrieved 22 August 2017.
- AVR Programming: Learning to Write Software for Hardware; Elliot Williams; Maker Media; 474 pages; 2014; ISBN 978-1449355784
- Arduino: A Quick Start Guide; Maik Schmidt; Pragmatic Bookshelf; 276 pages; 2011; ISBN 978-1-934356-66-1.
- Some Assembly Required: Assembly Language Programming with the AVR Microcontroller; Timothy S Margush; CRC Press; 643 pages; 2011; ISBN 978-1439820643
- AVR Microcontroller and Embedded Systems: Using Assembly and C; Muhammad Ali Mazidi, Sarmad Naimi, Sepehr Naimi; Pearson; 792 pages; 2010; ISBN 978-0138003319.
|Wikimedia Commons has media related to Atmel AVR.|
|The Wikibook Embedded Systems has a page on the topic of: Atmel AVR|
- Official Website
- Official Community
- Pinout Diagrams | <urn:uuid:d40ccc86-6420-4fa2-8372-629d5639682e> | {
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Information for Patients
Fetal Health and Development
A normal pregnancy lasts nine months. Each three-month period of pregnancy is called a trimester. During each trimester, the fetus grows and develops. There are specific prenatal tests to monitor both the mother's health and fetal health during each trimester.
With modern technology, health professionals can
- Detect birth defects
- Identify problems that may affect childbirth
- Correct some kinds of fetal problems before the baby is born
- Developmental disorders of the female reproductive tract
- Fetal development
- Intrauterine growth restriction
General Equivalence Map Definitions
The ICD-9 and ICD-10 GEMs are used to facilitate linking between the diagnosis codes in ICD-9-CM and the new ICD-10-CM code set. The GEMs are the raw material from which providers, health information vendors and payers can derive specific applied mappings to meet their needs.
- Approximate Flag - The approximate flag is on, indicating that the relationship between the code in the source system and the code in the target system is an approximate equivalent.
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Pneumonia ranks sixth in frequency of diagnoses processed by the McKesson Emergency Medicine Services division.
Patients who visit the emergency department for medical symptoms such as coughing, shortness of breath or difficulty breathing, low or mild fever, enlarged lymph nodes, sore throat, sharp chest pain, or dark or bluish fingernails or toenails may be evaluated for a respiratory/lung problem.
Emergency medicine providers may consider pneumonia one of the differential diagnoses, which would be considered a working diagnosis. If the provider’s cognitive thought process leads them to the path of pneumonia, they will also consider the type of pneumonia which may be present – viral, bacterial, infectious or a mycoplasma type of pneumonia.
If pneumonia is suspected, specific measures may be taken. A chest X-ray may be ordered, CBC blood tests may be drawn to check the white blood count, arterial blood gasses may be used to check if enough oxygen is getting into the blood from the lungs, and other specific tests may be performed. A CAT scan will be used to determine how the lungs are functioning; sputum tests will used to look for the organism (that can be detected by studying the saliva); and other tests may identify potential fluid in the space around the lungs. Additionally, a pulse Oximetry will be used to measure the oxygen moving through the bloodstream and possibly a bronchoscopy if the condition continues to worsen.
To date, many emergency department charts have shown final diagnosis documentation that states “typically after study, pneumonia,” without any elaboration of the type of pneumonia. In ICD-9 the code is “486 – Pneumonia, organism unspecified” and it approximately converts to ICD-10 code “J18.9 – Pneumonia, unspecified organism”. This type of medical condition, with the varied number of pneumonia types, requires the provider to include more detail to the final diagnosis based on the findings after study. As stated above there are many types of pneumonia.
There is a one-to-one crosswalk for pneumonia, organism unspecified.
Treatment for pneumonia depends on the type of pneumonia and how severe it is. The goals of treatment are to cure the infection and prevent complications. The entire work-up and treatment plan prepared for the patient is the provider’s responsibility. However, for that provider to get the greatest level of specificity in the final diagnosis under the ICD-10 world, more detailed documentation is required in that final statement of diagnosis for proper billing. This requirement also applies to the coding – in order for the coding staff to assign the appropriate ICD-10 code to its greatest level of specificity, it is important for the provider to document the detailed findings of study in the final impression or diagnosis. When a provider documents a final diagnosis that is not to its greatest level of detail, an unspecified code is typically assigned.
Pneumonia codes in ICD-9 are in the code range 480 – 488 under “Pneumonia and Influenza.” The ICD-10 section for Pneumonia is J09 – J18 under Influenza and Pneumonia. Note that this is not a typo but the way it is listed in the code books. The description has been reversed – as was similar to the description for the ICD-9 and ICD-10 codes for pneumonia unspecified. The beginning of the ICD-9 and ICD-10 pneumonia sections has a note which shows codes that are excluded from this family of codes. Some of the excluded codes are other types of pneumonia (i.e., allergic, aspiration and rheumatic – all pneumonia). These are good examples of why the greater level of detail is so important in order to assign the most appropriate ICD-10 code.
Some examples of crosswalks from ICD-9 to ICD-10 for pneumonia are outlined below.
As shown in the table above, there are a number of ICD-10 codes for pneumonia. This is only a small example of those codes in both ICD-9 and ICD-10 books. It is imperative that the provider document exactly what the diagnostic study’s findings are, if any, to determine the exact course of action for the condition presented or defined after study in order to establish the appropriate code.
This commentary is a summary prepared by McKesson’s Business Performance Services division and highlights certain changes, not all changes, in 2014 CPT® codes relating to the specialty of emergency medicine and emergency medical
services. This commentary does not supplant the American Medical Association’s current listing of CPT® codes, its documentation in the annual CPT Changes publications, and other related publications from American Medical Association, which are the authoritative source for information about CPT® codes. Please refer to your 2014 CPT® Code Book, annual CPT® Changes publication, HCPCS Book and Payer Bulletins for additional information, including additions, deletions, changes and interpretations that may not be reflected in this document.
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Information for Patients
Varicose veins are swollen, twisted veins that you can see just under the skin. They usually occur in the legs, but also can form in other parts of the body. Hemorrhoids are a type of varicose vein.
Your veins have one-way valves that help keep blood flowing toward your heart. If the valves are weak or damaged, blood can back up and pool in your veins. This causes the veins to swell, which can lead to varicose veins.
Varicose veins are very common. You are more at risk if you are older, are female, have obesity, don't exercise, or have a family history of varicose veins. They can also be more common in pregnancy.
Doctors often diagnose varicose veins from a physical exam. Sometimes you may need additional tests.
Exercising, losing weight, elevating your legs when resting, and not crossing them when sitting can help keep varicose veins from getting worse. Wearing loose clothing and avoiding long periods of standing can also help. If varicose veins are painful or you don't like the way they look, your doctor may recommend procedures to remove them.
NIH: National Heart, Lung, and Blood Institute
- Telangiectasia (Medical Encyclopedia)
- Varicocele (Medical Encyclopedia)
- Varicose and other vein problems - self-care (Medical Encyclopedia)
- Varicose vein - noninvasive treatment (Medical Encyclopedia)
- Varicose vein stripping (Medical Encyclopedia)
- Varicose veins and venous insufficiency (Medical Encyclopedia)
General Equivalence Map Definitions
The ICD-10 and ICD-9 GEMs are used to facilitate linking between the diagnosis codes in ICD-9-CM and the new ICD-10-CM code set. The GEMs are the raw material from which providers, health information vendors and payers can derive specific applied mappings to meet their needs.
- Approximate Flag - The approximate flag is on, indicating that the relationship between the code in the source system and the code in the target system is an approximate equivalent.
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Alicia: Q: For glaucoma bilateral dif types and dif stages, code each type but highest stage correct? Thanks, Carolyn
A: The fact is that there is a specific role for this. Now, let me just reiterate for some people what glaucoma is because you kind of have to understand what it is to be able to code it correctly. Glaucoma is that sight-threatening disorder. It’s marked by an increased intraocular pressure, or that’s abbreviated IOP. And the pressure which is in the eye that is too high for the optic nerve to tolerate. But to be more specific, I’ve got a little diagram of what it does. But there are two types of glaucoma – we’ll there’re several types of glaucoma but there’s two main types: open angle and closed angle. This is a closed angle view and just to see the detail on this – this was a really good shot and I want to show it to you. The arrow is showing the pressure building up after the cornea.
If you go to the next page, because it shows you open and closed. You do want to note because remember with diabetes, there’s a default with type 2 diabetes because more people have that. This doesn’t have a default but it’s good to note that open angle glaucoma accounts for 90% of all cases because it’s slow and it’s a progressive disease. Whereas, close angle is more of an acute situation; it happens very quickly and it’s very painful. But most people that have glaucoma, it’s open angle.
Glaucoma Coding – Video
What you’re seeing there, the drainage in the open angle, see behind the cornea and the iris, all that fluid that is there, that is all pressurized; and if the fluid flow from the back of the eye or the inside of the eye and what is between the cornea and the iris isn’t kept at an even balance pressure builds up. But what happens with the pressure is that, you think, “Well, OK, pressure,” but remember that your eye is pressurized and all the nerves and the blood vessels are so tiny in the eye that if you build up too much pressure it squishes them.
Let’s scroll down to the next page and they show…Here’s an example of normal vision and what people see when they start getting the glaucoma, see how it circles and starts getting darker and darker, and you actually lose that peripheral sight. So, the progression of glaucoma if you look at the optic nerve, see the optic nerve there, the red between the yellow lines and it’s nice and fat and juicy looking. Now, early damage though, if you look, see those lines going top to bottom they’re kind of straight; but in the second early stage one there’s that starts pressing on that optic nerve that the muscles start bowing and there’s a little circle or pocket of fluid that starts to build up and if you could see it’s actually inflamed. See the optic nerve starts getting inflamed. Then, in the severe damage that’s what you see when you look in but see how that optic nerve is pushed out of proportion and there’s a lot of pressure and fluid back there, once you get into severe damage, there’s nothing you can do, you lose your eyesight. So, this is something you need to have checked, and lots of different things cause glaucoma, it’s not something I can put in the slide because it really would take so long.
Let’s talk about the differences in glaucoma coding: Bilateral low-tension glaucoma, both moderate stages. Now, there’s a difference between ICD-9 and ICD-10 so I wanted to bring this out because I found this information on a fantastic blog. In ICD-9 you’ve got low tension and moderate stage glaucoma. With glaucoma, you’re going to usually have two codes: the type of glaucoma and the stage. So, we’ve got bilateral, your choices are: 365.12 low tension glaucoma, 365.72 moderate stage glaucoma. Now, that means both eyes (bilateral), that’s what we’re talking laterality here. ICD-10, though, one code, H40.1232 low-tension glaucoma, bilateral, moderate stage. Unlike we talked before where it gives you more codes for specificity, this is one code that covers everything.
Now, for example, let’s say that the left eye has low-tension glaucoma, mild stage, and the right eye has the same type but is moderate stage, ICD-9, how are we going to code that? 365.12 low-tension glaucoma, 365.72 moderate-stage glaucoma. But, let’s see what we do with ICD-10, changes everything up, gives us laterality and granularity. Now we have H40.1221 low-tension glaucoma, left eye, mild stage. Then, we have H40.1212 low-tension glaucoma, right eye, moderate stage. See how much more specificity you get and there’s no need for the payer to say, “Well, we need some more information, and you’re going to have to send in more documentation.”
Now, the ICD-9-CM guidelines where it’s still an ICD-9, so when you talk about the “guidelines state for bilateral glaucoma when each eye is a different stage, assign one code for the type and one for the highest glaucoma stage.” So, now we’re saying, you can’t get it very specific, you’ll have one that’s less. You’re not able to tell the difference, and you’re not even able to tell if it’s left or right. So, “Using ICD-9-CM for coding glaucoma lacks essential details of the patient’s condition. If we were looking for patient improvement we wouldn’t even know we were dealing with the involvement of both eyes and that only one was mild stage. Of course, with ICD-10-CM laterality and 7th character extensions for stages, there are many more code choices in the chapter. It makes sense in offering specific data of the patient’s condition and status. When data will be needed in the future for pay-for-performance, other healthcare policies, or disease research, the numbers will be there to be crunched.” And one more thing to make note of here guys is that with ICD-9, the reason that this question is even on the slide is because you don’t know what to do. Now, with ICD-10, you don’t have to worry about it. See how specific it is? Less guess work because it is very specific. Look, they got all the information from the right eye and they got all the information for the left eye. No guessing about the guidelines, what do I do; there’s no confusion there, very specific and easy to code. You’re going to love ICD-10. This is when you throw in the whoop-whoop! | <urn:uuid:c5957033-47b8-4857-b44d-2ab05f8e3e9e> | {
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What is the cause of gram negative sepsis? Criteria result as the body tries to counteract the damage done by these blood-borne agents. Common bacterial causes of sepsis are gram-negative bacilli for example, E. coli, P. aeruginosa, E. corrodens, and Haemophilus influenzae in neonates. Common bacterial causes of sepsis are gram-negative bacilli for example, E. coli, P. aeruginosa, E. corrodens, and Haemophilus influenzae in neonates. Other bacteria also causing sepsis are S. aureus, Streptococcus species, Enterococcus species and Neisseria; however, there are large numbers of bacterial genera that have been known to cause. However, a study in 2009 see epidemiology section demonstrated that gram-negative bacterial infections were more common than gram-positive bacterial infections as a cause of sepsis gram-negative- 62%; gram-positive- 47%; fungi-19% Septic shock caused by gram-positive bacteria was not as common as it is currently. Do all Gram negative bacteria cause septic shock? If they don't could they if you attacked them with an antibiotic that could lyse the cell? For example any antibiotic that attacks the cell wall, although I suppose that could be difficult with the gram negative wall, not to many gram.
Cause. Infections leading to sepsis are usually bacterial, but may be fungal or viral. Gram-positive bacteria was the predominant cause of sepsis before the introduction of antibiotics in the 1950s. After the introduction of antibiotics, gram-negative bacteria became the predominant cause of sepsis from the 1960s to the 1980s. In modern intensive care settings, gram-positive bacteria account for up to 50% of severe sepsis or septic shock cases, yet the pathogenesis of gram-positive shock is poorly understood.36, 45 This contrasts with the well-researched field of gram-negative sepsis, where the role of bacterial endotoxin is known to be central to development of.
have contributed to our current understanding of the pathogenesis of sepsis and septic shock caused by bacteria, both Gram negative and Gram positive. Direct invasion and the resulting interaction with critical host cells constitute one major mechanism by which bacteria can cause sepsis and septic shock. 17/01/2019 · Gram negative rod GNR infections cause a significant amount of morbidity and mortality amongst hospitalized patients. Patients with poor underlying medical status are most at risk, especially the immunosuppressed, elderly, and patients with malignancies. Infections with this class of bacteria. 07/09/2011 · Neonatal Sepsis - Etiology, pathophysiology, symptoms, signs,. and gram-negative enteric organisms predominantly Escherichia coli. E. coli is also becoming increasingly recognized as a significant cause of late-onset sepsis, especially in extremely LBW infants.
20/12/2019 · Sepsis is a clinical syndrome of life-threatening organ dysfunction caused by a dysregulated response to infection. In septic shock, there is critical reduction in tissue perfusion; acute failure of multiple organs, including the lungs, kidneys, and liver, can occur. tested positive for Gram-negative microorganisms from 2002 to 2008, retrospectively. Results: 143 cases of neonatal sepsis caused by Gram-negative microorganisms were identified. Eighty-one percent n=116 of these had nosocomial sepsis. In nosocomial sepsis, the most common isolated Gram- negative micro-organism was Serratia marcescens 16.4%. 29/02/2016 · “Gram-negative” refers to gram staining, a routine laboratory test used to determine the presence of microorganisms like bacteria or fungi in your blood or tissue. During the test, the gram stain will turn pink if gram-negative bacteria are present. These types of bacteria can also cause.
Start studying Gram-Positive Sepsis. Learn vocabulary, terms, and more with flashcards, games, and other study tools. If sepsis can be caused as readily by grampositive organisms as by gram-negative organ- HOW GRAM-POSITIVE ORGANISMS CAUSE SEPSIS isms, then the optimum approach to treatment may be agents directed at the pathways common to all forms of sepsis, the cascade of inflammatory mediators. Monotherapy with aztreonam appears to be as effective as combination of a beta lactam and an aminoglycoside Netspan for the treatment of patients with documented Gram negative sepsis 34. TREATMENT OPTIONS FOR INFECTIONS DUE TO EXTENDED –SPECTRUM β-LACTAMASE ESBL PRODUCING ORGANISMS. 17/01/2011 · Gram-negative bacteria cause infections including pneumonia, bloodstream infections, wound or surgical site infections, and meningitis in healthcare settings. Gram-negative bacteria are resistant to multiple drugs and are increasingly resistant to. 27/05/2010 · Gram-negative bacteremia has been associated with severe sepsis, although the exact mechanism and pathophysiological differences among bacterial species are not well understood. In the previous issue of Critical Care, Abe and colleagues report results of a retrospective study that show a significantly higher incidence of Gram.
Abstract. Sepsis and its sequelae are the leading causes of death among critically ill patients in non-coronary intensive care units ICUs. Paradoxically, despite a fall in the mortality rate, the incidence of sepsis has increased, with about 750,000 cases annually resulting in about 215,000 deaths a year [1, 2]. As pointed out above, LPS has been widely studied as the chief causative factor in gram-negative sepsis. It is clear, however, that gram-positive bacteria can also cause sepsis and septic shock. This is not likely to be mediated through LPS directly, as gram-positive bacteria lack endotoxin. Can gram negative ecoli sepsis cause brain disorders years after the episode.If so;what kind? I ended up with lesions and a stroke.Can this be? Dr. Mark Weston Dr. Weston 3 doctors agreed.
Gram Negative Bacterial Sepsis in a Cancer Centre: Bacteriological Spectrum and Antibiotic Susceptibility Profiles, Vivek G Bhat, Hemant J Vira, Rohini S Kelkar, Sanjay K Biswas, P. Septic shock refers specifically to distributive shock due to sepsis as a result of infection. Septic shock may be defined as sepsis-induced low blood pressure that persists despite treatment with intravenous fluids. Low blood pressure reduces tissue perfusion pressure, causing the tissue hypoxia that is characteristic of shock.
Doctor answers on Symptoms, Diagnosis, Treatment, and More: Dr. Shoemaker on gram negative sepsis symptoms: Needs usually two antimicrobials at the start. for topic: Gram Negative Sepsis. 05/02/2019 · The predominant infectious organisms that cause sepsis have changed over the years. Gram-positive bacteria are the most common etiologic pathogens, although the incidence of gram-negative sepsis remains substantial. The incidence of fungal sepsis has been rising with more patients on immunosuppressive therapies and more cases of HIV infection. 14/12/2018 · Pediatric sepsis, like sepsis in adults, is generally considered to comprise a spectrum of disorders that result from infection by bacteria, viruses, fungi, or parasites or the toxic products of these microorganisms. See also Neonatal Sepsis. Today’s medical world encompasses an environment in which gram-negative bacteria that once were defeated with common antibiotics, have now become resistant. Gram-negative bacteria like Klebsiella pneumoniae, Pseudomonas aeruginosa, Enterobacter, and Acinetobacter are pathogens that are an emerging threat causing sepsis due to multidrug. Other Gram-negative sepsis: ICD-10-CM/PCS codes version 2016/2017/2018, ICD10 data search engine Create codetable from scratch Show conversion to ICD-9-CM Contact. Certain infectious.
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Canzoni Slim Shady Album | <urn:uuid:ab940f45-3672-42cf-aae1-215f9a592bc3> | {
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Information for Patients
What is cerebral palsy (CP)?
Cerebral palsy (CP) is a group of disorders that cause problems with movement, balance, and posture. CP affects the cerebral motor cortex. This is the part of the brain that directs muscle movement. In fact, the first part of the name, cerebral, means having to do with the brain. The second part, palsy, means weakness or problems with using the muscles.
What are the types of cerebral palsy (CP)?
There are different types of CP:
- Spastic cerebral palsy, which is the most common type. It causes increased muscle tone, stiff muscles, and awkward movements. Sometimes it only affects one part of the body. In other cases, it can affect both arms and legs, the trunk, and the face.
- Dyskinetic cerebral palsy, which causes problems controlling the movement of the hands, arms, feet, and legs. This can make it hard to sit and walk.
- Ataxic cerebral palsy, which causes problems with balance and coordination
- Mixed cerebral palsy, which means that you have symptoms of more than one type
What causes cerebral palsy (CP)?
CP is caused by abnormal development or damage to the developing brain. It could happen when:
- The cerebral motor cortex doesn't develop normally during fetal growth
- There is an injury to the brain before, during, or after birth
Both the brain damage and the disabilities it causes are permanent.
Who is at risk for cerebral palsy (CP)?
CP is more common among boys than girls. It affects black children more often than white children.
Certain medical conditions or events that can happen during pregnancy and delivery that may increase a baby's risk of being born with cerebral palsy, including:
- Being born too small
- Being born too early
- Being born a twin or other multiple birth
- Being conceived by in vitro fertilization (IVF) or other assisted reproductive technology (ART)
- Having a mother who had an infection during pregnancy
- Having a mother with certain health problems in pregnancy, such as thyroid problems
- Severe jaundice
- Having complications during birth
- Rh incompatibility
- Exposure to toxins
What are the signs of cerebral palsy (CP)?
There are many different types and levels of disability with CP. So the signs can be different in each child.
The signs usually appear in the early months of life. But sometimes there is a delay in getting a diagnosis until after age two. Infants with CP often have developmental delays. They are slow to reach developmental milestones such as learning to roll over, sit, crawl, or walk. They may also have abnormal muscle tone. They may seem floppy, or they may be stiff or rigid.
It's important to know that children without CP can also have these signs. Contact your child's health care provider know if your child has any of these signs, so you can get a correct diagnosis.
How is cerebral palsy (CP) diagnosed?
Diagnosing CP involves several steps:
- Developmental monitoring (or surveillance) means tracking a child's growth and development over time. If there are any concerns about your child's development, then he or she should have a developmental screening test as soon as possible.
- Developmental screening involves a giving your child a short test to check for motor, movement, or other developmental delays. If the screenings are not normal, the provider will recommend some evaluations.
- Developmental and medical evaluations are done to diagnose which disorder your child has. The provider many use many tools to make the diagnosis:
- A check of your child's motor skills, muscle tone, reflexes, and posture
- A medical history
- Lab tests, genetic tests, and/or imaging tests
What are the treatments for cerebral palsy (CP)?
There is no cure for CP, but treatment can improve the lives of those who have it. It is important to begin a treatment program as early as possible.
A team of health professionals will work with you and your child to develop a treatment plan. Common treatments include:
- Assistive devices
- Physical, occupational, recreational, and speech therapy
Can cerebral palsy (CP) be prevented?
You cannot prevent the genetic problems that can cause CP. But it may be possible to manage or avoid some of the risk factors for CP. For example, making sure that pregnant women have been vaccinated could prevent certain infections that can cause CP in unborn babies. Using cars seats for infants and toddlers could prevent head injuries, which can be a cause of CP.
Centers for Disease Control and Prevention
General Equivalence Map Definitions
The ICD-9 and ICD-10 GEMs are used to facilitate linking between the diagnosis codes in ICD-9-CM and the new ICD-10-CM code set. The GEMs are the raw material from which providers, health information vendors and payers can derive specific applied mappings to meet their needs.
- Approximate Flag - The approximate flag is on, indicating that the relationship between the code in the source system and the code in the target system is an approximate equivalent.
- No Map Flag - The no map flag indicates that a code in the source system is not linked to any code in the target system.
- Combination Flag - The combination flag indicates that more than one code in the target system is required to satisfy the full equivalent meaning of a code in the source system.
Index of Diseases and Injuries Definitions
- And - The word "and" should be interpreted to mean either "and" or "or" when it appears in a title.
- Code also note - A "code also" note instructs that two codes may be required to fully describe a condition, but this note does not provide sequencing direction.
- Code first - Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. For such conditions, the ICD-10-CM has a coding convention that requires the underlying condition be sequenced first followed by the manifestation. Wherever such a combination exists, there is a "use additional code" note at the etiology code, and a "code first" note at the manifestation code. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation.
- Type 1 Excludes Notes - A type 1 Excludes note is a pure excludes note. It means "NOT CODED HERE!" An Excludes1 note indicates that the code excluded should never be used at the same time as the code above the Excludes1 note. An Excludes1 is used when two conditions cannot occur together, such as a congenital form versus an acquired form of the same condition.
- Type 2 Excludes Notes - A type 2 Excludes note represents "Not included here". An excludes2 note indicates that the condition excluded is not part of the condition represented by the code, but a patient may have both conditions at the same time. When an Excludes2 note appears under a code, it is acceptable to use both the code and the excluded code together, when appropriate.
- Includes Notes - This note appears immediately under a three character code title to further define, or give examples of, the content of the category.
- Inclusion terms - List of terms is included under some codes. These terms are the conditions for which that code is to be used. The terms may be synonyms of the code title, or, in the case of "other specified" codes, the terms are a list of the various conditions assigned to that code. The inclusion terms are not necessarily exhaustive. Additional terms found only in the Alphabetic Index may also be assigned to a code.
- NEC "Not elsewhere classifiable" - This abbreviation in the Alphabetic Index represents "other specified". When a specific code is not available for a condition, the Alphabetic Index directs the coder to the "other specified” code in the Tabular List.
- NOS "Not otherwise specified" - This abbreviation is the equivalent of unspecified.
- See - The "see" instruction following a main term in the Alphabetic Index indicates that another term should be referenced. It is necessary to go to the main term referenced with the "see" note to locate the correct code.
- See Also - A "see also" instruction following a main term in the Alphabetic Index instructs that there is another main term that may also be referenced that may provide additional Alphabetic Index entries that may be useful. It is not necessary to follow the "see also" note when the original main term provides the necessary code.
- 7th Characters - Certain ICD-10-CM categories have applicable 7th characters. The applicable 7th character is required for all codes within the category, or as the notes in the Tabular List instruct. The 7th character must always be the 7th character in the data field. If a code that requires a 7th character is not 6 characters, a placeholder X must be used to fill in the empty characters.
- With - The word "with" should be interpreted to mean "associated with" or "due to" when it appears in a code title, the Alphabetic Index, or an instructional note in the Tabular List. The word "with" in the Alphabetic Index is sequenced immediately following the main term, not in alphabetical order. | <urn:uuid:a1448f45-0397-4dd6-b5f5-f13962a6df30> | {
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- Sigma (σ) bond
- sp3 hybrid orbital
- Bonding orbital
- Antibonding orbital
- van der Waals forces
- Functional group
- Understand how orbital hybridization affects carbon's bonding characteristics
- Recognize a sigma (σ) bond
- Apply van der Waals forces to basic alkane characteristics, like boiling point
- Distinguish between alkanes and cycloalkanes and organic molecules with functional groups
Note that electrons seem to behave more like waves than like particles. So what is happening between two carbon atoms or a carbon atom and a hydrogen atom to cause them to "stick" together?
Because we cannot see atoms, we cannot be entirely sure. Nevertheless, a qualitative application of quantum theory can help explain how bonding occurs. If electrons act like waves in orbitals, then, presumably, those orbitals can overlap in such a manner that the waves constructively interfere (as opposed to destructive interference). This constructive interference occurs between the nuclei of the atoms as they approach one another, and it is related to the fact that the negatively charged electrons are attracted to the area between the positively charged nuclei owing to the electrostatic force. In the case of two hydrogen atoms, the spherical 1s orbitals overlap to form an ellipsoid-like orbital, as shown below (drawing not to scale), that represents the orbital of the bonded molecule H2.
This picture is simple enough: each hydrogen has a half-filled 1s orbital, and the overlapping orbitals yield a single full 1s orbital (i.e., a full valence shell) shared by both atoms. The hydrogen nuclei approach until the constructive interference of the electron wave functions is balanced by the repulsion of the positively charged nuclei (as well as the repulsion of the electrons, to some extent). At this point, the energy of the two-hydrogen "system" is minimized, and the hydrogen molecule is stable. The distance between the nuclei (the bond length) in this case is 74 picometers, or 0.000000000074 meters. This type of bond, where the orbitals overlap along the line formed by the two nuclei is called a sigma (σ) bond. Interestingly, though, this simple orbital view doesn't suffice for carbon.
Carbon has four valence electrons: two in its 2s orbital and two in its 2p orbital (one in each of two directional 2p orbitals, to be precise-2px and 2py, for instance). Following the above model, carbon would then only be able to form two covalent bonds, thereby filling up the two half-full directional 2p orbitals. But, as we have seen, carbon forms four covalent bonds to fill up its valence shell. One theory is that in its molecular form (that is, when bonded to other atoms), the 2s and 2p orbitals mix to form hybrid orbitals-in this case, sp3 hybrid orbitals. This type of hybrid orbital is one-quarter s-like and three-quarters p-like (because these orbitals are a mix of one s orbital and three p orbitals). A rough sketch of one of the sp3 orbitals is shown below.
Drawing the four sp3 orbitals as slightly elongated single lobes (emphasizing the major portion of the orbital drawn above) for illustration purposes, a carbon atom would "look" something like the tetrahedral sketch below.
A carbon-hydrogen covalent bond forms when the 1s orbital of a hydrogen atom overlaps one of the hybrid orbitals (in the case of an alkane, an sp3 orbital). Note that we represent electrons as arrows for the purposes of this illustration: these arrows are oriented either up or down to indicate their relative spins (or spin quantum numbers). Recall that for two electrons to exist in the same orbital, they must have different spin quantum numbers.
Another view of bonding is that free atoms have atomic orbitals, but atoms in molecules have molecular orbitals. The total number of molecular orbitals is the sum of the atomic orbitals, and these molecular orbitals are divided into lower-energy (and thus more stable) bonding orbitals and higher-energy (and thus less stable) antibonding orbitals. Consider, again, the simple case of two hydrogen atoms. Each atom has one atom in its atomic orbital, but when combined to form H2, these atoms form two molecular orbitals. Following the sigma bond notation, the bonding orbital is labeled σ, whereas the antibonding orbital is labeled σ*.
This molecular orbital model is complementary-rather than contradictory-to the hybrid orbital model ("valence bond model") discussed previously. Each can be helpful in its own way in the study of organic chemistry.
At first glance, alkanes-and other organic molecules with a balance of positive and negative charges-would seem to tend to "ignore" each other, since they are net neutral molecules. But electrons are not always evenly distributed around nuclei, and as such, molecules may actually be electric dipoles (that is, they may have a dipole moment). Dipoles, even though they may, as a whole, be charge neutral, nonetheless exhibit a weak electric field that can influence other charges, dipoles, or even neutral molecules with no inherent dipole moment. Furthermore, the mobility of electrons can actually cause two neutral molecules with no inherent dipole moments to induce such dipole moments in each other (this electron mobility also explains why two neutral hydrogen atoms can attract each other). These induced dipoles may then weakly attract one another. The forces of attraction between neutral molecules owing to dipole moments or induced dipole moments are called van der Waals forces. To these forces, some of the characteristics of organic molecules, such as alkanes, can be attributed.
Consider, for instance, the boiling point of simple alkanes like methane, ethane, and propane. Because these molecules do not exhibit a significant dipole moment, the only van der Waals force that exists between them is due to induced dipoles. Thus, two methane molecules might form mutually induced dipoles, causing a weak attraction between them.
At sufficiently a low temperature (i.e., the boiling point), the van der Waals force between the molecules is sufficient to cause them to "stick" together in a somewhat orderly manner-in other words, the substance goes from a gas (virtually no order owing to high energy of motion) to a liquid (slight order owing to lower energy of motion). Larger alkanes-in particular, those that are longer, less branched chains-have more possible locations in which dipole moments can be induced, meaning that the van der Waals forces between these larger molecules can accumulate. The result is that more energy of motion is required to break these forces, and therefore, the boiling point is higher.
For example, the boiling point of methane is -160°C, ethane is -89°C, and propane is -42°C.
You've probably heard of propane: a gas that is burned for heat in homes and cooking appliances, for example. Alkanes (and other hydrocarbons) burn (combust) rather easily, producing carbon dioxide, water, and heat when burned in the presence of oxygen. (Combustion is a type of oxidation-reduction reaction.) For instance, the following is a balanced chemical equation for the combustion of n-hexane:
2C6H14 + 19O2 → 12CO2 + 14H2O + Heat
In the case of n-hexane, combustion yields 4,163kJ/mol of heat.
Practice Problem: Write a balanced chemical equation for the combustion of ethylcyclohexane in pure oxygen.
Solution: First, we must determine a molecular formula for ethylcyclohexane. By following the IUPAC rules "in reverse," we obtain the molecule shown below. We can then count hydrogen and carbon atoms to get the molecular formula.
Now, write the chemical equation, making sure that the numbers of each element are the same on both sides.
C8H16 + 12O2 → 8CO2 + 8H2O
We have reviewed alkanes, the simplest hydrocarbons. But what about carbon compounds that have multiple bonds between carbon atoms or that incorporate atoms other than carbon and hydrogen? These multiple bonds and different atoms are largely responsible for the varying properties (reactivity) of different organic molecules. Specific groups of atoms that give organic molecules their reactive characteristics are called functional groups.
Alkanes are generally viewed as fundamental molecules that do not have functional groups. But when a double or triple bond between carbon atoms is added, or some atom or group of atoms, then functional groups are present. The following molecules each include a functional group (shown in red).
Of course, a molecule may incorporate a number of functional groups, and the above are just a few examples. As with alkanes, organic molecules have specific rules for nomenclature that help to identify a molecule accurately. In some cases, these rules can yield long and highly complicated names; sometimes, it's easier just to use the common name for a substance, as with the molecule below.
- Understanding Interactions of Acids and Bases
- How to Calculate Reactions of Aromatic Compounds
- Organic Chemistry and the Role of Amines
- Aldehydes and Ketones
- What is Stereochemistry?
- ICD-10-CM Coding Guidelines - Diseases of the Digestive System (Chapter 11) and Diseases of the Skin and Subcutaneous Tissue (Chapter 12)
- Understanding the Digestive System
- ICD-10-CM: Translating Documentation to Codes | <urn:uuid:8e3f7680-58ce-4b24-8dd5-1027209b9dcd> | {
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MedlinePlus Connect found the following health information for your request. Always consult your health care provider about your specific situation.
Results in MedlinePlus
Normally, if you get hurt, your body forms a blood clot to stop the bleeding. After the bleeding stops and healing takes place, your body usually breaks down and removes the clot. But some people get too many clots or their blood clots abnormally. Many conditions can cause the blood to clot too much... More on Blood Clots
The vascular system is the body's network of blood vessels. It includes the arteries, veins and capillaries that carry blood to and from the heart. Problems of the vascular system are common and can be serious. Arteries can become thick and stiff, a problem called atherosclerosis. Blood clots can... More on Vascular Diseases
MedlinePlus matched the above topic(s) to ICD-10-CM I80.8. ICD-10-CM stands for the International Classification of Diseases, 10th edition.
MedlinePlus Connect links to health information from the National Institutes of Health and other federal government agencies. MedlinePlus Connect also links to health information from non-government Web sites. See our disclaimers about external links and our quality guidelines. | <urn:uuid:bb169f00-bf75-488c-89a7-d36e4afe93d0> | {
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Use of hematopoietic stem cell transplantation (HSCT) has been investigated for treatment of patients with epithelial ovarian cancer. Hematopoietic stem cells are infused to restore bone marrow function after cytotoxic doses of chemotherapeutic agents with or without whole body radiotherapy.
Hematopoietic Stem Cell Transplantation
Hematopoietic stem cell transplantation (HSCT) refers to a procedure in which hematopoietic stem cells are infused to restore bone marrow function in cancer patients who receive bone-marrow-toxic doses of cytotoxic drugs with or without whole body radiotherapy. Bone marrow stem cells may be obtained from the transplant recipient (autologous HSCT) or from a donor (allogeneic HSCT). They can be harvested from bone marrow, peripheral blood, or umbilical cord blood and placenta shortly after delivery of neonates. Although cord blood is an allogeneic source, the stem cells in it are antigenically “naïve” and thus are associated with a lower incidence of rejection or graft-versus-host disease. Cord blood is discussed in greater detail in the Placental and Umbilical Cord Blood as a Source of Stem Cells policy.
HSCT is an established treatment for certain hematologic malignancies; however, its use in solid tumors in adults is largely experimental. Initial enthusiasm for the use of autologous transplantation with the use of high-dose chemotherapy for solid tumors has waned with the realization that dose intensification often fails to improve survival, even in tumors with a linear-dose response to chemotherapy. With the advent of reduced-intensity conditioning (RIC) allogeneic transplant, interest has shifted to determinants of alloreactivity to metastatic solid tumors via a graft-versus-tumor effect of donor-derived T cells.
Epithelial Ovarian Cancer
Several different types of malignancies can arise in the ovary; epithelial carcinoma is the most common. Epithelial ovarian cancer is the fifth most common cause of cancer death in women. New cases and deaths from ovarian cancer in the United States in 2016 are estimated at 22,280 and 14,240, respectively. Most ovarian cancer patients present with widespread disease, and yearly mortality is approximately 65% of the incidence rate.
Current management of advanced epithelial ovarian cancer is cytoreductive surgery in addition to combination chemotherapy. Approximately 75% of patients present with International Federation of Gynecology and Obstetrics stage III or IV ovarian cancer and treated with paclitaxel plus a platinum analog, the preferred regimen for newly diagnosed advanced disease. Use of platinum and taxanes has improved progression-free survival and overall survival in advanced disease to between 16–21 months and 32–57 months, respectively. However, cancer recurs in most women and they die of the disease because chemotherapy drug resistance leads to uncontrolled cancer growth.
High-dose chemotherapy has been investigated as a therapy to overcome drug resistance. However, limited data exist on this treatment approach; the ideal patient population and best treatment regimen remain to be established. Hematopoietic stem-cell transplantation has been tested in various patient groups with ovarian cancer:
The U.S. Food and Drug Administration (FDA) regulates human cells and tissues intended for implantation, transplantation, or infusion through the Center for Biologics Evaluation and Research, under Code of Federal Regulation (CFR) title 21, parts 1270 and 1271. Hematopoietic stem cells are included in these regulations. Cytotoxic drugs used in high-dose chemotherapy (HDC) require, and generally have received, FDA approval. HDC is an off-label use of approved drugs.
See Hematopoietic Stem-Cell Tranplantation in the Treatment of Germ-Cell Tumors medical policy for germ cell tumors of the ovary.
POLICYNo benefits will be provided for a covered transplant procedure or a transplant evaluation unless the Member receives prior authorization through case management from Blue Cross & Blue Shield of Mississippi.
Autologous and allogeneic hematopoietic stem cell transplantation are considered investigational to treat epithelial ovarian cancer.
POLICY EXCEPTIONSFor Federal Employee Program (FEP) subscribers, the Service Benefit Plan includes specific conditions in which autologous or allogeneic blood or marrow stem cell transplants would be considered eligible for coverage.
Investigative is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized as a generally accepted standard of good medical practice for the treatment of the condition being treated and; therefore, is not considered medically necessary. For the definition of Investigative, “generally accepted standards of medical practice” means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, and physician specialty society recommendations, and the views of medical practitioners practicing in relevant clinical areas and any other relevant factors. In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting.
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language.
POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.23 per approval by Medical Policy Advisory Committee (MPAC)
7/14/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC, no changes
10/26/2005: Code Reference section updated; CPT-4 code 38230 added; HCPCS code G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added; J9000-J9999 deleted
3/14/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
12/21/2006: Policy reviewed, no changes
12/19/2007: Coding updated per 2008 CPT/HCPCS revisions
1/06/2009: Policy reviewed. No changes.
4/26/2010: Policy title updated to remove “High-Dose Chemotherapy” and to change “Stem-Cell Support” to “Stem-Cell Transplantation.” “High-dose chemotherapy” removed from policy statement; intent unchanged. Policy description updated regarding prevalence of disease and treatment approaches. FEP verbiage added to the Policy Exceptions section. Added new CPT codes 86825 and 86826. Deleted HCPCS G0265, G0266, and G0267 from the code section as these codes were deleted on 12/31/2007. Added HCPCS S2140 and S2142 to the non-covered table.
12/28/2010: Policy reviewed; no changes.
01/17/2012: Policy reviewed; no changes.
02/20/2013: Policy reviewed; no changes.
03/10/2014: Policy reviewed; description updated. Policy statement unchanged.
12/19/2014: Policy reviewed; description updated. Policy statement unchanged.
08/26/2015: Code Reference section updated to add ICD-10 codes, updated the code descriptions for 38240, 38241, and 38242; removed deleted HCPCS code G0363, and removed deleted code CPT 96445 and replaced with CPT code 96446.
03/17/2016: Policy description updated regarding estimated data for 2016 and FDA regulations. Policy statement unchanged. Investigative definition updated in policy guidelines section.
05/25/2016: Policy number added.
SOURCE(S)Blue Cross Blue Shield Association Policy # 8.01.23
CODE REFERENCEThis may not be a comprehensive list of procedure codes applicable to this policy. | <urn:uuid:7d87afc3-e6e6-476d-bdd2-50ccd90e1577> | {
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Sources of Health-Related Statistics
The Centers for Disease Control & Prevention (CDC) is a major source health care statistics. Here are some links within the CDC website for various types of data.
- CDC Home Page
A good starting point for exploring the CDC. Find links to pages on specific diseases and conditions, a data & statistics section, statistics on accidents, etc.
- CDC--Diseases & Conditions
List of links to pages on specific diseases and conditions. Each page contains disease description, background, diagnosis and treatment info, incidence & prevalence stats, and links to non-governmental websites focusing on each disease.
- CDC--Data & Statistics
Links to pages with disease-specific stats, stats by state, health insurance access stats, disability info, birth and mortality data, cancer registry, risk factors, occupational hazards, and much more.
- CDC--National Center for Health Statistics (NCHS)
Use the FastStats feature to find data on how people use health services: hospital utilization statistics by diagnosis and procedure, ambulatory care, nursing home care, ER visits, hospice services, etc. Also is a source of stats on diseases and conditions.
This is a public health database with statistics on causes of death, incidence of cancer and other acute and chronic diseases, behavioral risk factors, health and nutrition, environmental health, and much more.
National Institutes of Health (NIH)
The NIH's various sections may have summary pages about diseases and conditions (like on the CDC website) that are not covered on other websites or in other databases.
The data is collected and supplied from agencies from the U.S. Department of Health and Human Services as well as state partners. This includes the Centers for Medicare and Medicaid Services (CMS), Centers for Disease Control and Prevention (CDC), Food and Drug Administration (FDA), and the Agency for Health Care Research and Quality, among others.
- Health Services Research Information Central
Maintained by the National Library of Medicine (NLM), this site is a huge collection of links to health information resources both inside and outside the federal government. Links are grouped by topic under the "Data, Tools & Statistics" section.
Maintained by the Agency for Healthcare Research & Quality, this is a web-searchable version of the more detailed (and harder to access) HCUP database. Covers utilization and expenditures on inpatient and outpatient health care services by ICD-10-CM code.
Medical Expenditure Panel Survey (MEPS). A set of large-scale surveys of families and individuals, their medical providers (doctors, hospitals, pharmacies, etc.), and employers across the United States. MEPS collects data on the specific health services that Americans use, how frequently they use them, the cost of these services, and how they are paid for, as well as data on the cost, scope, and breadth of health insurance held by and available to U.S. workers. Overseen by the Agency for Healthcare Research and Quality (AHRQ).
National Cancer Institute SEER database. An enormous database of statistics about incidence of cancer, outcomes, and much more. A lot of the information is free and easily searchable by type of cancer, type of data, and patient demographic characteristics.
- Statistical Abstract of the United States
A compendium of statistics, mostly from governmental sources, covering a wide range of fields in the U.S.: health care, industry, geography, state-specific statistics, manpower data, and much much more.
- Integrated Health Interview Survey (IHIS)
Based on the U.S. National Health Interview Survey, IHIS is a source for downloadable, in-depth datasets capturing individuals' health and health care utilization behavior. While the datasets require knowledge of detailed statistical files, an online report generator produces ad hoc reports on a wide range of variables (e.g., "Do you have a regular health care provider?")
AAMC Physician Workforce Statistics. Statistics on physicians by specialty and type of institution/location, nationally and by state. New data are published each year.
These library-subscribed databases include statistics or data on a wide range of topics. Search them to find sources you may have missed.
Statista: The Statistics Portal
Contains statistics and analysis on a wide range of topics, such as health care, economics, industry, market research, social issues, and much more. Covers the globe.
Collects together documents, from a wide range of governmental and private sources, containing statistics and analysis on many topics including health care.
Another resource similar to Statistical Insight, but with data mapping and table-creation capabilities.
Intended for clinical practitioners, contains voluminous global information on epidemiology and treatment of almost every disease and condition. Good source of statistics on incidence and prevalence of diseases.
Data & Statistics Research Guide
This online guide from our data librarian is dedicated to sources of datasets on many topics.
Cortellis Competitive Intelligence
Use this database from Clarivate Analytics to track over 60,000 individual drugs throughout their development cycle. Generate reports and visualizations on patent filings, companies and universities, clinical trial stages and funding deals—searchable by disease, process, drug characteristics, developer, or location of developing entity. View the extensive collection of research reports, conference presentations and upcoming conference previews. Access through SSO (single sign-on) with your JHU ID/password.
- All Payer Claims Database (APCD)A national initiative to standardize, collect, and disseminate provider-specific and patient-specific health service data. Several states have available data, with each state having its own access criteria and process.
World Health Organization (WHO)Gathers and reports on all types of data and other information on the world and individual countries--individuals' health status, health systems by country, mortality and birth rates, per capita expenditures on health care, and much more. Look especially at the following tabs: Data & Statistics, Countries, & Programs.
OECD Health StatisticsProvides a wide range of health statistics for 26 countries going back several years: mortality, morbidity, perceived health status, dental health, child health, health manpower, determinants of health, health systems attributes, etc.
Demographic & Health Surveys (Measure DHS-USAID).International database of population and health surveys covering over 70 countries. Depending on what you want, users may need to create an account and in some cases request data in advance. Some datasets require statistical package for viewing. However, the STATCOMPILER feature within the “Data” tab allows for online table generation.
- EurostatStatistics on health care, population, and other indicators for European Union members.
- National Health Service DigitalHealth Care Delivery statistics for the United Kingdom. Quite detailed.
These private organizations often fund research on key topics that are not covered by federal agencies. They also work in conjunction with federal agencies on certain projects.
- Health News Review
Contains carefully selected articles, from a wide range of sources, on specific health conditions, diagnostic methods, and treatments. Keyword searchable and very reliable/authoritative.
- National Cancer Institute Seer Database
"The" official source for statistics on specific types of cancer.
- Dartmouth Atlas of Health
Contains extensive data on health care use and expenditure variations by location within the U.S. (e.g., tonsillectomy rates by state), with an eye toward documenting disparities in access, efficiency, and cost. Data is presented by topic, region, and individual hospital.
An independent organization focusing on best practices in health care, alternative delivery systems, global health issues, chronic care, patient safety, and more--all focusing on creating the most rational, efficient, effective health care system possible.
IOM is the health care arm of the National Academy of Sciences. It is an independent organization that reports on policy issues independently and upon request by federal agencies. It has reported on public health, biomedical research, diseases, quality and patient safety, access and coverage, veterans' health, health care workforce, women's health, aging, and lots more.
This independent arm of Kaiser Permanente conducts extensive research on access to health care services, the impact of various insurance models on patient behavior, health reform, global health, and women's health issues.
Covers health care's effects on people's lifestyles, veterans' health issues, and numerous surveys that include questions on peoples use of health care services and attitudes toward health programs.
Point to the "Research" tab and click on "Health & Health Care" to find research, analysis, and quantitative info on various diseases, health care cost, health care facilities, health care quality, health economics, primary care, and many more topics
RWJ focuses on children's health, health care coverage, alternative delivery methods, disease prevention, vulnerable populations, nursing and much more.
Conducts research and writes in-depth reports on topics such as health system performance, health care delivery, health care coverage, vulnerable populations, state health policy, and health reform.
- Consumer Assessment of Healthcare Providers and Systems (CAHPS)
Click on the CAHPS database link to access AHRQ's comparative consumer opinion data on quality of service at hospitals and other providers
- Agency for Healthcare Research & Quality (AHRQ)
Federal agency that conducts, funds, collects, and reports on research about cost effectiveness, value, and quality in the delivery of health care services.
Patient safety non-profit working in conjunction with the U.S. Centers for Medicare and Medicaid Services (CMS), and conducting its own annual surveys. Offers safety scores for over 2,000 U.S. acute care hospitals, focusing on hand-washing practices, bed sores, falls, etc.
- American Hospital Association (AHA) Annual Survey and IT Databases via Wharton Research Data Service
The Wharton Research Data Service (WRDS) is available to JHU faculty, staff and students who register and receive approval for an account, specifically for academic research. Please allow up to two business days for the registration and authentication process. Among the library’s selected subscriptions through it is the American Hospital Association (AHA) Annual Survey for demographic, operational, staffing, employment model, insurance and utilization characteristics for more than 6,000 U.S. hospitals. Use the supplemental AHA IT database to analyze healthcare IT indicators and technology integration within over 3,500 hospitals.
American Hospital Directory (AHD)This link leads to a Welch Library webpage with the login details. Once logged in, set criteria. Explore sections of hospital profiles on quality, utilization, financial results, etc. One user at a time can access this database. Please log out in top corner when done. | <urn:uuid:f70a4b43-c187-4126-a91d-1bc26cde2f32> | {
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Please note that these scenarios, medical reports, and coding examples are all theoretical. Some of them may have been simplified for space. They are presented solely as teaching examples.
Let’s start off with a relatively straightforward visit to the doctor’s office. Here’s some context: our patient is in his late 20s and has not seen this doctor before. He’s had a fever, a cough, some slight chest pain, and difficulty breathing.
Here’s the hypothetical medical report.
Patient is a 27-year-old white male. Not an established patient. Height is 74 inches, weight 220 lbs. Patient states he is allergic to penicillin, but has no other outstanding medical history. Does not smoke, exercises moderately.
Patient presents with chills, headache, cough, fever (101 degrees), difficulty breathing. Examination via stethoscope yields heavy rales. Percussion test on thorax suggests buildup in lungs. Streptococcal pneumoniae suspected.
Obtained blood sample for Antistreptolysin O titer. Results yield level of ASO above 200. Diagnosis of streptococcal pneumoniae confirmed.
Prescribed patient two weeks of 500mg azithromycin (Zithromax), and scheduled follow-up for next week.
Let’s start abstracting the information from this medical report. We can start right away with the most straightforward code: the diagnosis. The doctor has diagnosed streptococcal pneumoniae in this patient. (Remember, we always code the definitive diagnosis, meaning we wouldn’t code the cough, fever, or any of the other symptoms unless the doctor could come to a definitive diagnosis).
So, in order to get the proper diagnosis code, we turn to the ICD-10-CM manual. We’d look to the range J00– J99, for Diseases of the Respiratory System. In that section we’d find “J13 – pneumonia due to Streptococcus pneumoniae,” which is the code we’re looking for: pneumonia caused by streptococcal bacteria. In this case, there are no subcategories or subclassifications. J13 is our diagnosis code.
(Bear in mind that you could also just look up Streptococcus Pneumoniae in the alphabetic index of ICD-10-CM. We’re taking the long route for the sake of instruction).
Now we get into the procedure codes. There are a couple here. Firstly, since a new patient is coming into the doctor’s office with an as-yet unspecified condition, we know it’s an Evaluation and Management (E&M) procedure. Secondly, we see that the doctor performed a test on the patient to confirm the diagnosis. That’s a pathology and laboratory test.
Let’s start with the E&M codes. You may think that the prescription of medication by the doctor falls into yet another category of procedure, but prescribing a medication is actually part of the E&M process. So too are the basic examinations the doctor performed (the thoracic percussion and the use of the stethoscope). Those are each part of the History, Exam, and Medical Decision-Making portions of E&M codes, often abbreviated to HEM. The doctor asked the patient about his history, he performed various exams, and he made a medical decision to prescribe antibiotics.
When you’re selecting E&M codes, you look at the intensity of the evaluation and patient management. We can do this by the time spent with the patient, or we can do it by evaluating the amount of work that goes into the HEM.
E&M codes will list the level of intensity (and the time) of the procedure in their description. In our example, since the patient is new, there will be a more involved ‘history’ section of HEM. This would go with a thorough examination. The medical decision-making of prescribing antibiotics by oral administration is relatively low-risk, so this E&M procedure would probably be of low to moderate complexity.
Since the patient is a new patient, we’d look for codes in that subsection of E&M. We’d find code 99203, which includes a “detailed history; a detailed examination; medical decision making of low complexity.” That’s our E&M code.
But the doctor also performed a test that confirmed his diagnosis. How do we code that? Since the doctor took a sample from the patient to test, we know it’s in the Pathology Section of the CPT Manual.
A little medical background here: the test in the medical report was an Antistreptolysin O, or ASO, titer. A titer is a type of test. ASOs are antibodies the immune system creates to combat streptococcal bacteria. The human body typically has around 200 units of ASO as a baseline. If a test confirms a heightened level of ASO, that’s usually a definitive sign of the presence of strep bacteria.
We can find the test for ASO in the immunology subsection of Pathology. We could also look up antistreptolysin in the index at the back of the CPT manual. Both methods would lead us to the CPT code 86060, “antistreptolysin; titer.” That’s our Pathology code.
Now what about the medication the doctor’s prescribed to our patient? We’d include that as part of our medical decision making process—the prescription of antibiotics is the decision the doctor made for the patient. However, if we wanted to add it to the E&M code to give the payer more information, we can do that pretty easily.
Previously, we talked about Category II CPT codes as useful for administrative and performance management purposes, but they can also be used in informational settings. These Category II codes are optional, and are added to Category I codes with a hyphen. We’d look up the proper Category II code in the index under “antibiotic administration.” That would point us to 4120F, “antibiotics prescribed or dispensed.” We’d flip there in Category II to confirm.
So we’d add the Category II CPT code 4120F to our extant E&M code 99203 to get 99203-4120F, which is a new patient visit of low complexity, with the prescription or dispensation of antibiotics.
So our codes would be…
We’d enter these into a superbill that would include…
- The patient’s information
- The provider information
- Procedure information
- Diagnostic information
We’d then send that superbill on to the medical biller so that they could create the medical claim.
Let’s look at another hypothetical situation, this time involving surgery.
We’ll jump right in with our medical report. This one, you’ll note, is different in format from the previous one. There’s no uniform style of medical report, so coders should be prepared to abstract information from a whole variety of reports.
CHIEF COMPLAINT: Pain and swelling in abdomen
HISTORY OF PRESENT ILLNESS: Patient is a 67-year-old female presents to the emergency room with sharp, shooting pain in her lower abdomen and pronounced swelling. Patient is nauseous, has vomited, and has a fever. Abdomen is firm and slightly distended. Patient states she has no history of abdominal problems, disease, or hernia.
PAST MEDICAL HISTORY: Patient is on a program of anti-depressants, but is otherwise physically sound. States she has never been admitted for any abdominal problems.
CURRENT MEDICATIONS: Wellbutrin, 5 mg daily
SOCIAL HISTORY: Used to smoke (using Wellbutrin to quit) and does not drink
REVIEW OF SYMPTOMS: As above
Vital Signs: Blood pressure is 150/88, with a fever of 102 degrees.
Skin: Warm and dry and normal, except in lower abdomen, where it is swollen and tight
Chest: no respiratory problems detected
Cardiac: regular rhythm
Back: No abnormalities detected
Abdomen: is firm above the pelvic bones. Patient experiences pain upon palpation. Blumberg sign elicits painful response, as does a forced cough. Abdomen is tight and swollen.
INTERVENTION: Physical examination suggests appendicitis. Ultrasound test ordered, and diagnosis of appendicitis is confirmed. Patient is rushed to surgery and is prepped for general anesthesia. Once anesthetized, patient receives appendectomy via laparoscopy. Exploration during surgery reveals no signs of peritonitis, local or general. Following surgery, patient is taken to observation room, and then to hospital room. Patient responds well to surgery, and is discharged later that night with a prescription for pain medication.
Diagnosis: Acute appendicitis
As you can tell, this medical report is significantly more involved than our first one. Thankfully, it’s a pretty direct procedure, so we can dive right in. Let’s start with the diagnosis.
As listed above, the diagnosis is acute appendicitis. To find this in ICD-10-CM, we’d look for Diseases of the Digestive System. In that section we’d find the code for acute appendicitis: K35. Under that code we’d find multiple subcategories. As we saw in the medical report, there was no sign of any peritoneal complications, so we’d choose K35.80, unspecified acute appendicitis. That’s our diagnosis code.
Let’s move on to procedure codes. We’ll start again with E&M. This is an emergency department services code. Emergency codes, like outpatient or office codes, are coded depending on the intensity/risk of the procedure. When our patient checks in, she’s not in directly life-threatening danger, but if the appendicitis goes septic, it could endanger her life. With that in mind we’d pick the E&M code 99284, a visit for a condition that “requires urgent evaluation by the physician…. but [does] not pose an immediate significant threat to life or physiological function.” So, 99284 is our E&M code.
Of course, our procedure coding doesn’t stop there. As we saw from the medical report, the emergency department performed an ultrasound to confirm their diagnosis, and performed a surgical procedure with general anesthesia. This means we need three more codes: a Radiology code (for the ultrasound), a Surgery code (for the appendectomy), and an Anesthesia code (for the general anesthesia).
Let’s start with the ultrasound. Diagnostic ultrasounds are found after diagnostic radiology (e.g. x-rays) in the Radiology Section. We’d look for a diagnostic ultrasound for the abdomen and find 76700, for “ This means it’s an ultrasound for the entire abdomen. That’s close, but not exactly what we want. Below 76700 you’ll see code 76705, for a limited abdominal ultrasound of a single organ or quadrant. That’s what we want. So 76705 is our Radiology code.
Let’s move to Surgery. The Surgery Section is relatively straightforward. We find the procedure we want by the area of the body it’s performed on. In our case, we’d turn to the digestive system (recall that the appendix is attached to the large intestine). There we’d find codes for the appendix, including incision, excision, and laparoscopy. We’re looking for an appendectomy done via laparoscopy, so we’d look at laparoscopy codes, and we’d select 44970, laparoscopy, surgical, appendectomy. That’s our Surgery code.
With every surgery we’ll need some sort of Anesthesia code. Per the medical report, the patient received general anesthesia, but we select Anesthesia codes based on the location of the procedure performed under the anesthetic. So the Anesthesia code would be located under “Lower Abdomen” in the Anesthesia Section. Specifically, we’d choose 00840, Anesthesia for intraperitoneal procedures in lower abdomen including laparoscopy; not otherwise specified.” Remember also that with every Anesthesia code, you need to add a physical status modifier. These are found in the Anesthesia section, and are added to the Anesthesia code to describe the condition of the patient. In our example, the patient is a P3—the patient has a severe systemic disease (since appendicitis can go septic, and thus potentially life-threatening, it’s regarded as severe). So our Anesthesia code is 00840-P3.
Here’s what we’d end up with:
with 00840-P3 (Anesthesia)
K35.80 – Unspecified acute appendicitis
We’d include that information in a superbill, along with the provider information (in this case it’d be a hospital), patient information, and prices. We’d send those on to the medical biller, whose work we’ll explore in the next Course. | <urn:uuid:129b0432-c032-40c4-b595-1d5d1bfc7844> | {
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For hundreds of years, people have believed in ghosts; they appear in ancient literature, plays and movies. In folklore, a ghost is the spirit of a deceased person or animal that appears to the living, generally in a semi-visible form. Ghosts may also be known as apparitions, haunts, poltergeists, shades, specters, spooks or wraiths, with descriptions varying widely from an invisible airy presence to translucent or barely visible misty shapes, to realistic, life-like visions. Spiritualists believe that theunseen things that make up a personality, such as ego and intellect, do not die and instead carry on in another plane of existence. According to the Gallup Poll News Service, belief in haunted houses, ghosts, communication with the dead, and witches had an especially steep increase over the 1990s. And, a2005 Gallup poll found that approximately 32 percent of Americans believe in ghosts.
The spirit of a deceased person that persists in the material world (the ghost) is regarded as an unnatural or undesirable state of existence and the thought of ghosts in the general proximity may cause nervousness or fear. This could be due, at least in part, to the thought that ghosts are frequently considered to be seeking vengeance for acts perpetrated against them, or have unfulfilled goals they did not accomplish while alive. Another theory is that the ghost is imprisoned on earth due to their wicked activities during life. Regardless, a place where a ghost resides is described as haunted, although not all hauntings are at a place of brutal death or even on violent grounds.
A White Lady is a specific type of ghost dressed all in white and reported primarily in rural areas. These spectral females supposedly died tragically or suffered severe trauma in life. While White Lady legends are found in many countries around the world, they are most common in the United States, Ireland and Great Britain. The theme of painfully losing or being betrayed by a husband or fiancé is common to many of the White Lady tales.
Elva Zona Heaster was born in Greenbrier County, West Virginia and made history as a not-dressed-in-white spirit who helped solve her own murder. Zona met Erasmus Stribbling Trout Shue in 1896, a drifter who moved to Greenbriar to start a new life working as a blacksmith. The two were attracted to each other and quickly married, against the wishes of Zona’s mother, Mary Jane Robinson Heaster. On January 23, 1897, only a few months after their marriage, Zona’s body was discovered inside her house by an errand boy. She was stretched out at the bottom of the stairs, with her feet together, one hand on her abdomen and the other lying next to her still form. Her head was turned slightly to one side and her eyes were open and staring.
Before the local doctor and coroner could arrive, Erasmus carried his wife’s body up to their bedroom and laid her out on the bed. In a breach of local custom, he dressed the corpse himself in a high-necked, stiff-collared dress, put a scarf around her neck (her favorite, he said) and a veil over her face. Erasmus never left his wife’s body, continuously sobbing and cradling her head. Due to this extreme display of grief on the part of her husband, the coroner was unable to complete a thorough examination of Zona’s body; he listed the cause of death as“everlasting faint.”
On January 24, Zona’s body was transferred to her parent’s home several miles away, with Erasmus in constant vigil at the head of the open coffin. During the subsequent wake, Erasmus would not allow anyone to get too close to the coffin and when the body was moved, several of the mourners present noted a strange looseness to Zona’s head. After the interment of herremains, Mary Jane noticed a strange odor and color when she washed the sheet used to cover her daughter. As a result, sheprayed every night for four weeks that Zona would return to her and reveal the truth about the manner of her death.
Some weeks later, her prayers were answered. According to Mary Jane, Zona appeared over the course of four dark nights, waking her mother from sleep and explaining that Erasmus had indeed murdered her, attacking her and savagely breaking her neck. [Coincidentally, this story mirrors one of the more recognizable ghosts in English literature: the shade of Hamlet’s murdered father who demands that Hamlet investigate his “murder most foul” and seek revenge upon his usurping uncle.]Mary Jane approached the local prosecutor, requesting that the investigation into Zona’s death be re-opened. While the prosecutor agreed to talk to those involved in the case, he actually re-opened the case because others in the community were also suspicious about the nature of Zona’s death.
On February 22, 1897 the body of Zona Shue, well-preserved in the frozen ground, was exhumed to perform a more complete autopsy. During the course of this examination, it was determined that Zona’s neck had indeed been broken (ICD-10-CM code S12.9XXA, Fracture of neck, unspecified, initial encounter), her trachea crushed (code S17.0XXA, Crushing injury of larynx and trachea, initial encounter) and there werebruises on her throat indicating that she had been choked (code Y04.8XXA, Assault by other bodily force, initial encounter; and Y92.018, Other place in a private house as the place of occurrence). Erasmus was arrested, arraigned and entered a plea of not guilty. He was also overheard at the time of the autopsy to state “They cannot provide I did it.” The highlight of the trial, of course, occurred when the defense attorney asked Zona’s mother about her ghostly visitation. Although the attorney planned to discredit Mary Jane as a witness, the tactic backfired. It was apparent that most of the people in the community believed in Zona’s ability to reach from beyond the grave and point to her murderer.
Erasmus was subsequently convicted of murder, but in the absence of a unanimous decision he was sentenced to life in prison. He died on March 13, 1900 from one of the epidemics of measles, mumps or pneumonia that rampaged through the prison that spring. Mary Jane Robinson Heaster died in September 1916, without ever recanting her story about her daughter’s ghost. Zona, also called the Greenbriar Ghost, was never seen again. However, there is a roadside marker along Route 60 that commemorates the only known case in which the testimony of a ghost helped convict a murderer. | <urn:uuid:68cb3175-b35a-4c3d-86a0-c4549e137916> | {
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Diagnosis Code E71.540
Information for Medical Professionals
The ICD-10 and ICD-9 GEMs are used to facilitate linking between the diagnosis codes in ICD-9-CM and the new ICD-10-CM code set. The GEMs are the raw material from which providers, health information vendors and payers can derive specific applied mappings to meet their needs.
- 277.86 - Peroxisomal disorders (approximate) Approximate Flag
The approximate flag is on, indicating that the relationship between the code in the source system and the code in the target system is an approximate equivalent.
- Chondrodysplasia punctata
- Loss of multiple peroxisomal functions
- Rhizomelic chondrodysplasia punctata syndrome
Index of Diseases and Injuries
References found for the code E71.540 in the Index of Diseases and Injuries:
- Type 1 Excludes Notes: Type 1 Excludes Notes
A type 1 Excludes note is a pure excludes note. It means "NOT CODED HERE!" An Excludes1 note indicates that the code excluded should never be used at the same time as the code above the Excludes1 note. An Excludes1 is used when two conditions cannot occur together, such as a congenital form versus an acquired form of the same condition.
- chondrodysplasia punctata NOS (Q77.3)
Information for Patients
Metabolism is the process your body uses to get or make energy from the food you eat. Food is made up of proteins, carbohydrates, and fats. Chemicals in your digestive system break the food parts down into sugars and acids, your body's fuel. Your body can use this fuel right away, or it can store the energy in your body tissues, such as your liver, muscles, and body fat.
A metabolic disorder occurs when abnormal chemical reactions in your body disrupt this process. When this happens, you might have too much of some substances or too little of other ones that you need to stay healthy. There are different groups of disorders. Some affect the breakdown of amino acids, carbohydrates, or lipids. Another group, mitochondrial diseases, affects the parts of the cells that produce the energy.
You can develop a metabolic disorder when some organs, such as your liver or pancreas, become diseased or do not function normally. Diabetes is an example.
- Acidosis (Medical Encyclopedia)
- Alkalosis (Medical Encyclopedia)
- Lactic acid test (Medical Encyclopedia)
- Metabolic acidosis (Medical Encyclopedia)
- Metabolic neuropathies (Medical Encyclopedia)
- Pseudohypoparathyroidism (Medical Encyclopedia)
Rhizomelic chondrodysplasia punctata Rhizomelic chondrodysplasia punctata is a condition that impairs the normal development of many parts of the body. The major features of this disorder include skeletal abnormalities, distinctive facial features, intellectual disability, and respiratory problems.Rhizomelic chondrodysplasia punctata is characterized by shortening of the bones in the upper arms and thighs (rhizomelia). Affected individuals also have a specific bone abnormality called chondrodysplasia punctata, which affects the growth of the long bones and can be seen on x-rays. People with rhizomelic chondrodysplasia punctata often develop joint deformities (contractures) that make the joints stiff and painful.Distinctive facial features are also seen with rhizomelic chondrodysplasia punctata. These include a prominent forehead, widely set eyes (hypertelorism), a sunken appearance of the middle of the face (midface hypoplasia), a small nose with upturned nostrils, and full cheeks. Additionally, almost all affected individuals have clouding of the lenses of the eyes (cataracts). The cataracts are apparent at birth (congenital) or develop in early infancy.Rhizomelic chondrodysplasia punctata is associated with significantly delayed development and severe intellectual disability. Most children with this condition do not achieve developmental milestones such as sitting without support, feeding themselves, or speaking in phrases. Affected infants grow much more slowly than other children their age, and many also have seizures. Recurrent respiratory infections and life-threatening breathing problems are common. Because of their severe health problems, most people with rhizomelic chondrodysplasia punctata survive only into childhood. It is rare for affected children to live past age 10. However, a few individuals with milder features of the condition have lived into early adulthood.Researchers have described three types of rhizomelic chondrodysplasia punctata: type 1 (RCDP1), type 2 (RCDP2), and type 3 (RCDP3). The types have similar features and are distinguished by their genetic cause. | <urn:uuid:be559eb7-cf82-4b67-9050-157e44f56cb0> | {
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Indicator Report Data View Options
Why Is This Important?
Birth defects pose a significant public health problem. One in 33 babies is born with a structural birth defect in the United States. Birth defects are a leading cause of infant mortality and responsible for considerable morbidity and disability. Among people with hypoplastic left heart syndrome (HLHS), the underdeveloped left side of the heart is unable to provide enough blood flow to the body. The normal shunts present at birth help to direct blood to the body; when these connections close the oxygen-rich blood supply decreases. Thus, babies with HLHS might look normal at birth, but will develop symptoms of HLHS within a few days. These symptoms might include: poor feeding; problems breathing; pounding heart; weak pulse; and ashen or bluish skin color. Without treatment, babies with HLHS die. Although this defect cannot be corrected, surgeries after birth can create the needed connections, or shunts, to allow the blood to get to the body.
Hypoplastic left heart syndrome (HLHS) is a problem with the heart's structure that is present at birth (congenital). It is a group of related defects that, together, mean that the left side of the heart is underdeveloped. The prevalence of HLHS is the number of live-born infants with HLHS per 10,000 live born infants. (Live-born infants are the infants born with any evidence of life). New Mexico live-born infants with hypoplastic left heart syndrome (HLHS), 2015-2019.
Data NotesThe following International Classification of Diseases, 9th and 10th Revisions Clinical Modification (ICD-9-CM and ICD-10-CM) codes were used in 2015 to identify HLHS: 746.7 and Q23.4, respectively. Only ICD-10-CM code was used from 2016-2019. In 1987, CDC put forth a set of 6-digit codes (the sixth digit provides greater specificity for diagnosis) based on the British Pediatric Association Classification of Diseases and the ICD-9-CM. If CDC/BPA codes are present, the following were used to identify HLHS: 746.70.
- Birth Defects Prevention and Surveillance System (BDPASS), New Mexico Department of Health.
- Birth Certificate Data, Bureau of Vital Records and Health Statistics (BVRHS), Epidemiology and Response Division, New Mexico Department of Health.
How the Measure is Calculated
Numerator:Number of live-born infants with hypoplastic left heart syndrome (HLHS).
Denominator:Number of live-born infants.
Birth Defects Prevention and Surveillance System (BDPASS)
Birth defects are reported on the birth certificates, which are provided for all births occurring in-state as well as births to NM resident mothers who gave birth out-of-state. Some birth defects (Hypoplastic Left Heart Syndrome, Tetralogy of Fallot, Transposition of Great Arteries, Hypospadias, Lower and Upper Limb Deficiencies, and Trisomy 21) were not reported on birth certificates until 2004.
Birth Certificate Data
Birth certificate information is submitted electronically by hospital medical records staff who use standard mother and facility worksheets and medical charts to collect the needed information. Training of hospital staff is provided by the Bureau of Vital Records and Health Statistics (BVRHS). The birth certificate information is reviewed by BVRHS for completeness and consistency with state law and NMDOH and national guidelines. BVRHS will contact hospital staff for clarification of missing, inconsistent or incorrect entries. CDC's National Center for Health Statistics provides feedback to BVRHS on data quality and the NMDOH provides feedback to the hospitals to improve data quality and training. | <urn:uuid:f22ef2c2-3ff8-4678-a9ca-4adb8c7acfc3> | {
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Medical coding is the way in which procedures and diagnoses are classified by a coding shorthand to determine how sick someone is and what was done to fix it. Medical coding software makes that process easier.
our experience with medical coding software
Here are a few of our medical coding software projects
- Creating custom medical coding software to allow a coding service to manage pdfs from clients and code them easily.
- Creating the ability for an EMR to code visits using ICD-9 and CPT codes
Medical coding was once used as an internal measure for the medical providers; it is now used by healthcare providers to bill medical insurance companies and patients. The medical codes indicated by the healthcare provider determine what they will be paid for a procedure.
A medical diagnosis is what condition(s) the patient has. For example, a patient could be diagnosed with a fractured humerus (upper arm), as well as a fractured ulna (lower arm).
A medical procedure code is what action is performed on a patient. For example, putting a cast on a patient from their shoulder to their hand is a procedure.
Health Insurance providers have the benefit of being able to collect medical coding and billing data from many different sources. They use this medical billing and coding information to set rates for each procedure done; taking into account how difficult the procedure was to perform based on how sick the person was. This gives them power to evaluate the validity of the charges and to squeeze the best deal out of healthcare providers.
The United States has its own flavor of medical billing and coding systems. Currently, the typical medical billing and coding systems that are used in the United States are CPT codes and ICD-9-CM codes. CPT codes describe the medical procedures that were done. ICD-9-CM codes describe the patient’s diagnoses that were present at the time of treatment. In the United States, ICD-9-CM was created which adds a medical procedure section to the existing ICD-9 diagnoses and extends the list of diagnoses.
While ICD-10 is standard across the world as diagnosis codes, ICD-9 is currently the standard for diagnosis codes in the United States. The U.S. created additional diagnosis codes for ICD-9 and then named this modification ICD-9-CM.
ICD-9 uses 5 digit codes with a decimal to define conditions. For example, 008.61 means Enteritis (inflammation of the small intestine) caused by a rotavirus. ICD-9 contains approximately 13,000 codes, whereas ICD-10 contains over 120,000 codes. The reason why ICD-10 was created is that ICD-9 ran out of room to effectively code all of the disease conditions that exist.
ICD-10 codes add an alphanumeric character to the front of the ICD-9 codes, so that they consist of one alphanumeric character followed by 5 digits. Some of the additional space provided by ICD-10 is used to define new conditions, and some space is used to increase the specificity of existing conditions. For example, in ICD-9, fracture of the humerus is 812. In ICD-10, there are three possible diagnoses for fracture of the humerus.
- Sample – ICD-9
- 812 – Fracture of the humerus
- Sample – ICD-10
- S42.2 - Fracture of upper end of humerus
- S42.3 - Fracture of shaft of humerus
- S42.4 -Fracture of lower end of humerus
The US has also expanded ICD-10 with additional diagnoses and named this modification ICD-10-CM. ICD-10 is required to be implemented in 2011 in order to receive payment from Medicaid and Medicare.
CPT (Current Procedural Terminology) codes are the most common method of medical billing and coding in the United States to indicate which medical procedures have been performed. CPT codes were created & are managed by the American Medical Association (AMA). AMA owns and licenses the use of the CPT codes. CPT codes are required to be used to receive reimbursement from Medicaid or Medicare.
CPT codes are identified using 5 numeric digits. CPT codes only include procedures that are performed by or in the office of a physician.
HCPCS has two sections of codes that are currently in use - Level I and Level II.
Level I of the HCPCS is comprised of CPT codes (see above for more information).
Level II of the HCPCS is a standardized coding system that is used primarily to identify products, supplies, and services not included in the CPT codes, such as ambulance services and durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) when used outside a physician's office. Level II codes consist of a single alphabetical letter followed by 4 numeric digits, while CPT codes are identified using 5 numeric digits.
ICD-9-CM is an expanded version of the international standard ICD-9, created by the U.S. National Center for Health Statistics, which adds medical procedure codes (which are very similar to CPT codes). ICD-9-CM adds a Volume 3 to the standard. ICD-9-CM was created by the U.S. National Center for Health Statistics (NCHS) and is managed by NCHS as well as the U.S. Centers for Medicare and Medicaid Services. The ICD-9-CM procedure codes were created more as a method to track public health than as a reimbursement tool.
The U.S. added codes for medical procedures to ICD-10 and called that section ICD-10-PCS. Medical procedures were in the previous U.S. version of ICD-9 (ICD-9-CM), but used the same standard name as the diagnostic section. These two sections were named differently in ICD-10 to reduce confusion.
DRGs were created to provide an easier way to evaluate how complicated treating a particular patient would be. They are used by CMS for reimbursement calculations. | <urn:uuid:b6f365ac-05ca-4b5d-8c57-bcd52a19e6cb> | {
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History/Background and/or General Information
Urine drug testing (UDT) provides objective information to assist clinicians in identifying the presences or absence of drugs or drug classes in the body and assist in making treatment decisions.
This LCD details:
- The appropriate indications and expected frequency of testing for safe medication management of prescribed substances in risk stratified pain management patients and/or in identifying and treating substance use disorders.
- Designates documentation, by the clinician in the patient’s medical record, of medical necessity for, and testing ordered on an individual patient basis;
- Provides an overview of presumptive urine drug testing (UDT) and definitive UDT testing by various methodologies.
By way of definition and as used in this LCD, the following terminology relates to the basic forms of controlled substance and drug of abuse testing:
- Presumptive/Qualitative Drug Testing (hereafter called "presumptive" UDT) - Used when medically necessary to determine the presence or absence of drugs or drug classes in a urine sample; Results expressed as negative or positive or as a numerical result; Includes competitive immunoassays (IA) and thin layer chromatography.
- Definitive/Quantitative/Confirmation (hereafter called “definitive” UDT) - Used when medically necessary to identify specific medications, illicit substances and metabolites; Reports the results of drugs absent or present in concentrations of ng/ml; Limited to GC-MS and LC-MS/MS testing methods.
- Specimen Validity Testing - Urine specimen testing to ensure that it is consistent with normal human urine and has not been adulterated or substituted; May include pH, specific gravity, oxidants and creatinine.
- Point of Care Testing (POCT) - Used when medically necessary by clinicians for immediate test results for the immediate management of the patient; Available when the patient and physician are in the same location; IA test method that primarily identifies drug classes and a few specific drugs; Platform consists of cups, dipsticks, cassettes, or strips; Read by the human eye.
- Immunoassay (IA) - Ordered by clinicians primarily to identify the presence or absence of drug classes and some specific drugs; Biochemical tests that measure the presence above a cutoff level of a substance (drug) with the use of an antibody; Read by photometric technology.
- Standing Orders - Test request for a specific patient representing repetitive testing to monitor a condition or disease for a limited number of sequential visits; Individualized orders for certain patients for pre-determined tests based on historical use, risk and community trend patient profiles; Clinician can alter the standing order. Note: A “profile” differs from a “panel” in that a profile responds to the clinical risks of a particular patient, whereas a panel encourages unnecessary or excessive testing when no clinical cause exists.
- Blanket Orders - Test request that is not for a specific patient; rather, it is an identical order for all patient’s in a clinician’s practice without individualized decision making at every visit.
- Reflex Testing - Laboratory testing that is performed reflexively after initial test results to identify further diagnostic information essential to patient care. Testing performed as a step necessary to complete a physician’s order is not considered reflex testing.
Drug Test Methods
The Clinical Laboratory Improvement Amendments (CLIA) regulates laboratory testing and requires clinical labs to be certified by their State as well as the CMS before they can accept human samples for diagnostic testing. Multiple types of CLIA certificates may be obtained based on the complexity of testing a lab conducts. CLIA levels of complexity (CLIA-waived, moderate complexity and high complexity) are addressed only as they relate to the HCPCS code description and the coding/billing guidance.
A. Presumptive Testing Methods:
1. CLIA-waived Presumptive UDT:
CLIA-waived presumptive UDT consists of various platforms including cards, dipsticks, cassettes and cups based on qualitative competitive immunoassay methodology with one or more analytes in the test. A CLIA- waived presumptive IA test detects the presence of the amount of drug/substance present in urine above a predetermined “cut-off” value.
A positive test result is reported when the concentration of drug is above the cut-off value; a negative test result is reported when the concentration of drug is below the cut-off value. Positive test results are presumptive or not definitive due to sensitivity and cross-reactivity limitations. Negative test results do not necessarily indicate the absence of a drug or substance in the urine specimen. The accuracy of the results of a CLIA-waived presumptive UDT will depend on the testing environment, type of test, and training of the individual conducting the test.
This type of test should only be used when results are needed immediately.
2. Presumptive UDT by FDA Approved/Cleared IA Analysis:
Chemistry analyzers with IA UDT technology are used in an office or clinical laboratory setting. When FDA approved/cleared platforms and reagents are used, testing is classified as moderately complex. This test may be used when less immediate test results are required. At no time is IA technology by chemistry analyzer considered confirmatory testing.
A presumptive positive IA test detects the amount of drug/substance present in urine above a predetermined cut-off value. If the concentration of the drug is below the cut-off value, the result will be negative. Presumptive positive tests are not definitive due to sensitivity, specificity, and cross-reactivity limitations. Negative test results do not necessarily indicate the absences of a drug or substance in the urine specimen.
3. Presumptive UDT by Laboratory Developed Test (LDT) IA Analysis:
Subject to appropriate internal quality control and test validation, an immunoassay performed on a bench top chemistry analyzer becomes a high complexity test in the following two situations:
a. Test Assay Not Classified: Per CFR 493.17(c)(4), if a laboratory test system, assay and examination does not appear on the list of tests in the Federal Register notices, it is considered a test of high complexity until Public Health Service (PHS) reviews the matter and notifies the applicant of its decision. Examples of current tests that fall into this category are listed below:
- Extended opioids such as fentanyl, meperidine, tramadol and tapentadol,
- Muscle relaxants such as carisoprodol and meprobamate
- Stimulants such as methylpenidate,
- Sleep aids such as zolpidem
b. Lowering Cutoff for Detection: Modified FDA approved/cleared test platforms and/or reagents are considered laboratory developed tests (LDTs). Drug testing platforms and/or reagents that are not FDA approved/cleared are also considered LDTs. LDTs have presumably been modified to test at a lower cutoff in order to detect substances that would have been missed at a higher threshold. For example, a FDA labeled cutoff may be 300 ng/mL and the LDT cutoff for the same drug may be a 100 ng/mL.
Presumptive UDT can be carried out at any validated cut-off concentration. Lowering of the cut-off concentration provides more stringent cut-off values for illicit drugs. LDTs may include non-FDA cleared tests not available in CLIA-waived or moderate complexity tests (e.g. tramadol, tapentadol, carisoprodol, fentanyl, zolpidem, etc.) Lowering the cut-off values increases the possibility of detecting a drug when the test has been modified from the recipe of the manufacturer.
4. Limitations of Presumptive UDT
Presumptive UDT testing is limited due to
- Primarily screens for drug classes rather than specific drugs, and therefore, the practitioner may not be able to determine if a different drug within the same class is causing the positive;
- Produces erroneous results due to cross-reactivity with other compounds or does not detect all drugs within a drug class;
- Not all prescription medications or synthetic/analog drugs are detectable; it is unclear as to whether other drugs are present
- Cut-off value may be too high to detect presence of drug
This information could cause a practitioner to make a wrong assumption.
An IA involves an antibody that reacts best with the stimulating drug, and reacts to a lesser extent (cross- reactive) or not at all with other drugs in the drug class. While presumptive tests vary in their ability to detect illicit drugs such as tetrahydrocannabinol (THC), cocaine, 3, 4-methylenedioxy-N-methylamphetamine (MDMA; “ecstasy”), and phencyclidine (PCP), they may not be optimal tests for many prescription drugs, namely opiates, barbiturates, benzodiazepines and opioids.
For example, opiate reagents are formulated for morphine. Consequently, the cross-reactivity for other opioids and opiates varies based on the manufacturer and lot number. The semisynthetic opioids, hydromorphone and hydrocodone, may contribute to a positive presumptive result, while the semisynthetic opioids, oxycodone and oxymorphone, will not typically be detected even at 300 ng/mL cut-off value. Synthetic opioids, such as fentanyl, meperidine and methadone, will not be detected by current opiate IA testing. Consequently, a positive opiate result by IA necessitates more specific identification of the substance(s) that account for the positive result, and a negative result does not rule out the presence of opiates or opioids.
Presumptive UDT reagents for benzodiazepine are formulated for oxazepam, a metabolite of diazepam (Valium®) and chlordiazepoxide (Librium®), the main benzodiazepines prescribed twenty years ago. However, many of the more than 10 benzodiazepines that are currently available do not cross-react with IA benzodiazepine reagents. In particular, clonazepam and lorazepam give false negative results with presumptive IA tests and may necessitate more specific identification to account for the negative result. Similarly, a positive screening test result may require definitive UDT to identify the specific drug(s).
Synthetic/analog or “designer” drugs manufactured to elude law enforcement require definitive testing for detection. Most commercially available IA reagents fail to detect designer drugs, such as psychedelic phenethylamines even at very high concentrations.
In summary, presumptive IA UDT is unable to identify specific drugs within many drug classes, particularly within the amphetamine, barbiturate, benzodiazepine, tricyclic antidepressants, and opitate/opioid drug classes. Drugs such as fentanyl, carisoprodol, tramadol, tapentadol and synthetic designer drugs cannot be detected by presumptive IA. Therefore, it may be medically necessary for clinicians to utilize definitive UDT with lower cut-off levels when the presumptive tests for these drugs are negative.
B. Definitive UDT:
Gas Chromatography coupled with Mass Spectrometry (GC-MS) and High Performance Liquid Chromatography coupled with Tandem Mass Spectrometry (LC-MS/MS) are complex technologies that use the separation capabilities of gaseous or liquid chromatography with the analytical capabilities of mass spectrometry. Both methodologies require the competency of on-site highly trained experts in this technology and interpretation of results. While these tests require different sample preparation and analytical runs, they identify all specific drugs, metabolites, and most illicit substances and report the results as absent or present in concentrations of ng/mL.
Quantification should not be used to determine adherence with a specific dosage or time of dose of a pain medication or illicit drug for clinical purposes. Rather, the use of quantitative drug data may be important for many reasons such as in a differential patient assessment. For example, when several opioids are present in the urine of a patient prescribed a single opioid, quantification may help the clinician decide whether the presence of the other opioids is consistent with metabolism of the prescribed opioid, opioid contamination during manufacturing, or if more than one drug within a class is being used.
Quantification may also provide information in the setting of illicit drug use. Serial creatinine-corrected quantitative values may assist in the differential assessment of ongoing drug use or cessation of drug use with continued drug excretion.
GC-MS can only be performed on molecules that are volatile. If the test drug is not volatile in its own right, it must be modified or derivatized to a volatile form. To derivatize, the test drug must be extracted from the urine, eluted from the extraction device, concentrated, and then reacted with a chemical reagent to make a volatile product. Each drug class may require a different derivatizing agent. For patients on multiple classes of medications, laboratories using GC procedures must make different volatile derivatives in order to perform comprehensive testing. Since a GC column may not be able to separate more than one class of compounds, multiple chromatographic runs on different column types may be required to monitor multiple drug classes. Newer GC-MS instruments use tandem systems. GC-MS methodology allows for the testing of multiple substances but differs in ease of run.
LC-MS/MS is roughly 100 times more sensitive and selective, involves less human steps, provides quicker turn- around time, uses less specimen volume and can test for a larger number of substances simultaneously when compared to GC-MS. After sample preparation, it is injected into the LC-MS/MS. The sample has to undergo hydrolysis to break the glucuronide bond that frees the drug and drug metabolites. Hydrolysis is followed by multiple additional steps including protein precipitation, centrifugation and purification. Deuterium-labeled isotopic internal standards are added prior to sample preparation to quantify the drugs and drug metabolites.
The sample is injected when the mobile phase is flowing through the chromatographic column. Each drug and drug metabolite interacts with the mobile phase and stationary phase differently and moves at different speeds depending on their chemical properties. In other words, each analyte elutes at different times. Specific drugs are identified by their retention time and mass spectrum of each peak, and quantified against isotropic internal standards for each drug and metabolite. Each drug peak has a minimum of two mass transitions, which the technician has to compare to drug standards (calibrators) in order to ensure identification.
CLIA specifies quality standards for proficiency testing, facility administration, general laboratory systems, pre- analytic, analytic and post-analytic systems, onsite supervision requirements, personnel qualifications and responsibilities, quality control, and quality assessment.
High complexity laboratories must ensure that testing is carried out by onsite qualified, trained personnel using validated reliable methods compliant with regulatory procedures (42 CFR Part 493). Both GC-MS and LC-MS/MS require a quality program to monitor the quality and audit the competency of the staff. LC-MS/MS instrument maintenance must be performed daily as well as instrument performance prior to patient specimens. Final review and approval of GC-MS and LC-MS/MS results must be performed by qualified clinical laboratory scientist as defined in 42 CFR Part 493.1489 (Testing Personnel Qualifications). A GC-MS or LC-MS/MS laboratory must have a qualified laboratory director as provided in 42 CFR 493.1443 (Laboratory Director Qualifications).
Assay validation must be consistent with FDA guidelines. Laboratories that use “application notes” from vendors to establish drug validation do not comply with federal standards, and put providers at risk for reporting inaccurate test results. Only FDA 510(k) cleared test methods can be distributed by vendors.
Purpose of UDT:
Presumptive UDT may be ordered when it is necessary to rapidly obtain and integrate results into clinical assessment and treatment decisions.
Definitive UDT is reasonable and necessary for the following circumstances:
- Identify a specific substance or metabolite that is inadequately detected by a presumptive UDT screen;
- Definitively identify specific drugs in a large family of drugs;
- Identify a specific substance or metabolite that is not detected by presumptive UDT such as fentanyl, Meperidine, synthetic cannabinoids and other synthetic/analog drugs;
- Identify drugs when a definitive concentration of a drug is needed to guide management (e.g., discontinuation of THC use according to a treatment plan);
- Identify a negative, or confirm a positive, presumptive UDT result that is inconsistent with a patient’s self- report, presentation, medical history, or current prescribed pain medication plan;
- Rule out an error as the cause of an unexpected presumptive UDT result;
- Identify non-prescribed medication or illicit use for ongoing safe prescribing of controlled substances; and
- Use in a differential assessment of medication efficacy, side effects, or drug-drug interactions.
Definitive UDT may be reasonable and necessary based on patient specific indications, including historical use, medication response, and clinical assessment, when accurate results are necessary to make clinical decisions. The clinician’s rationale for the definitive UDT and the tests ordered must be documented in the patient’s medical record.
Drug Test Panels
1. Presumptive UDT Panels
Presumptive UDT testing may be ordered as a panel because the Medicare billing codes are defined on a “per patient encounter” basis regardless of the number of analytes tested. Presumptive UDT orders should be individualized based on clinical history and risk assessment, and must be documented in the medical record.
2. Definitive UDT Panels
At the current time, physician-directed definitive profile testing is reasonable and necessary when ordered for a particular patient based upon historical use and community trends. However, the same physician-defined profile is not reasonable and necessary for every patient in a physician’s practice. Definitive UDT orders should be individualized based on clinical history and risk assessment, and must be documented in the medical record.
Urine or oral fluid is the preferred biologic specimen for testing because of the ease of collection, storage, and cost- effectiveness. UDT cannot detect the dosage of drug ingested/used, the time of use, or the means of delivery (intravenous vs. oral vs. inhaled). Detection time of a substance in urine is typically 1-3 days depending on the drug, rate of metabolism, and rate of excretion. Lipid-soluble drugs, such as marijuana, may remain in body fat and be detected upwards of a week or more.
Covered Indications for UDT
Group A – Symptomatic patients, multiple drug ingestion and/or patients with unreliable history
A patient who presents in a variety of medical settings with signs or symptoms of substance use toxicity will be treated presumptively to stabilize the patient while awaiting rapid test results, then definitive testing to determine the cause(s) of the presentation. The need for definitive UDT is based upon rapid test findings, responses to medical interventions, and treatment plan.
A presumptive UDT screen should be performed as part of the evaluation and management of a patient who presents in an urgent care setting with any of the following:
- Altered mental status in the absence of a clinically defined toxic syndrome or toxidrome
- Severe or unexplained cardiovascular instability (cardiotoxicity)
- Unexplained metabolic or respiratory acidosis in the absence of a clinically defined toxic syndrome or toxidrome
- Seizures with an undetermined history
- To provide antagonist to specific drug
The presumptive findings, definitive drug tests ordered and reasons for the testing must be documented in the patient’s medical record.
Group B – Treatment for substance abused or dependence:
A patient in active treatment for substance use disorder (SUD) or monitoring across different phases of recovery may undergo medical management for a variety of medical conditions. A physician who is writing prescriptions for medications to treat either the SUD or other conditions may need to know if the patient is taking substances which can interact with prescribed medications or taking prescribed medications as expected. The risk of drug-drug interactions is inherent to the patient, and may be compounded by prescribed medications.
UDT is medically necessary and useful component of chemical dependency treatment. The drug screen result influences treatment and level of care decisions. Ordered tests and testing methods (presumptive and/or definitive) must match the stage of treatment or recovery, the documented history and Diagnostic and Statistical Manual of Mental Disorders (DSM V) diagnosis.
For patients with no known indicators of risk for SUDs, the clinician may screen for a broad range of commonly abused drugs using presumptive UDT. For patients with known indicators of risk for SUDs, the clinician may screen for a broad range of commonly abused drugs using definitive UDT.
For patients with a diagnosed SUD, the clinician should perform random UDT, at random intervals in order to properly monitor the patient. Testing profiles must be determined by the clinician based on the following medical necessity guidance criteria:
- Patient history, physical examination, and previous laboratory findings;
- Stage of treatment or recovery;
- Suspected abused substance;
- Substances that may present high risk for additive or synergistic interactions with prescribed medication (e.g., benzodiazepines, alcohol)
The patient’s medical record must include an appropriate testing frequency based on the stage of treatment or recovery, the rationale for the drug/drug classes ordered and the results are documented in the medical record and used to direct care.
1. Frequency of Presumptive UDT for SUD:
The testing frequency must meet the medical necessity and be documented in the clinician’s medical record. For patients with 0 to 90 consecutive days of abstinence, presumptive UDT is expected at a frequency of 1 to 3 presumptive UDT per week. More than 3 presumptive UDT in one week is not reasonable and necessary and is not covered by Medicare
a. For patients with > 90 consecutive days of abstinence, presumptive UDT is expected at a frequency of 1 to 3 UDT in one month. More than 3 physician-directed UDT in one month is not reasonable and necessary and is not covered by Medicare.
2. Frequency of Definitive UDT for SUD:
Depending on the patient’s specific substance use history, definitive UDT to accurately determine the specific drugs in the patients system may be necessary. Definitive testing may be ordered when accurate and reliable results are necessary to integrate treatment decisions and clinical assessment. The frequency and the rationale for definitive UDT must be documented in the patient’s medical record.
a. For patients with 0 to 30 consecutive days of abstinence, definitive UDT is expected at a frequency not to exceed 1 physician-directed testing profile in one week. More than 1 physician-directed testing profile in one week is not reasonable and necessary and is not covered by Medicare
b. For patients with 31 to 90 consecutive days of abstinence, definitive UDT is expected at a frequency 1 – physician-directed testing profiles in one month. More than 3 UDT in one month is not reasonable and necessary and is not covered by Medicare
c. For patients with >90 consecutive days of abstinence, definitive UDT is expected at a frequency 1 – 3 physician-directed testing profiles in one month. More than 3 UDT in three months is not reasonable and necessary and is not covered by Medicare
Group C – Chronic pain management drug testing for patients on chronic opioid therapy (COT).
A physician who is writing prescriptions for medication to treat chronic pain may need to know if the patient is taking substances which can interact with prescribed medications or taking prescribed medications as expected. Additionally, the physician must monitor for adherence/compliance, efficacy, patient safety, side effects, and drug-drug interaction.
A broad cross section of the general population will develop either cancer pain syndrome or non-cancer pain which will require prolonged or chronic opioid therapy for management. The risk of addiction in this population is considered equivalent to the risk of the general population. In contrast to the population of individuals who have a history of SUD in the cancer and the non-cancer pain population the risk of SUD is inherent to the substance(s) to which the patient is exposed.
1. COT UDT Patient Management Testing Objectives
- Identifies absence of prescribed medication and potential for abuse, misuse, and diversion
- Identifies undisclosed substances, such as alcohol, unsanctioned prescription medication, or illicit substances
- Identifies substances that contribute to adverse events or drug-drug interactions
- Provides objectivity to the treatment plan
- Reinforces therapeutic compliance with the patient
- Provides additional documentation demonstrating compliance with patient evaluation and monitoring
- Provide diagnostic information to help assess individual patient response to medications (e.g. metabolism, side effects, drug-drug interaction, etc.) over time for ongoing management of prescribed medications.
2. Medical Necessity Guidance
Criteria to establish medical necessity for drug testing must be based on patient-specific elements identified during the clinical assessment, and documented by the clinician in the patient’s medical record and minimally include the following elements:
- Patient history, physical examination and previous laboratory findings
- Current treatment plan
- Prescribed medication(s)
- Risk assessment plan
National pain organizations, physician societies, and the Federation of State Medical Boards recommend a practical approach to definitive UDT for COT. Frequency of testing beyond the baseline presumptive UDT screen must be based on individual patient needs substantiated by documentation in the patient’s medical record. Recommendations for the ordering of presumptive and definitive UDT for patients on COT are as follows:
a. COT Baseline Testing
Initial presumptive and/or definitive COT patient testing may include amphetamine/methamphetamine, barbiturates, benzodiazepines, cocaine, methadone, oxycodone, tricyclic antidepressants, tetrahydrocannabinoid, opioids, opiates, heroin and synthetic/analog or “designer” drugs.
b. COT Monitoring Testing
Ongoing testing may be medically reasonable and necessary based on the patient history, clinical assessment, including medication side effects or inefficacy, suspicious behaviors, self-escalation of dose, doctor-shopping, indications/symptoms of illegal drug use, evidence of diversion, or other clinician documented change in affect or behavioral pattern. The frequency of testing must be based on a complete clinical assessment of the individual’s risk potential for abuse and diversion using a validated risk assessment interview or questionnaire and should include the patient’s response to prescribed medications and the side effects of medications.
The clinician should perform random UDT at random intervals, in order to properly monitor a patient. UDT testing does not have to be associated with an office visit.
Patients with specific symptoms of medication aberrant behavior or misuse may be tested in accordance with this document’s guidance for monitoring patient adherence and compliance during active treatment (<90 days) for substance use or dependence.
3. UDT Frequency Based on Validated Risk Assessment and Stratification*:
Testing must be based on clinician’s documented medical necessity and reviewed by the clinician in the management of prescribing/renewing a controlled substance for every risk group outlined below:
Prior to initiation of COT
Random testing 1-2 times every 12 months for prescribed medications, non-prescribed medications that may pose a safety risk if taken with prescribed medications, and illicit substances based on patient history, clinical presentation, and/or community usage.
Prior to initiation of COT
Random testing 1-2 times every 6 months for prescription medications, non-prescribed medication that may pose a safety risk if taken with prescribed medications, and illicit substances, based on patient history, clinical presentation, and/or community usage.
Prior to initiation of COT
Random testing performed 1-3 times every 3 months for prescribed medications, non-prescribed medications that may pose a safety risk if mixed with prescribed and illicit substances based on patient history, clinical presentation and/or community usage.
*Note: Any additional definitive UDT beyond recommendations above must be justified by the clinician in the medical record in situations in which changes in prescribed medications may be needed, such as
- Patient response to prescribed medication suddenly changes
- Patient side effects profile changes
- To assess for possible drug-drug interactions
- Sudden change in patient’s medical condition
- Patient admits to use of illicit or non-prescribed controlled substance
Other Covered Services
1. Reflex Testing by Reference Laboratories – since reference laboratories do not have access to patient-specific data, reflex testing under the following circumstances is reasonable and necessary:
- To verify a presumptive positive UDT using definitive UDT (GC-MS or LC-MS/MS) before reporting the presumptive finding to the ordering clinician and without an additional order from the clinician; or
- To confirm the absence of prescribed medications when a negative result is obtained by presumptive UDT in the laboratory for a prescribed medication listed by the ordering clinician.
2. Direct to definitive UDT without a presumptive UDT is reasonable and necessary, when individualized for a particular patient, in the following circumstances:
- To identify a specific substance or its metabolite that is in a large class of drugs, or that is inadequately detected or not detected by presumptive UDT, such as fentanyl, meperidine, synthetic cannabinoids, and other synthetic/analog drugs;
- For use in a differential assessment of medication efficacy, side effects, or drug-drug interactions;
- To identify non-prescribed medication or illicit substance use for ongoing safe prescribing of controlled substances, where clinician has documented concerns related to safety risks attendant to failure to identify specific substances suspected based upon clinical review and judgment; or
- To identify drugs when a definitive concentration of a drug is needed to guide management (e.g., discontinuation of THC use according to a treatment plan).
3. Definitive testing to confirm a negative presumptive UDT result, upon the order of the clinician, is reasonable and necessary in the following circumstances:
- The result is inconsistent with a patient’s self-report, presentation, medical history, or current prescribed medication plan (should be present in the sample);
- Following a review of clinical findings, the clinician suspects use of a substance that is inadequately detected or not detected by a presumptive UDT; or
- To rule out an error as the cause of a negative presumptive UDT result.
4. Definitive testing to confirm a presumptive UDT positive result, upon the order of the clinician, is reasonable and necessary when the result is inconsistent with the expected result, a patient’s self-report, presentation, medical history, or current prescribed medication plan.
- Blanket Orders
- Reflex definitive UDT is not reasonable and necessary when presumptive testing is performed at point of care because the physician may have sufficient information to manage the patient. If the clinician is not satisfied, he/she must determine the clinical appropriateness of and order specific subsequent definitive testing (e.g., the patient admits to using a particular drug, or the IA cut-off is set at such a point that is sufficiently low that the physician is satisfied with the presumptive test result).
- Routine standing orders for all patients in a physician’s practice are not reasonable and necessary.
- It is not reasonable and necessary for a reference laboratory to perform and bill IA presumptive UDT prior to definitive testing without a specific physician’s order for the presumptive testing.
- It is not reasonable and necessary for a physician to perform presumptive POCT and order presumptive IA testing from a reference laboratory. Medicare will only pay for one presumptive test result per patient per date of service regardless of the number of billing providers.
- It is not reasonable and necessary for a physician to perform presumptive IA testing and order presumptive IA testing from a reference laboratory. Medicare will only pay for one presumptive test result per patient per date of service regardless of the number of billing providers.
- It is not reasonable and necessary for a reference laboratory to perform and bill IA presumptive UDT prior to a definitive testing without a specific physician’s order for the presumptive testing.
- IA testing, regardless of whether it is qualitative or semi-quantitative (numerical) may not be used to “confirm” or definitively identify a presumptive test result obtained by cups, dipsticks, cards, cassettes or other CLIA- waived methods. Semi-quantitative IA testing provides a presumptive test (numerical) result. Definitive UDT provides specific identification and/or quantification by GC-MS or LC-MS/MS.
- Drug testing of two different specimen types from the same patient on the same date of service for the same drugs/metabolites/analytes.
- UDT for medico-legal and/or employment purposes or to protect a physician from drug diversion charges.
- Specimen validity testing including, but not limited to, pH, specific gravity, oxidants, creatinine.
As published in the CMS IOM Publication 100-08, Medicare Program Integrity Manual, Chapter 13, Section 13.5.4, an item or service may be covered by a contractor LCD if it is reasonable and necessary under the Social Security Act Section 1862 (a)(1)(A). Contractors shall determine and describe the circumstances under which the item or service is considered reasonable and necessary. | <urn:uuid:61605626-5a50-42ca-8f96-2990942c00e8> | {
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What Is Medical Coding?
Medical coders are fundamental to medical record keeping and essential to
the medical practice's existence. A healthcare provider who delivered a medical service to a patient or client
is entitled to receive money for these services. Accurate medical coding is just as critical to get paid as
timely filing a claim with the patient's health insurance, or managed care organization.
Medical coding involves identifying a medical service that was provided from the patient's
medical record, or the superbill, and assigning a numerical code that corresponds with this service. Coders need to
know how to code for specific insurance companies within their established policies and applicable laws and
regulations. It is a systematic process that can get complicated.
What Medical Coders Do
Many see medical billing and medical coding as two distinct disciplines, however, both embrace so many facets
that overlap, or go hand-in-hand, that one couldn't exist without the other. The art of medical
coding cannot be learned through using software, it is learned by listening to the instructor, taking
notes, opening the CPT/ICD-10 books and using your mind to code through practice, practice, and practice. You don't
succeed by using software as your main tool. You learn and succeed through hard work.
Although the medical coding process somewhat resembles looking up a name and phone number
in a telephone book it is not as simple as it may sound. And although medical coders work hand-in-hand with medical
billers, the experts in the field feel strongly that medical billers should not code unless trained to do so and
with proper professional liability insurance in place.
KNOWLEDGE OF INSURANCE CLAIM AND REGULATORY CONSIDERATIONS. New patient
interview and check-in procedures; established patient return visits; post-clinical check-out;
computerized practice procedure methods.
ICD-10-CM CODING. Using the ICD-10-CM coding system; primary vs. principal
diagnosis; ICD-10-CM terms, marks, abbreviations and symbols; index tables.
CPT CODING. Basic format of CPT service and procedure codes on the
CMS-1500 claim; comparing CPT with ICD-10-CM coding; modifiers; new vs. established patient; assigning
emergency department and critical care codes; consultation vs. confirmatory visit; preventive medicine
HCPCS CODING AND CMS REIMBURSEMENT. The HCPCS system for reporting
professional services, procedures, supplies and equipment; HCPCS level II coding system; CMS
reimbursement; rules of the Medicare physician fee schedule payment system.
CODING FOR MEDICAL NECESSITY. Assessment and coding from patient medical
records; securing the correct physician documentation; coding an operative report; selecting and coding
diagnoses and procedures from case studies and sample records.
Special codes exist for all types of encounters, services, tests, treatments, and procedures provided by a
healthcare provider in a medical office, hospital, or clinic. These codes are described as CPT4 codes that consist
of 5 digit numbers. Even the simplest patient complaints such as headache, or nausea have codes which consist of a
set of numbers and combinations of sets of numbers. Software is NO guarantee of 100% accuracy.
When a provider sees and treats a person seeking medical advice in the medical office or practice it is referred
to as an encounter. An encounter is defined as "a face-to-face contact between a healthcare professional and an
Medical Coding Purpose
The American Medical Association (AMS) developed the CPT coding system. CPT stands for Current
Procedural Terminology to tell the health insurance companies or government entities the reason why a patient was
seen and what services were performed so that the provider can get paid. Codes also are implemented to gather and
communicate public health statistics. Medical codes are used for a variety of purposes.
- Coding diseases and procedures
- Physician billing and reimbursement
- Recording causes of death
Surveys show that MANY medical coding positions remain unfilled due to a lack of qualified
candidates! The US Bureau of Labor Statistics states coding (as well as billing) is one of the ten fastest growing
allied health occupations. Physicians depend on well trained, reliable medical coding and billing staff because
otherwise they might not get paid for their services, or might wind up being charged large penalties due to
improper coding, which could mean financial disaster, and cost them their livelihoods. Once hired, medical coders
and billers hold secure jobs, with good futures. Supervisors spend weeks or months training medical billers and
coders one-on-one. Once they are trained and have gained experience by participating in the daily office routine,
chances are good that their positions will be long term.
Post Your Medical Billing Job
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search tools are included on our site. Your job ad appears throughout the Indeed
network and on our medical billing job website for
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Information for Patients
Also called: Arteriosclerosis
Atherosclerosis is a disease in which plaque builds up inside your arteries. Plaque is a sticky substance made up of fat, cholesterol, calcium, and other substances found in the blood. Over time, plaque hardens and narrows your arteries. That limits the flow of oxygen-rich blood to your body.
Atherosclerosis can lead to serious problems, including
- Coronary artery disease. These arteries supply blood to your heart. When they are blocked, you can suffer angina or a heart attack.
- Carotid artery disease. These arteries supply blood to your brain. When they are blocked you can suffer a stroke.
- Peripheral arterial disease. These arteries are in your arms, legs and pelvis. When they are blocked, you can suffer from numbness, pain and sometimes infections.
Atherosclerosis usually doesn't cause symptoms until it severely narrows or totally blocks an artery. Many people don't know they have it until they have a medical emergency.
A physical exam, imaging, and other diagnostic tests can tell if you have it. Medicines can slow the progress of plaque buildup. Your doctor may also recommend procedures such as angioplasty to open the arteries, or surgery on the coronary or carotid arteries. Lifestyle changes can also help. These include following a healthy diet, getting regular exercise, maintaining a healthy weight, quitting smoking, and managing stress.
NIH: National Heart, Lung, and Blood Institute
- Angioplasty and stent placement - peripheral arteries
- Atherosclerosis - NIH (National Heart, Lung, and Blood Institute)
- Doppler ultrasound exam of an arm or leg
- Extremity angiography
- Hardening of the arteries
- How Is Atherosclerosis Treated? - NIH (National Heart, Lung, and Blood Institute)
- Magnetic resonance angiography
General Equivalence Map Definitions
The ICD-9 and ICD-10 GEMs are used to facilitate linking between the diagnosis codes in ICD-9-CM and the new ICD-10-CM code set. The GEMs are the raw material from which providers, health information vendors and payers can derive specific applied mappings to meet their needs.
- Approximate Flag - The approximate flag is on, indicating that the relationship between the code in the source system and the code in the target system is an approximate equivalent.
- No Map Flag - The no map flag indicates that a code in the source system is not linked to any code in the target system.
- Combination Flag - The combination flag indicates that more than one code in the target system is required to satisfy the full equivalent meaning of a code in the source system.
Index of Diseases and Injuries Definitions
- And - The word "and" should be interpreted to mean either "and" or "or" when it appears in a title.
- Code also note - A "code also" note instructs that two codes may be required to fully describe a condition, but this note does not provide sequencing direction.
- Code first - Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. For such conditions, the ICD-10-CM has a coding convention that requires the underlying condition be sequenced first followed by the manifestation. Wherever such a combination exists, there is a "use additional code" note at the etiology code, and a "code first" note at the manifestation code. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation.
- Type 1 Excludes Notes - A type 1 Excludes note is a pure excludes note. It means "NOT CODED HERE!" An Excludes1 note indicates that the code excluded should never be used at the same time as the code above the Excludes1 note. An Excludes1 is used when two conditions cannot occur together, such as a congenital form versus an acquired form of the same condition.
- Type 2 Excludes Notes - A type 2 Excludes note represents "Not included here". An excludes2 note indicates that the condition excluded is not part of the condition represented by the code, but a patient may have both conditions at the same time. When an Excludes2 note appears under a code, it is acceptable to use both the code and the excluded code together, when appropriate.
- Includes Notes - This note appears immediately under a three character code title to further define, or give examples of, the content of the category.
- Inclusion terms - List of terms is included under some codes. These terms are the conditions for which that code is to be used. The terms may be synonyms of the code title, or, in the case of "other specified" codes, the terms are a list of the various conditions assigned to that code. The inclusion terms are not necessarily exhaustive. Additional terms found only in the Alphabetic Index may also be assigned to a code.
- NEC "Not elsewhere classifiable" - This abbreviation in the Alphabetic Index represents "other specified". When a specific code is not available for a condition, the Alphabetic Index directs the coder to the "other specified” code in the Tabular List.
- NOS "Not otherwise specified" - This abbreviation is the equivalent of unspecified.
- See - The "see" instruction following a main term in the Alphabetic Index indicates that another term should be referenced. It is necessary to go to the main term referenced with the "see" note to locate the correct code.
- See Also - A "see also" instruction following a main term in the Alphabetic Index instructs that there is another main term that may also be referenced that may provide additional Alphabetic Index entries that may be useful. It is not necessary to follow the "see also" note when the original main term provides the necessary code.
- 7th Characters - Certain ICD-10-CM categories have applicable 7th characters. The applicable 7th character is required for all codes within the category, or as the notes in the Tabular List instruct. The 7th character must always be the 7th character in the data field. If a code that requires a 7th character is not 6 characters, a placeholder X must be used to fill in the empty characters.
- With - The word "with" should be interpreted to mean "associated with" or "due to" when it appears in a code title, the Alphabetic Index, or an instructional note in the Tabular List. The word "with" in the Alphabetic Index is sequenced immediately following the main term, not in alphabetical order. | <urn:uuid:c3e800d8-dfbf-4f7d-ac89-391bf878d8e9> | {
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Abdominal pain (stomach ache) ranges from a mild to severe pain. There are many organs in the stomach cavity and any disorder in these organs may cause a.
Internal hernias or adhesions (scar tissue) from surgery may cause bloating or pain. Fatty foods can delay stomach emptying and cause bloating and discomfort, but not necessarily too much gas. Abdominal pain and discomfort. Gas in the intestine causes pain for some people. When it collects on the left side of the colon,
Jul 26, 2016. Trapped gas or trapped wind refers to a pocket of gas in the part of the colon that runs horizontally below the lowest ribs. Constant pain (except at night) in the upper left or right abdomen or lower chest, on the side of the body or in the middle back lasting for several hours; it can be aggravated by sitting.
The spleen is a brown, flat, oval-shaped lymphatic organ that filters and stores blood to protect the body from infections and blood loss. Protected by our.
Get information on causes of mild to severe lower back pain (arthritis, pregnancy, herniated disc, sciatica, ovarian cysts). Read about low back pain.
Find out why you're having gas problems during pregnancy, how you can relieve gas pain and how you can prevent gas and bloating from bubbling up down the line. Feeling bloated and gassy? Blame the pregnancy! We've got the deets on how to handle that discomfort—and prevent it from coming back. Are your burps.
Free, official coding info for 2018 ICD-10-CM R14.1 – includes detailed coding rules & notes, synonyms, ICD-9-CM conversion, index & annotation crosswalks, DRG grouping and more.
While being gassy is generally nothing to worry about, recognizing the cause of your gas problems is important for ensuring you're not overwhelmed by your. Overwhelming gas can cause both stomach pains and chest pains, and – depending on where you are – you may experience additional anxiety by trying not to pass.
WebMD Symptom Checker helps you find the most common medical conditions indicated by the symptoms Foul smelling stools, Increased passing gas, Pain or.
Lower back and upper leg pain ask if there are some indications that peripheral conditions can cause lumbago too.
Get information about back pain, lower back pain, neck pain, and sciatica, and learn about back pain causes, treatments, and medications.
Common causes for back pain includes strains, ruptured discs or bulging discs, sciatica, skeletal irregularities, arthritis, osteoporosis etc. Read more for treatment and remedies.
Keep a diary of your daily diet. Keeping a food diary can be a great way to figure out which foods are responsible for your gas pains or gas in general. You can then go back and see when you experience a great deal of gas and look to see what you eat as this may have caused it. Then you will know what food to avoid.
If back pain is reducing your quality of life or you’ve tried conventional treatments to no avail, you may want to try some of these natural remedies.
Listening to your newborn suffer through gas pain can be difficult. Learn how to recognize the signs of gas pain, and the best remedies to help your baby get some relief. Also be sure to check out our section. Babies are naturally gassy, but you can take preventive measures to keep your little one comfortable. Find out how.
Experiencing pain in both your abdomen and back can be overwhelming and frightening. Pain in the left lower abdomen and back can signal a problem with any.
Mar 19, 2009. Does any one else have trouble like this?[/quote:b4a77979d7]. I suffer terrible pain around my back on a daily basis. I know the pain originates in my gut cause whenever I pass wind the pain eases off for a bit. It seems to come from deep inside, but always around the back for some reason. It's so bad I feel.
For centuries caraway has been used to give trapped gas in the digestive track a little shove out the back door. In England from. Lemon is good for you in a number of ways, including lending a hand when it comes to easing your gas pain. Many of the foods we eat today, particularly in western culture, just spell trouble.
Dr. Stephen Montgomery, MD, an orthopedic spine surgeon in Raleigh, NC and a contributing author to Spine-health.com, discusses treatments for neck pain.
How to Get Rid Of Gas Pains Quickly. You may be relieved to know that gas pains are a very common problem among people. There are many individuals who suffer from gas pain on a daily basis. These pains are usually accompanied by undesirable sounds which can also make you feel uncomfortable. I know you are.
Looking for online definition of pain in the Medical Dictionary? pain explanation free. What is pain? Meaning of pain medical term. What does pain mean?
Heartburn and GERD remedies, diets and other information collected by a long time heartburn sufferer.
Find out why you may burp and fart more than usual when you’re pregnant and how to relieve gas and bloating.
Mar 31, 2017. Heart attack pain can radiate to your back, but other causes of back pain are more likely. Learn the connection between back pain & heart attack & when to be concerned.
Nov 16, 2017. Chest pain due to gas can be caused by a number of reasons. For example, eating fiber-rich foods, having a food intolerance, or digestive problems can cause a buildup of gas in your chest. If you are bothered by a constant gassy feeling in your chest, then natural remedies like peppermint, chamomile,
Valium Back Pain Doses Dog Gone Knit: Grr. Not brr. Free Dog Sweater Knitting Patterns. Woof! For that reason, it is usually most effective when given every 8 hours for severe pain if pain resurfaces with 12-hour dosing. Tramadol can be combined with steroids or NSAIDs as well as Gabapentin and Robaxin or Valium. Nice to know info: Tramadol
Your free comprehensive online resource on abdominal pain. You will be able to find the causes, diagnosis and treatment of common causes of "stomach pains".
Belching or passing gas (flatus) is natural and common. Excessive belching or flatus, accompanied by bloating, pain or distention, can occasionally.
Mar 18, 2015. Gas pains — whether they're sharp, jabbing pains, cramps, or a general feeling of being bloated — are uncomfortable, unwanted, and totally natural. A high fiber diet — whether the fiber is from foods (fruits, vegetables, whole grains) or supplements (Metamucil type products), try cutting back somewhat.
Abdominal Pain and Symptoms Chart. Abdominal pain — a dull ache, a burning sensation, or a sharp, stabbing pain — is one of the most common complaints in.
Feb 21, 2016. But as natural as it is to let one rip periodically throughout the day, no one wants to be excessively gassy. Especially when it's uncomfortable. And when you work in an office surrounded by other people. If you feel like you're desperately holding back your gas more often than you should be, here are some.
The need to get back on your feet is one reason you should take the pain medicine your doctor prescribes. "My nurses practically forced me to get out of bed and move in order to relieve the gas pains I had following my first C-section," says Maureen Connolly, a mother of three in Montclair, N.J. Your physician might also.
If your gas is truly noxious, it could be a sign that something isn't agreeing with you, Dr. Chutkan says. Track what you're eating (dairy products are common offenders), then try cutting back on likely suspects. Also, stay hydrated, exercise, and eat a fiber-rich diet to keep things moving, because bacteria feed on stool that sits.
How to Get Low Back Pain to Fade Out Quickly and for Good — new type of therapeutic exercises
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- How To Ease A Back Pain: 11.05.2016 · How to Ease Gallbladder Pain. Gallbladder pain can be mild to crippling. If the pain is mild, you might be able to ease it enough at home. If.
Don't suffer with lower back pain. WebMD shows you ways to get back pain …
- Back Pain Tests Online: May 18, 2015. This free online pregnancy quiz can help you determine if your. This online pregnancy test is not to be used in place of an at-home. my Gp did preg test also came back negative.am stll having period pains but no periods.
Back pain — Com…
- Low Back Pain New Zealand: [embedyt]//www.youtube.com/embed/[/embedyt]
Dr Robert Maigne, a French orthopaedic specialist, proposed that low back pain could in fact originate from the thoraco lumbar facet joints, mediated by.
The results of this review show that for low back pa…
- Back Pain In The Middle Of: What is upper and middle back pain? Upper and middle back pain can occur anywhere from the base of your neck to the bottom of your rib cage. Your ribs attach to a long, flat bone in the center of the chest called the sternum and attach to and wrap ar…
- Lower Back Pain Right Side Only Constipation: Jan 10, 2015. Constipation – Crampy pain in the lower abdomen, incomplete bowel. Sometimes the whole body is affected, not just the stomach. the form of pressure or cramping in the lower abdomen and sometimes in the back. Appendicitis (inflammation o…
- Lower Back Pain Can T Bend: You can help prevent low back pain by learning how to sit, stand, lift, and exercise correctly. You may want to put a small pillow or rolled towel behind your lower back if you must drive or sit. Don't sleep on your stomach unless you put a pill… | <urn:uuid:0a620d86-94f8-4cc1-aea5-0ef32f57bf33> | {
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Diagnosis Code E72.03
Information for Medical Professionals
The ICD-10 and ICD-9 GEMs are used to facilitate linking between the diagnosis codes in ICD-9-CM and the new ICD-10-CM code set. The GEMs are the raw material from which providers, health information vendors and payers can derive specific applied mappings to meet their needs.
- 270.8 - Dis amino-acid metab NEC (approximate) Approximate Flag
The approximate flag is on, indicating that the relationship between the code in the source system and the code in the target system is an approximate equivalent.
- Lowe syndrome
Index of Diseases and Injuries
References found for the code E72.03 in the Index of Diseases and Injuries:
Information for Patients
Amino Acid Metabolism Disorders
Metabolism is the process your body uses to make energy from the food you eat. Food is made up of proteins, carbohydrates, and fats. Your digestive system breaks the food parts down into sugars and acids, your body's fuel. Your body can use this fuel right away, or it can store the energy in your body. If you have a metabolic disorder, something goes wrong with this process.
One group of these disorders is amino acid metabolism disorders. They include phenylketonuria (PKU) and maple syrup urine disease. Amino acids are "building blocks" that join together to form proteins. If you have one of these disorders, your body may have trouble breaking down certain amino acids. Or there may be a problem getting the amino acids into your cells. These problems cause a buildup of harmful substances in your body. That can lead to serious, sometimes life-threatening, health problems.
These disorders are usually inherited. A baby who is born with one may not have any symptoms right away. Because the disorders can be so serious, early diagnosis and treatment are critical. Newborn babies get screened for many of them, using blood tests.
Treatments may include special diets, medicines, and supplements. Some babies may also need additional treatments if there are complications.
Lowe syndrome Lowe syndrome is a condition that primarily affects the eyes, brain, and kidneys. This disorder occurs almost exclusively in males.Infants with Lowe syndrome are born with thick clouding of the lenses in both eyes (congenital cataracts), often with other eye abnormalities that can impair vision. About half of affected infants develop an eye disease called infantile glaucoma, which is characterized by increased pressure within the eyes.Many individuals with Lowe syndrome have delayed development, and intellectual ability ranges from normal to severely impaired. Behavioral problems and seizures have also been reported in children with this condition. Most affected children have weak muscle tone from birth (neonatal hypotonia), which can contribute to feeding difficulties, problems with breathing, and delayed development of motor skills such as sitting, standing, and walking.Kidney (renal) abnormalities, most commonly a condition known as renal Fanconi syndrome, frequently develop in individuals with Lowe syndrome. The kidneys play an essential role in maintaining the right amounts of minerals, salts, water, and other substances in the body. In individuals with renal Fanconi syndrome, the kidneys are unable to reabsorb important nutrients into the bloodstream. Instead, the nutrients are excreted in the urine. These kidney problems lead to increased urination, dehydration, and abnormally acidic blood (metabolic acidosis). A loss of salts and nutrients may also impair growth and result in soft, bowed bones (hypophosphatemic rickets), especially in the legs. Progressive kidney problems in older children and adults with Lowe syndrome can lead to life-threatening renal failure and end-stage renal disease (ESRD). | <urn:uuid:4f8d2a93-e3d0-412a-9979-d54de37fa9b6> | {
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Is medical coding the career for you?
Are you on the hunt for a new career in a growing industry? If so, then consider medical coding. This rewarding field can offer a wide variety of potential opportunities for employment and can be a satisfying profession for those with the right skills, mindset, and aptitude. Plus, it’s a career on the rise—according to the Bureau of Labor Statistics, it’s slated to grow faster than average through the next eight years.
Let’s learn more about what it’s like to be a medical coder and how you can get started.
According to the AAPC website, “Medical coding is the transformation of healthcare diagnosis, procedures, medical services, and equipment into universal medical alphanumeric codes. The diagnoses and procedure codes are taken from medical record documentation, such as transcription of physician’s notes, laboratory and radiologic results, etc.”
Basically, medical coders oversee all the codes that are used during the often-complex medical billing process. This is no simple task: qualified coders should have a thorough knowledge of anatomy and medical terminology and be familiar with several different coding systems (including CPT®, HCPCS Level II, and ICD-10-CM). On top of that, coders should know which codes are accepted by which insurance plans and how to be compliant while coding.
The first steps toward becoming a medical coder include ensuring that you meet the educational requirements to secure a position in the field, which can vary depending on the field, discipline, and work environment you choose to pursue.
According to the AAPC, the medical coding professionals should obtain the Certified Professional Coder (CPC®) credential. While earning a bachelor’s degree or master’s degree can strengthen a medical coder’s career, it’s not a set requirement. What is necessary is to have a solid foundation of anatomy, physiology, and medical terminology, which you will learn and master through earning the CPC® credential. “It’s recommended for serious coders to complete a medical coding course of study and pass an exam to designate him or her as a CPC®. Employers know CPCs® are individuals who can perform medical coding tasks with the utmost proficiency and excellence,” according to the official site.
So, what would a typical day as a medical coder look like? You’d likely be working in the billing office in a focused healthcare setting, which can range from a hospital to a therapeutic or treatment center, doctor’s office, outpatient facility, nursing home, or similar facility, and will be coding patient files—an essential task in the field—to ensure appropriate and accurate billing. In sum, your coding will help document each patient’s treatment process from beginning to end, in an effort to secure reimbursement for all services rendered during each visit.
Still interested in pursuing a career as a medical coder? If so, then consider the helpful information provided here as your launching pad to help you plan your first steps on this exciting career journey. You can build on this information with the wealth of resources and information available online, and before long you’ll be well on your way to achieving your goal. | <urn:uuid:c3a304bc-70de-4f25-af86-18133b51ca86> | {
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Diagnosis Code P37.5
Information for Medical Professionals
The ICD-10 and ICD-9 GEMs are used to facilitate linking between the diagnosis codes in ICD-9-CM and the new ICD-10-CM code set. The GEMs are the raw material from which providers, health information vendors and payers can derive specific applied mappings to meet their needs.
- 771.7 - Neonatal candida infect
- Acute oral pseudomembraneous candidiasis
- Candida albicans or Candida dubliniensis
- Candida inconspicua or Candida norvegensis
- Candidiasis of tongue
- Congenital candidiasis
- Disseminated candidiasis
- Granulomatous hepatitis
- Hepatic candidiasis
- Infection caused by Candida albicans
- Localized candidiasis
- Neonatal candidiasis
- Neonatal candidiasis of intestine
- Neonatal candidiasis of lung
- Neonatal candidiasis of perineum
- Neonatal systemic candidosis
- Neonatal thrush
- Pseudomembranous thrush
- Pseudomembranous thrush
- Sepsis caused by Candida
- Sepsis caused by fungus
Information for Patients
Uncommon Infant and Newborn Problems
It can be scary when your baby is sick, especially when it is not an everyday problem like a cold or a fever. You may not know whether the problem is serious or how to treat it. If you have concerns about your baby's health, call your health care provider right away.
Learning information about your baby's condition can help ease your worry. Do not be afraid to ask questions about your baby's care. By working together with your health care provider, you make sure that your baby gets the best care possible.
- Crying - excessive (0-6 months)
- Failure to thrive
- Hemorrhagic disease of the newborn
- Hyperglycemia - infants
- Neonatal respiratory distress syndrome
- Neonatal sepsis
- Neutropenia - infants
Also called: Candidiasis, Moniliasis
Candida is the scientific name for yeast. It is a fungus that lives almost everywhere, including in your body. Usually, your immune system keeps yeast under control. If you are sick or taking antibiotics, it can multiply and cause an infection.
Yeast infections affect different parts of the body in different ways:
- Thrush is a yeast infection that causes white patches in your mouth
- Candida esophagitis is thrush that spreads to your esophagus, the tube that takes food from your mouth to your stomach. It can make it hard or painful to swallow.
- Women can get vaginal yeast infections, causing itchiness, pain and discharge
- Yeast infections of the skin cause itching and rashes
- Yeast infections in your bloodstream can be life-threatening
Antifungal medicines get rid of yeast infections in most people. If you have a weak immune system, treatment might be more difficult.
- Candida infection of the skin
- Vaginal yeast infection | <urn:uuid:3f3f00c8-ec9f-4ff5-b68f-3e46dd6fd691> | {
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In light of much media coverage and an obvious lack of knowledge demonstrated on social media sites, our first post for cultural competency is on Transgendered patients. Our hope is to educate others on this important topic so that they can better understand the patients under our care and the laws implicated or suggested in our country.
It first is important to understand some important vocabulary differences:
Gender Identity: One’s innermost concept of self as male, female, a blend of both, or neither – how individuals perceive themselves and what they call themselves. One’s gender identity can be the same or different from their sex assigned at birth.
Gender Expression: external appearance of one’s gender identity, usually expressed through behavior, clothing, haircut or voice, and which may or may not conform to socially defined behaviors and characteristics typically associated with being either masculine or feminine.
Sexual Orientation: a person’s sexual identity in relation to the gender to which they are attracted; the fact of being heterosexual, homosexual, or bisexual. There are some transgendered people who are sexually attracted to their own sex as well as some that are attracted to the opposite sex. There are some married couples that may appear heteronormative, where for one example, a female to male transgendered person who now presents as a male (and may be legally recognized as a male) is married to a biological female.
Transgender: an umbrella term for people whose gender identity and/or expression is different from cultural expectations based on the sex they were assigned at birth. Being transgender does not imply any specific sexual orientation. Therefore, transgender people may identify as straight, gay, lesbian, bisexual, etc.
Gender Dysphoria: clinically significant distress caused when a person’s assigned birth gender is not the same as the one with which they identify. According to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM), the term – which replaces Gender Identity Disorder – “is intended to better characterize the experiences of affected children, adolescents, and adults.”
Gender Transition: the process by which some people strive to more closely align their internal knowledge of gender with its outward appearance. Some people socially transition, whereby they might begin dressing, using names and pronouns and/or be socially recognized as another gender. Others undergo physical transitions in which they modify their bodies through medical interventions.
Drag Queen: a man who dresses up in women’s clothes, typically for the purposes of entertainment.
Drag King: a woman who dresses up in men’s clothes, typically for the purposes of entertainment.
Crossdresser (sometimes formerly called “Transvestite”): the term cross-dressing denotes an action or a behavior without attributing or implying any specific causes for that behavior. It is often assumed that the connotation is directly correlated with behaviors of transgender identity or sexual, fetishist, and homosexual behavior, but the term itself does not imply any motives and is not synonymous to one’s gender identity, however many will refer to a gay man dressing in women’s clothes as a drag queen and use the term crossdresser for an identified straight male who enjoys wearing women’s clothing, most often for sexual fetish purposes. If the purpose was entertainment, then it would be a drag queen scenario, and if it were about gender identify, then they would likely identify as a transgendered person.
FTM, MTF- Stands for “female to male” and “male to female.”
Cisgender: Often shortened to “cis,” cisgender is a term used frequently in the intersectional, feminist, LGBT+, and transgender communities. It is an adjective used to describe someone whose gender identity matches their body and the gender assigned to them at birth– in other words, someone who is not transgender, nonbinary, or intersex. (i.e. A male who is born male, and is heterosexual is a cisgendered male or heterosexual cisgendered male to be more specific.)
F64.- Gender identity disorder (Category):
F64.0 Transsexualism (Gender identity disorder in adolescence and adulthood, or Gender dysphoria in adolescents and adults. )
F64.1 Dual role transvestism Use additional code to identify sex reassignment status (Z87.890) [Excludes1: gender identity disorder in childhood (F64.2), Excludes2: fetishistic transvestitism (F65.1)]
F64.2 Gender identity disorder of childhood (Gender dysphoria in children) [Excludes1: gender identity disorder in adolescence and adulthood (F64.0), Excludes2: sexual maturation disorder (F66)]
F64.8 Other gender identity disorders
F64.9 Gender identity disorder, unspecified (Gender-role disorder NOS)
F65.1 Transvestic fetishism (Fetishistic transvestism)
Z87.89- Personal History of other specified conditions (Category):
Z87.890 Personal history of sex reassignment
- Keep in mind that the decision to go through complete and full sex reassignment surgery is a private and individual choice. Some patients may chose to “go all the way” while others may chose to go through hormonal treatments only and not have full surgery for sex reassignment. There are multiple reasons for this such as personal preference, successes or unsuccessful outcomes of these surgeries, as well as cost. The surgery itself does not make one “transgendered.”
From the American Psychological Association:
Highlights include the following statements:
- Transgender and gender nonconforming1 (TGNC) people are those who have a gender identity that is not fully aligned with their sex assigned at birth. The existence of TGNC people has been documented in a range of historical cultures (Coleman, Colgan, & Gooren, 1992; Feinberg, 1996; Miller & Nichols, 2012; Schmidt, 2003). Current population estimates of TGNC people have ranged from 0.17 to 1,333 per 100,000 (Meier & Labuski, 2013). The Massachusetts Behavioral Risk Factor Surveillance Survey found 0.5% of the adult population aged 18 to 64 years identified as TGNC between 2009 and 2011 (Conron, Scott, Stowell, & Landers, 2012).
- The purpose of the Guidelines for Psychological Practice with Transgender and Gender Nonconforming People (hereafter Guidelines) is to assist psychologists in the provision of culturally competent, developmentally appropriate, and trans-affirmative psychological practice with TGNC people.
- Trans-affirmative practice is the provision of care that is respectful, aware, and supportive of the identities and life experiences of TGNC people (Korell & Lorah, 2007).
- Because of the high level of societal ignorance and stigma associated with TGNC people, ensuring that psychological education, training, and supervision is affirmative, and does not sensationalize (Namaste, 2000), exploit, or pathologize TGNC people (Lev, 2004), will require care on the part of educators. Students will benefit from support from their educators in developing a professional, nonjudgmental attitude toward people who may have a different experience of gender identity and gender expression from their own.
The full report from December 2015 may be viewed here: https://www.apa.org/practice/guidelines/transgender.pdf
It should be noted that being transgendered is not a whimsical choice that just happens one day. These people are born with a feeling and knowing in their own mind, through gender identity, as the opposite (in a mental identity sense) of what is presented physically on their body. A great deal of emotional and psychological trauma is often endured. There is a lengthy process of counseling, hormonal therapy, and legal battles that ensue for these patients.
Additional Valuable Resources Include:
The Bathroom Bill Crisis Issues in Many States:
A bathroom bill is the common name for legislation or a statute that defines access to public facilities – specifically restrooms – by transgender individuals. Bathroom bills affect access to restrooms for an individual based on a determination of their sex as defined in some specific way – such as their sex as assigned at birth, their sex as listed on their birth certificate, or the sex that corresponds to their gender identity. A bathroom bill can either be inclusive or exclusive of transgender individuals, depending on the aforementioned definition of their sex.
Critics of bills which exclude transgender individuals from restrooms which conform to their gender identity argue that they do not make public restrooms any safer for cisgender (non-transgender) people, and that they make public restrooms less safe for both transgender people and gender non-conforming cisgender people. Additionally, while there is not a single documented case of a transgender person attacking a cisgender person in a public restroom, many transgender people have been verbally, physically, and sexually harassed or attacked by cisgender people in public facilities.
The LGBT+ community has successfully managed bathroom access for years. It is standard practice in gay bars for example to utilize the restroom that identifies with your current gender expression. This means that men would use the mens room, unless they were presenting as a female (in wig, dress, etc.) and in such cases they would normally utilize the women’s restroom.
For those who argue that one cannot deny their born gender, they should be educated. Transgendered people do indeed exist in this world. It only makes sense that people should use the restroom of their expression. Naysayers have argued that this places risk of women and girls to “perverts” who might then dress in women’s clothing to gain access to women’s facilities for unsavory purposes, however no true transgendered person would have any such inclination. Trans FTM wish to be seen and accepted as men, and MTF trans people wish to be seen and regarded as women.
If you are still unsure, then take a look at the photos below. Each of the “male appearing” folks were born female, and each of the “female appearing” folks were born male. Would you want them being forced to use a restroom based on their physical or birth gender or how they appear/express themselves?
I do not think that most cisgendered men would be comfortable with these trans women entering a men’s room…
Nor would cisgendered women would feel comfortable with these trans men entering a women’s restroom.
Bathroom bills that discriminate against these people must be stopped, but this can only happen through education and learning. Some argue that they should be based on gaining a new legally recognized identification that present the new identified gender, however this process is lengthy, and varies in time from state to state. If a transgendered person is awaiting this legal approval, and going through a transition, (and often taking hormonal therapies simultaneously) then it only stands to reason by all common sense that they should be allowed to use a restroom that matches their physical expression.
Some Videos on How it Feels to Be Transgendered:
Transgendered Patients are at an increased risk as Victims of Hate Crimes and Violence
Brian Boyce, BSHS, CPC, CPC-I, CRC, CTPRP is an AAPC-approved PMCC medical coding instructor, and ICD-10-CM trainer and the author of the AAPC CRC® curriculum. He has specialized in risk adjustment from the very beginnings of these models being utilized and has assisted large and small clients nationally. He has special interest in ethics, patient safety, disease management, and management and leadership of people. Brian is a veteran of Desert Storm, where he served on active duty with the US Air Force with a job specialty of Aeromedical Evacuation. He went into physician practice management and medical coding after an honorable discharge. He is the CEO of ionHealthcare® LLC, a company that specializes in healthcare consulting, risk adjustment coding, management & support services. For additional inquiries contact ionHealthcare® at info@ionHealthcare.com. | <urn:uuid:fb911d6d-19dc-4be6-9400-279d97d4d99d> | {
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Diagnosis Code B72
Information for Medical Professionals
The diagnosis code B72 is grouped in the following Diagnostic Related Group(s) (MS-DRG v33.0)
- OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH MCC 867
- OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH CC 868
- OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITHOUT CC/MCC 869
Convert to ICD-9 General Equivalence Map
The ICD-10 and ICD-9 GEMs are used to facilitate linking between the diagnosis codes in ICD-9-CM and the new ICD-10-CM code set. The GEMs are the raw material from which providers, health information vendors and payers can derive specific applied mappings to meet their needs.
- 125.7 - Dracontiasis
- Disease caused by superfamily Dracunculoidea
- Filarial infection and dracontiasis
- Guinea-worm ulcer
- Infection caused by Dracunculus insignis
- Infection caused by Dracunculus medinensis
Index of Diseases and Injuries
References found for the code B72 in the Index of Diseases and Injuries:
- Includes Notes: Includes Notes
This note appears immediately under a three character code title to further define, or give examples of, the content of the category.
- guinea worm infection
- infection due to Dracunculus medinensis
Information for Patients
Parasites are living things that use other living things - like your body - for food and a place to live. You can get them from contaminated food or water, a bug bite, or sexual contact. Some parasitic diseases are easily treated and some are not.
Parasites range in size from tiny, one-celled organisms called protozoa to worms that can be seen with the naked eye. Some parasitic diseases occur in the United States. Contaminated water supplies can lead to Giardia infections. Cats can transmit toxoplasmosis, which is dangerous for pregnant women. Others, like malaria, are common in other parts of the world.
If you are traveling, it's important to drink only water you know is safe. Prevention is especially important. There are no vaccines for parasitic diseases. Some medicines are available to treat parasitic infections.
- Amebic liver abscess
- Creeping eruption
- Stool ova and parasites exam | <urn:uuid:c0d8b2ad-8519-46b2-9ad2-116266054e45> | {
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Well differentiated neuroendocrine tumors (NETs) of the stomach (gastric carcinoid tumors) are observed more often, with a tenfold increase in the US in the last 30 - 35 years, and the prognosis has improved greatly in that time. Nowadays most carcinoids of the stomach are diagnosed at an early stag Stomach. TX: The tumor cannot be evaluated. T0 (T plus zero): There is no evidence of a tumor. T1: The tumor is 1 cm or smaller and has grown into a deeper layer of cells in the stomach, the lamina propria or submucosa. T2: The tumor is larger than 1 cm in size, or it has grown into the muscle layer of the stomach, called the muscularis propria Gastrointestinal neuroendocrine tumors (GI-NETs) are rare neoplasms, like all NETs. However, the incidence of GI-NETS has been increasing in recent years. Gastric NETs (G-NETs) and duodenal NETs (D-NETs) are the common types of upper GI-NETs based on tumor location. G-NETs are classified into three . The grade gives doctors an idea of how quickly a cancer might grow and whether it will spread. Treatment by type of stomach NET. The treatment you have for a stomach neuroendocrine tumour (NET) depends on a number of things. This includes the type of NET and whether it has spread
Grade 1 (low-grade tumor): These cells divide at a low rate and therefore grow slowly. Grade 2 (intermediate-grade tumor): These cells divide at an intermediate rate. Grade 3 (high-grade tumor): These cells divide at a fast rate and therefore grow quickly. Grade is determined by both the mitotic count and Ki-67, both markers of how fast the. Gastrointestinal neuroendocrine carcinomas (NECs) are high-grade (grade 3) tumors that grow very quickly. There are also some low- (grade 1) and intermediate-grade (grade 2) carcinoid tumors that act like neuroendocrine carcinomas because they grow fast Cancers that are grade 1 or grade 2 are called GI neuroendocrine tumors. These cancers tend to grow slowly and can possibly spread to other parts of the body. Cancers that are grade 3 are called GI neuroendocrine carcinomas (NECs). These cancers tend to grow and spread quickly and can spread to other parts of the body Generally, from the staging system, we can draw the conclusion that Grade 1 neuroendocrine tumor is usually that stage of the tumor in which the cancer is present at the site of its origin. It has not spread to the lymph nodes or any other organs in the body. The neuroendocrine tumor may or may not be malignant
1) is generally advised.1,5,7,8,43-46 The classification of NET is site- and grade-dependent, requiring careful evaluation of Figure 1. Well-differentiated neuroendocrine tumor (A: Giemsa stain) with (B) chromogranin A, (C) synaptophysin, and (D) AE1/AE3 positivity. Algorithmic Approach to NETs in Targeted Biopsies/Duan and Met Neoplasia (carcinoid tumor or well differentiated neuroendocrine tumor/neoplasm) >0.5 mm greatest dimension Nodules 0.5 mm to 0.5 cm have been termed microcarcinoids; Invasion into submucosa; High grade / poorly differentiated neuroendocrine carcinoma is covered separatel Classification. 2019 WHO classification. Neuroendocrine tumor (NET): NET, grade 1 (G1): well differentiated low grade. NET, G2: well differentiated intermediate grade. NET, G3: well differentiated high grade. Neuroendocrine carcinoma, small cell type (SCNEC The stages for this type are the same as the ones for pancreatic cancer. It's based on where your tumor is located. Stage 0. It's only in the top layers of the duct cells of the pancreas -- a gland.. Neuroendocrine tumors are cancers that begin in specialized cells called neuroendocrine cells. Neuroendocrine cells have traits similar to those of nerve cells and hormone-producing cells. Neuroendocrine tumors are rare and can occur anywhere in the body. Most neuroendocrine tumors occur in the lungs, appendix, small intestine, rectum and pancreas
The neuroendocrine tumor survival rate can vary significantly from patient to patient based on the location, type and stage of the cancer. Therefore, any general statistics relating to prognosis must be viewed within a proper context and are best understood with the help of a treating physician 1. Introduction. According to the most recent comprehensive studies, the incidence of neuroendocrine tumors (NET) is clearly on the rise in a manner independent from that expected by a simple increased awareness or improvements in diagnostic technologies. 1 Indeed, several studies from North America, Europe and Asia have also shown similar increases, although no specific explanations have been. Benign neuroendocrine tumor stomach; Carcinoid tumor of stomach; Neoplasm of uncertain behavior of stomach; ICD-10-CM D3A.092 is grouped within Diagnostic Related Group(s) (MS-DRG v 38.0): 393 Other digestive system diagnoses with mcc; 394 Other digestive system diagnoses with cc; 395 Other digestive system diagnoses without cc/mcc; Convert D3A.
The stomach, small intestine, colon and rectum are made up of different layers of tissues. The stage often depends on which layer the tumour has grown into. Only well-differentiated NETs and well-differentiated neuroendocrine carcinomas of the stomach, small intestine, ampulla of Vater, colon and rectum use the following stages. Stage 1 rare, slow-growing neoplasms of neuroendocrine origin 1,2,4; most common sites of primary tumor include gastrointestinal tract (reported in 62%-67% of cases) and lungs and bronchi (reported in 22%-27% of cases) 1,2,4 neuroendocrine tumors are typically sporadic, although some (well-differentiated neuroendocrine tumors) are associated with multiple endocrine neoplasia type 1 (MEN1), von Hippel.
The WHO 2010 classification of neuroendocrine neoplasm defined low to intermediate grade tumors (grade 1-2) and well to moderately differentiated neuroendocrine neoplasms as neuroendocrine tumors. All tumors in the stomach that do not cross the GE junction (or have an epicenter in the stomach >2 Well-Differentiated Neuroendocrine Tumors Proliferation of cells with round nuclei, salt and pepper (speckled) chromatin and abundant Grade 1 <3% <2 Grade 2 3-20% 2-20 Grade 3 >20% >20. Other Malignancie Strosberg J, Gardner N, Kvols L. Survival and prognostic factor analysis of 146 metastatic neuroendocrine tumors of the mid-gut. Neuroendocrinology 2009; 89:471. Jann H, Roll S, Couvelard A, et al. Neuroendocrine tumors of midgut and hindgut origin: tumor-node-metastasis classification determines clinical outcome. Cancer 2011; 117:3332 high grade neuroendocrine carcinoma of the stomach. My 33 old husband has been diagnosed with NEC in stomach with mets to liver. As per the biopsy, ki67 index of stomach is less than 10% while the index for the liver is up to 40% (high grade). He cannot have a surgery because it's too invasive
C7A.1 - Malignant poorly differentiated neuroendocrine tumors C7A.8 - Other malignant neuroendocrine tumors The symptoms of neuroendocrine tumors are wide-ranging, depending on the specific location in the body where the disease is found The treatment options for your neuroendocrine tumor will depend on the type of tumor, its location, and whether you're experiencing signs and symptoms of excess hormones produced by the tumor. In general, neuroendocrine tumor treatment options might include: Surgery. Surgery is used to remove the tumor. When possible, surgeons work to remove.
Characteristic Everolimus N = 205 Placebo N = 97 Tumor grade Grade 1 / grade 2 63% / 37% 67% / 33% Metastatic extent of disease† Liver 80% 78% Lymph node or lymphatic system 42% 46% Lung 22% 21% Bone 21% 16% Median time from initial diagnosis to randomization, months (range) 29.9 (0.7-258.4) 28.9 (1.1-303.3) Median time from most recent. Tumors involving the EGJ with their epicenter >2 cm into the proximal stomach (i.e., >2cm distal to the EGJ) are now classified using the stomach schema. Cardia cancers that do not invade the EGJ should be classified based on the stomach cancer schema for stage groupings. Note 3: Schema Discriminator 1: EsophagusGEJunction (EGJ)/Stomach is used.
Pancreatic neuroendocrine tumors (PNETs) arise from the hormone-secreting islet cells, and account for 1-2% of all pancreatic neoplasms. The most common site of PNET metastases is to the lymph nodes at 50%, followed by liver at 30% .Liver metastasis is the most common cause of death in PNET Neuroendocrine tumours (also referred to as NET) are an uncommon type of tumour that forms in these cells. The type is generally defined by where the abnormal cells come from and can range from low grade (slow growing) to high grade (fast growing). Neuroendocrine tumours that produce extra amounts of hormones can cause certain symptoms and are. The coding depends on the grade of the tumor. Low Grade Neuroendocrine is the new term for Carcinoid so that would be C7A.094 in this case. If it is High Grade or Poorly Differentiated it would be the C7A.1. It would depend on the the pathology report Although NETs comprise less than 2 percent of gastrointestinal malignancies, these tumors are more prevalent than cancers of the stomach and pancreas combined. The National Cancer Institute reports a five-fold increase in the incidence of neuroendocrine tumors from 1973 to 2004
Neuroendocrine tumors were first described in 1907 by the German pathologist Siegfried Oberndorfer in the small intestines of seven patients, and named carcinoid tumors because of their small size and apparent indolent nature. 1 Since then, gastroenteropancreatic neuroendocrine tumors (GEP-NETs) have been better characterized and are now. Cells that are similar to nerve cells make up the neuroendocrine system. They make chemical messengers called hormones. Hormones control how different organs in the body work. Neuroendocrine cells are found throughout the body, in organs such as the stomach, bowel and lungs. NETs can be non-cancerous (benign) or cancerous (malignant) Neuroendocrine tumours (NETs) are when malignant cancer cells form in the neuroendocrine system. This is a network of glands and nerve cells that produce and release hormones into the bloodstream to control how our bodies function normally. Neuroendocrine cells can be found in most organs of the body
Neuroendocrine tumors are tumors which begin in neuroendocrine cells. 1 They may occur in the digestive tract, the lungs, or the brain. In the digestive tract, they may involve the stomach, the pancreas, the small intestine, colon, and rectum. Unfortunately, unlike some other types of colon cancer, the prognosis has not changed much in. Symptoms of neuroendocrine tumours. The symptoms of a neuroendocrine tumour depend on where in the body it is and what hormones it produces. For example, a tumour in the digestive system (gastrointestinal neuroendocrine tumour) may cause diarrhoea, constipation or tummy pains.. A tumour in the lung (pulmonary neuroendocrine tumour) may cause wheezing or a persistent cough
-Histologically or cytologically confirmed high-grade neuroendocrine tumor that has progressed on first line therapy, excluding small cell lung cancer (SCLC). High grade includes any neuroendocrine neoplasm with a Ki-67 of >=20% or with mitotic count of more than 20 mitoses per high power field or any poorly differentiated neoplasm or any. Neuroendocrine tumors (NETs) are a broad family of tumors classified by site of origin and histologic characteristics. Per a Surveillance, Epidemiology and End Results (SEER) database analysis, the incidence of NETs in the United States was estimated to be 5.25/100,000 in 2004; this was likely an underestimation, given that these tumors often go unreported or undiagnosed.[1 Low grade neoplasm of the appendix demonstrating neuroendocrine differentiation; Note. WHO 2010 has changed back to neuroendocrine cell from endocrine cell for these lesions Endocrine neoplasm/tumor are equivalent terms to those used below; Carcinoid and low grade or well differentiated neuroendocrine neoplasm/tumor/carcinoma are equivalent term 7 Microcarcinoid tumors of the stomach Microcarcinoid and carcinoid tumors are reportable. The ICD-O-3.2 histology code is 8240/3. Microcarcinoid is a designation for neuroendocrine tumors of the stomach when they are less than 0.5 cm. in size. Neuroendocrine tumors of the stomach are designated carcinoid when they are 0.5 cm or larger
Patients diagnosed with Neuroendocrine Tumors (NET) often are also diagnosed with Neuroendocrine Liver Metastases (NLM) during the course of their disease. NLM can cause significant morbidity and mortality, oftentimes much more than compared to patients with NET. Treatment options have been limited in the past, focusing on surgical resections, for which only a minority of patients are candidates Neuroendocrine neoplasms, also neuroendocrine tumours, are a group of tumours whose behaviour varies from benign to malignant and are found in may different sites.Neuroendocrine tumour is commonly abbreviated NET.. These tumours arise from epithelium; thus, malignant tumours in this group are referred to as neuroendocrine carcinomas The tumor grade as mentioned above correlates with the mitotic count and Ki-67 proliferation index. Gallbladder NETs can be classified into four broad histological categories based on tumor differentiation and grade: (1) well-differentiated NETs (typical carcinoid), (2) well-differentiated neuroendocrine carcinoma (atypical or malignant.
- Well-differentiated Neuroendocrine Tumor, WHO Grade 1 - Well-differentiated Neuroendocrine Tumor, WHO Grade 2 - Well-differentiated Neuroendocrine Tumor, WHO Grade 3. COMMENT: Histologic sections of the *** biopsy show a proliferation of nests of cells with round nuclei and stippled chromatin. These cells show strong, diffuse staining. CAP Approved Endocrine • Neuroendocrine Tumors of the Stomach StomachNET 184.108.40.206 + Data elements preceded by this symbol are not required. However, these elements may be clinically important but are not yet validated or regularly used in patient management
Neuroendocrine tumors in 2015. 1. ROLE OF TARGETED THERAPY IN NEUROENDOCRINE TUMORS Mohamed Abdulla M.D. Prof. of Clinical Oncology Kasr Al-Aini School of Medicine Cairo University Target Therapy: Future Directions Helnan Palestine Hotel Thursday, 30/04/2015. 2 A subset are high grade by proliferative or mitotic rate but demonstrate well-differentiated histology (well-differentiated grade 3 [G3] neuroendocrine tumors [NETs]) and have a prognosis that is midway between the high-grade poorly differentiated NECs and well-differentiated grade 2 NETs, which are more indolent Introduction. Neuroendocrine tumors (NETs) are a group of rare cancers that arise from neuroendocrine cells throughout the body; they account for 0.46% of gastroenteropancreatic and bronchopulmonary malignancies. 1 They are a heterogeneous group of malignancies that are most common in the lung/bronchus but also originate in the pancreas, small intestine, colon and rectum, ovaries, and thyroid.
Neuroendocrine cancer prognosis - Overall, it is estimated that more than 12 000 people in the United States are annually diagnosed with neuroendocrine tumors. A 5-year survival rate tells you which percentage of people live at least 5 years after cancer detection. Percentage means how many 100 Different types of neuroendocrine tumors (NET) cause different symptoms, depending on the location of the tumor, and whether the NET is functional or nonfunctional. Functioning NETs are defined based on the presence of clinical symptoms due to excess hormone secretion by the tumor. Nonfunctional NETs do not secrete hormones For neuroendocrine tumors in any part of the gastrointestinal tract, size greater than 2.0 cm is associated with a higher risk of lymph node metastasis. In the stomach, types 3 and 4 neuroendocrine tumors are significantly larger than type 1 tumors,3 which usually measure 1 cm or less5,6 . Tumor size correlates with depth of invasion for. | <urn:uuid:df7bd0c4-45e9-4ada-ad41-0573e658a2d6> | {
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1 9.0 - Chapter Intrductin In this chapter, yu will learn t use net present value analysis in cst and price analysis. Time Value f Mney. The time value f mney is prbably the single mst imprtant cncept in financial analysis. When we say that mney has time value, we mean that a dllar t be received tday is wrth mre than a dllar t be received at any future time. Mney has a time value because f the pprtunity t earn interest r the cst f paying interest n brrwed capital. Fr example, assume that yu need t buy a new car but d nt have the mney that yu need t pay fr it. Yu must brrw the entire purchase price. Tw dealers ffer t sell yu identical cars fr $21,000. Dealer #1 requires cash n delivery. Dealer #2 will prvide yu an interest-free lan fr ne year. Where wuld yu buy the car? Prbably frm Dealer #2, because yu will save all the interest fr the first year f wnership. Present Value. In the example abve, Dealer #2 was clearly the lw-cst chice (because f the interest-free lan fr ne year), but what if Dealer #1 ffered the car at a lwer price, say $20,000? Which wuld be the lw-cst chice then? T make that decisin, yu must be able t determine the present value f each alternative. If yu culd invest $20,000 at 5.0 percent interest, it wuld be wrth $21,000 at the end f ne year. Based n that calculatin, we culd say that $20,000 is the present value f $21,000 ne year frm nw when the interest rate is 5.0 percent. At that interest rate, yu wuld presumably be indifferent abut where t buy yur car because the present value f the tw chices is the same. Net Present Value. Calculating present value may invlve receipts as well as expenditures. Fr example, the alternatives may have sme salvage value after their useful life has ended. The estimated receipt frm the sale f the item must be cnsidered in yur analysis. The difference between the present value f the receipts and the present value f the expenditures is net present value. The best financial chice is the alternative with the highest net present value. In prcurement, the alternative with the
2 highest net present value is the alternative with the smallest payment net present value. Factrs Affecting Net Present Value. The majr factrs affecting present value are the timing f the expenditure (receipt) and the discunt (interest) rate. The higher the discunt rate, the lwer the present value f an expenditure at a specified time in the future. Fr example, as yu learned abve, $20,000 is the present value f $21,000 ne year frm nw when the interest rate is 5.0 percent. If the interest rate were 10.0 percent, $19,09 wuld be the apprximate present value f $21,000 ne year frm nw. Nte that the change in the interest rate wuld have a significant affect n yur net present value analysis in the car case. Yur chice is still t pay $20,000 nw r $21,000 a year frm nw. At an interest rate f 10 percent yu culd invest $19, tday t earn the $21,000 a year frm nw. S it appears that the lw-cst chice is t wait and pay the $21,000 in ne year. Office f Management and Budget (OMB) Circular A-94Circular A-94, Guidelines and Discunt Rates fr Benefit-Cst Analysis f Federal Prgrams, delineates the rates that yu shuld use in Gvernment net present value analysis. These rates are based n the rate that the Treasury Department pays t brrw mney fr perids frm 91 days t 30 years and they are updated annually at the time f the President's budget submissin t Cngress. These rates can be fund n the internet at r btained by telephning (202) Net Present Value Analysis. Regardless f the applicatin, yu shuld use this 5-step prcess in net present value analysis: Step 1. Select the discunt rate. Step 2. Identify the csts/benefits t be cnsidered in analysis. Step 3. Establish the timing f the csts/benefits. Step 4. Calculate net present value f each alternative.
3 Step 5. Select the ffer with the best net present value. Lease-Purchase Analysis Examples (OMB Circular A-94, Paragraph 13). In this chapter, we will demnstrate the applicatin f net present value analysis cncepts using lease-purchase examples. Our use f these examples is nt meant t ignre ther uses f net present value analysis in Gvernment cntracting. We selected the lease-purchase decisin because f the emphasis in OMB Circular A-94 and because f the grwing Gvernment interest in leasing as a viable alternative t purchase Identifying Situatins Fr Use OMB Suggested Use (FAR and OMB Circular A-94, Paragraph 4). Unless precluded by agency prcedures, OMB suggests the use f net present value analysis in any analysis t supprt Gvernment decisins t initiate, renew, r expand prgrams r prjects which wuld result in a series f measurable benefits r csts extending fr three r mre years int the future. Examples f acquisitin decisins that invlve such analyses include: Lease-purchase analyses; Analyses f different lease alternatives; Life-cycle cst analyses; and Trade-ff analyses cnsidering acquisitin csts and energy-utilizatin csts f peratin. Required Lease-Purchase Analysis (OMB Circular A-94, Paragraph 13). In additin t the suggested applicatin t any benefit-cst analysis, OMB Circular A-94 requires that any decisin t lease a capital asset be justified as preferable t direct Gvernment purchase and wnership in situatins where bth the fllwing are true: The lease-purchase analysis cncerns a capital asset r a grup f related assets whse ttal fair market value exceeds $1 millin. The lease-purchase analysis cncerns a capital asset (including durable gds, equipment, buildings, facilities, installatins, r land) which is: Leased t the Gvernment fr a term f three r mre years;
4 New, with an ecnmic life f less than three years, and leased t the Gvernment fr a term f 75 percent r mre f the ecnmic life f the asset; Built fr the express purpse f being leased t the Gvernment; r Leased t the Gvernment and clearly has n alternative cmmercial use (e.g., a specialpurpse Gvernment installatin). The analysis cnducted in supprt f that justificatin shuld invlve net present value analysis and can be perfrmed in ne f three ways, as delineated in the table belw: Methds f Lease-Purchase Analysis Cnduct a separate leasepurchase analysis fr each acquisitin. Use... Only fr majr acquisitins. A lease is a majr acquisitin when ne f the fllwing is true: Cnduct peridic lease-purchase analysis f the recurring acquisitin f assets fr the same general purpse. Adpting a plicy fr smaller leases and submitting the plicy t OMB fr apprval. Acquisitin is a separate line item in the Agency's budget. The agency r the OMB determines that the acquisitin is a majr ne. The ttal purchase price f the asset r grup f assets will exceed $500,000. Fr an entire class f assets. Nrmally after the agency demnstrates that: The leases in questin wuld generally result in substantial savings t the Gvernment. The leases in questin are s small r s shrt as t
5 make separate analyses impractical. Leases f different types are scred cnsistent with the requirements f OMB Circular A-11, Preparatin and Submissin f Annual Budget Estimates Selecting A Discunt Rate OMB Discunt Rate Guidance (OMB Circular A-94, Appendix C). Unless precluded by agency practice, yu shuld use the current discunt rates cntained in OMB Circular A-94, Appendix C. Nminal Treasury Rates (OMB Circular A-94, Appendix A & Appendix C). Fr mst benefit-cst analysis yu shuld use nminal discunt rates (i.e., discunt rates that include the effect f actual r expected inflatin/deflatin). The fllwing rates are the actual rates cntained in OMB Circular A-94, Appendix C fr use thrugh January 1999: Nminal Discunt Rates Maturity in Discunt Rate Years 3 years 5.6% 5-year 5.7% 7-year 5.8% 10-year 5.9% 30 years 6.1% Real Treasury Rate (OMB Circular A-94, Appendix A & Appendix C). Fr sme prjects (e.g., lng-term real estate leases), yu may find it mre reasnable t state payments in terms f stable purchasing pwer (that is, cnstant dllars) and adjust them separately using a predetermined price index. In such situatins, cash flws shuld be discunted using the real Treasury brrwing rate fr debt f cmparable maturity. The real Treasury rate is the nminal Treasury rate adjusted t eliminate the effect f anticipated inflatin/deflatin. These rates are als
6 cntained in OMB Circular A-94, Appendix C f and are updated annually. The fllwing real rates are t be used fr discunting dllar cash flws thrugh January Real Discunt Rates Maturity in Discunt Rate Years < 3 years 3.4% 5 year 3.5% 7 year 3.5% 10 year 3.6% > 30 years 3.8% Selecting the Rate fr Analysis. Whether yu are using nminal r real treasury rates, match the rate t the analysis perid (e.g., use 5.6 percent t discunt all expenditures/ receipts fr a 3-year lease analysis). T analyze a prject requiring analysis fr a perid different frm thse presented abve, use linear interplatin t determine the apprpriate discunt rate. Step 1. Estimate the change in the discunt rate fr each year between the next lwer and next higher maturity perid with identified discunt rates. Where: R C = Change in the discunt rate fr each year difference in the prject maturity perid M 1 = Next lwer maturity perid with an identified discunt rate M 2 = Next higher maturity perid with an identified discunt rate R 1 = Discunt rate fr maturity perid M 1 R 2 = Discunt rate fr maturity perid M 2
7 Step 2. Calculate the interplated rate using the rate fr the next lwer maturity perid with an identified rate and the estimated change in the discunt rate fr each year difference in the maturity perid. Where: R I = Interplated discunt rate fr the prject maturity perid M P = Maturity perid fr the prject All ther symbls are as defined abve Linear Rate Interplatin Example. The fllwing example demnstrates the steps invlved in interplating a nminal interest rate fr evaluating an 8-year lease: Step 1. Estimate the change in the discunt rate fr each year between the next lwer and next higher maturity perid with identified discunt rates. Step 2. Calculate the interplated rate using the rate fr the next lwer maturity perid with an identified rate and the estimated change in the discunt rate fr each year difference in the maturity perid.
8 9.3 - Identifying Cash Flws T Cnsider Cash Flw. A cash flw is a receipt r expenditure related t the prpsed lease r purchase. Guidance n the csts/benefits that yu shuld cnsider in lease-purchase analysis is prvided in bth FAR and OMB Circular A-94. The slicitatin shuld require each fferr t identify relevant cash flws assciated with its prpsal. Remember, the purpse f the Gvernment evaluatin is t identify the best net present value. Analysis Perid (OMB Circular A-94, Paragraph 13c8). In lease-purchase analysis, the prper perid fr analysis is the lease perid including all renewal ptins. The perid f the prjected lease must be defined in the slicitatin t assure identificatin and analysis f all relevant cash flws. Pints t Cnsider in Identifying Csts and Benefits fr Analysis (OMB Circular A-94, Para 6a1 & 13c1). Lease-purchase analysis shuld cmpare the net present value f the incremental csts related t leasing the asset with the incremental csts related t purchasing (r cnstructing) and wning the asset. Yu shuld cnsider incremental csts assciated with acquisitin as well as the ancillary csts related t acquisitin and wnership. Use the fllwing general guidelines as yu identify incremental benefits and csts t include in yur analysis: Analysis shuld cnsider csts r benefits assciated with ne alternative in the evaluatin f ther alternatives. Fr example, if the lease payments include maintenance, the purchase alternative shuld als include the cst f maintenance. Analysis shuld cnsider csts r benefits that will be different fr different alternatives. Fr example, if different alternatives will use substantially different amunts f electricity, the cst f electricity shuld be cnsidered. Analysis shuld nt cnsider sunk csts r benefits. Past experience is relevant nly in helping t estimate future csts r benefits. Fr example, if the Gvernment has decided t replace existing equipment, the value f that equipment is nt relevant. Analysis shuld nt cnsider csts which will be identical fr all alternatives. Fr example, if the
9 Gvernment has decided t replace existing equipment, the cst f remving that equipment is nt relevant because it must be accmplished fr all alternatives. Examples f Lease-Purchase Csts and Benefits Cmmnly Cnsidered (FAR and OMB Circular A-94 Paragraph 13c). Lease-purchase analysis is ne area where yu might be required t use net present value analysis. The csts and benefits identified belw fr lease-purchase analysis demnstrate the type f cash flws that yu shuld cnsider in a net present value analysis. Net Purchase Price. Any net present value analysis f a decisin t purchase an asset must cnsider the purchase price. OMB defines the purchase price f the asset as the price a willing buyer culd reasnably expect t pay a willing seller in a cmpetitive market t acquire the asset. Nrmally, lease-purchase decisins d nt cnsider trade-ins f existing equipment. Dispsal f existing equipment shuld be handled fllwing agency prperty dispsal prcedures and cnsidered as part f dispsal csts and salvage value as presented belw. Lease Payments. Any decisin t lease prperty using net present value analysis must cnsider the amunt and timing f lease payments. Ancillary Services. If ancillary csts differ between alternatives, they shuld be cnsidered. (If csts and timing are the same fr all alternatives, they need nt be cnsidered.) Bth OMB Circular A-94 and the FAR prvide guidance n the ancillary csts and benefits that yu shuld cnsider in lease-purchase analysis. The fllwing pints cmbine the recmmendatins frm bth surces: All csts assciated with acquiring the prperty and preparing it fr use including: Csts; Transprtatin; Installatin; Site preparatin; Design; and Management. Repair and imprvement csts, including: Estimated unplanned service calls; and
10 Imprvements prjected t be required during the lease perid t assure cntinued peratin. Operatin and maintenance csts, including: Operating labr and supply requirements; and Ruting maintenance. Dispsal csts and salvage value, including the: Cst f mdificatins required t return related equipment t its riginal cnfiguratin; Cst r mdificatins required t return related facilities t their riginal cnfiguratin; and Equipment value t the Gvernment at the end f the lease perid (e.g., salvage value) Determining Cash Flw Timing The timing f cash flws is a vital element f any net present value analysis. This sectin presents tw methds fr cnsidering that timing Discunt Factrs fr End-f-Year Payment Discunt Factrs fr Mid-Year Payment General Equatin fr Present Value Calculatin. Yu can cmpute the present value f any cash flw (expenditure/receipt) in the future, by multiplying the amunt by the apprpriate discunt rate: PV = DF(CF) Where: PV = Present value DF = Discunt factr CF = Cash flw Discunt Factrs. The discunt factr that yu use in net present value analysis will depend n the discunt rate that yu use and the timing f the cash flw. In defining the timing f the cash flw, yu must identify the year and
11 the timing during the year. There are tw cmmnly used assumptins abut when during the year the payment ccurs: End-f-year payment -- use this assumptin when a single payment is made at the end f the year r the beginning f the year. A payment that is due immediately is nt discunted. A payment that is due at the beginning f Year t is evaluated as a payment due at the end f Year t-1. Fr example, payments due at the beginning f Year 2 and Year 3 will be treated as if they are due at the end f Year 1 and Year 2. Mid-year payment -- use this assumptin when a single payment will be made mid-year r payments will be made at regular intervals thrughut the year. Offer-Identified Cash Flws. Slicitatins must require all fferrs t clearly define the amunt and timing f each cash flw (expenditure/receipt) unique t the prpsal. The prpsal shuld als include a ratinale t supprt the timing f any cash flw unless the timing is set frth in the cntract. Fr example: The timing f lease payments des nt require any additinal supprt because the timing (e.g., mnthly, quarterly, r annually) is defined in the lease agreement. Hwever, the lease agreement may include additinal charges (e.g., n-call equipment repair). Fr such charges, the ratinale fr bth the estimated expenditure and its timing shuld be clearly defined in the prpsal. Gvernment-Identified Cash Flws. Gvernment technical persnnel must identify cash flws related t different prpsals that are beynd the cntrl f the fferrs. Fr example: The amunt and timing f expenditures related t Gvernment wnership must als be identified prir t prpsal evaluatin. Nrmally, Gvernment persnnel will be respnsible fr preparing these estimates based n available infrmatin. Hwever, each fferr may be required t prvide infrmatin required t develp these estimates (e.g., csts t mdify equipment t meet anticipated changes in Gvernment requirements).
12 Discunt Factrs Fr End-Of-Year Payment When t Use End-f-Year Discunt Factrs. Use end-f-year discunt factrs when payments are due at the end f the year r the beginning f the year. Remember, that a payment due at the beginning f Year 3 is the same as a payment due at the end f Year 2. End-f-Year Discunt Factr Calculatin. The discunt factr frmula fr each end-f-year cash flw (payment/ receipt) is written: Where: DF = End-f-year discunt factr i = Discunt rate t = Number f years until the payment (receipt is due) Fr Example: Determine the present value (PV) f a payment f $1,000 due at the end f 1 year using the nminal discunt rate fr three years r less, 5.6 percent. Discunt Factr Calculatin: Present Value Calculatin:
13 Sum Factrs fr Repetitive End-f-Year Cash Flws. When there is a repetitive cash flw such as a lease payment, yu can use a sum factr t speed the calculatin prcess. Where: PV = Present value SF = End-f-year sum factr CF = Cash flw Fr example: Determine the present value f a series f three payments f $1,000 each due at the end f each f the next three years, when the discunt rate is 5.6 percent. Discunt Factr (DF) Present Value (PV) Year Payment Frmula Calculatin 1 $1,000 1/(1.056) 1 1/ a $ 947 b 2 1,000 1/(1.056) 2 1/ $ ,000 1/(1.056) 3 1/ $ 849 Ttal $2,693 a Factrs are runded t the fur decimal places. b Amunts are runded t the nearest dllar. The present value f a series f three $1,000 end-fyear payments is $2,693 when the discunt rate is 5.6 percent. The sum f the three factrs is Using the sum factr and the equatin abve: Nte: The answer calculated using the sum factr is the same as the answer calculated using individual discunt factrs. Hwever, answers may vary slightly because f differences in runding. End-f-Year Nminal Discunt Tables. Appendix A-1, Discunt Factrs -- Nminal Rates, End-f-Year Payments,
14 cntains factrs fr the 3-year, 5-year, 7-year, 10-year, and 30-year discunt rates. End-f-Year Real Discunt Tables. Appendix A-3, Discunt Factrs -- Real Rates, End-f-Year Payments, cntains factrs fr the 3-year, 5-year, 7-year, 10-year, and 30- year discunt rates Discunt Factrs Fr Mid-Year Payment When t Use Mid-Year Discunt Factrs. Use mid-year discunt factrs when a single payment will be made midyear r payments will be made at regular intervals (e.g., mnthly r quarterly) thrughut the year. Mid-Year Discunt Factr Calculatin. The discunt factr frmula fr mid-year cash flw (payment/receipt) is written: Where: MYDF = Mid-year discunt factr i = Discunt rate t = Number f years until the payment (receipt) is due Fr example: Determine the present value f a series f 12 mnthly payments f $1,000 each due at the beginning f each mnth fr 1 year. The ttal amunt fr the year is $12,000. These payments are spaced evenly ver the year; hence the use f a MYDF wuld be apprpriate. Discunt Factr Calculatin:
15 Present Value Calculatin: Sum Factrs fr Repetitive Mid-Year Cash Flws. When there is a repetitive cash flw such as a lease payment, yu can use sum factrs t speed the calculatin prcess. Where: PV = Present value MYSF = Mid-year sum factr CF = Cash flw Fr example: Determine the present value f a series f 36 mnthly payments f $1,000 each due at the beginning f each mnth fr the next three years; that is, $12,000 per year fr three years. These payments are spaced evenly ver the year; hence the use f a MYDF wuld be apprpriate. Discunt Factr (MYDF) Present Value (PV) Year Payment Frmula Calculatin 1 $12,000 1/(1.056).5 1/ a $11,677 b 2 $12,000 1/(1.056) 1.5 1/ $11,058 3 $12,000 1/(1.056) 2.5 1/ $10,472 Ttal $33,207
16 a Factrs are runded t the fur decimal places. b Amunts are runded t the nearest dllar. The present value f a series f three $12,000 mid-year payments is $33,207, when the discunt rate is 5.6 percent. The sum f the three mid-year discunt factrs is Using the sum factr and the equatin abve: Nte: The answer calculated using the sum factr is slightly higher than the ne calculated using individual discunt factrs, because f runding differences. Mid-Year Nminal Discunt Tables. Appendix A-2, Discunt Factrs -- Nminal Rates, Mid-Year Payments, cntains factrs fr the 3-year, 5-year, 7-year, 10-year, and 30- year discunt rates. Mid-Year Real Discunt Tables. Appendix A-4, Discunt Factrs -- Real Rates, Mid-Year Payments, cntains factrs fr the 3-year, 5-year, 7-year, 10-year, and 30-year discunt rates Calculating Net Present Value And Selecting The Best Alternative Net Present Value Analysis. Remember frm the Chapter Intrductin that yu shuld use the fllwing 5-step prcess in net present value analysis: Step 1. Select the discunt rate. Step 2. Identify the csts/benefits t be cnsidered in analysis. Step 3. Establish the timing f the csts/benefits. Step 4. Calculate net present value f each alternative. Step 5. Select the ffer with the best net present value.
17 This sectin will demnstrate the use f that 5-step prcess in tw lease-purchase decisin examples using nminal discunt rates. Yu shuld fllw the same steps fr any net present value analysis whether yu are using nminal discunt rates r real discunt rates. Lease-Purchase Decisin Example 1. Assume that yu want t determine which f the fllwing prpsals will result in the lwest ttal cst f acquisitin? Offerr A: Prpses t lease the asset fr 3 years. The annual lease payments are $10,000 per year. The first payment will be due at the beginning f the lease, the remaining tw payments are due at the beginning f Years 2 and 3. Offerr B: Prpses t sell the asset fr $29,000. It has a 3-year useful life. Salvage value at the end f the 3-year perid, will be $2,000. Step 1. Select the discunt rate. The term f the lease analysis is three years, s we will use the nminal discunt rate fr three years, 5.4 percent. Steps 2 and 3. Identify and establish the timing f the csts/benefits t be cnsidered in analysis. The expenditures and receipts assciated with the tw ffers and their timing are delineated in the table belw: (Parentheses indicate a cash utflw.) Offer-Related Expenditures/Receipts t Offer A Offer B 0 ($10,000) ($29,000) 1 ($10,000) -0-2 ($10,000) $2,000 Step 4. Calculate net present value. The tables belw summarize the net present value calculatins applied t each alternative. Net present value f Offer A t Cash Flw DF PV 0 ($10,000) ($10,000)
18 1 ($10,000) ($9,470) 2 ($10,000) ($8,968) Net Present Value ($28,438) Nte the fllwing pints in the net present value calculatins abve: There are n cash inflws assciated with Offer A, nly utflws. Payments due nw are nt discunted. Offerr A payments due at the beginning f Years 2 and 3 are treated as if they are due at the end f Years 1 and 2. Yu culd have calculated the net present value f Offer A using the Sum f Discunt Factrs (Appendix A-1) fr the payments due at the beginning f Years 2 and 3. Remember that payments due nw are nt discunted and payments due at the beginning f Years 2 and 3 are treated as if they are due at the end f Years 1 and 2. The calculatins wuld be: Net present value f Offer B t Cash Flw DF PV 0 ($29,000) ($29,000) 3 $2, $ 1,698 Net Present Value ($27,302) Nte the fllwing pints in the net present value calculatins abve: Offer B salvage value is treated as a cash inflw at the end f Year 3. Payments due nw are nt discunted. Step 5. Select the ffer with the best net present value. In this example, we wuld select Offer B, the ffer with the smallest negative net present value.
19 Lease-Purchase Decisin Example 2. Assume that we want t determine which f the fllwing prpsals will result in the lwest acquisitin cst? Offerr A-Prpses t lease the asset fr 3 years. The mnthly lease payments are $1,500; that is, the ttal amunt fr each year is $18,000. These payments are spaced evenly ver the year, s the use f a MYDF wuld be apprpriate. Offerr B-Prpses t sell the asset fr $56,000. It has a 3-year useful life. At the end f the 3-year perid it will have a $3,000 salvage value. Step 1. Select the discunt rate. The term f the analysis is three years, s we will use the nminal discunt rate fr three years, 5.6 percent. Steps 2 and 3. Identify and establish the timing f the csts/benefits t be cnsidered in analysis. The expenditures and receipts assciated with the tw ffers and their timing are delineated in the table belw: Offer Expenditures/Receipts t Offer A Offer B 0-0- ($56,000) 1 ($18,000) -0-2 ($18,000) -0-3 ($18,000) $3,000 Step 4. Calculate net present value. The tables belw summarize the net present value calculatins applied t each alternative. Net present value f Offer A t Cash Flw DF PV 1 ($18,000) ($17,516) 2 ($18,000) ($16,587) 3 ($18,000) ($15,709) Net Present Value ($49,812) NOTE the fllwing pints in the net present value calculatins abve:
20 There are n cash inflws assciated with Offer A, nly utflws. Offerr A payments are due mnthly, s we used the nminal rate, mid-year factrs frm Appendix A-2. Yu culd als calculate the net present value f Offer A using the Sum f Discunt Factrs in Appendix A-2. That calculatin wuld prduce a slightly different answer due t runding differences. Net present value f Offer B t Cash Flw DF PV 0 ($56,000) ($56,000) 3 $3, $2,548 Net Present Value ($53,452) Nte the fllwing pints in the net present value calculatins abve: Offer B salvage value is treated as a cash inflw at the end f Year 3. Payments due nw are nt discunted. Step 5. Select the ffer with the best net present value. In this example, we wuld select Offer A, the ffer with the smallest negative net present value Identifying Issues And Cncerns Questins t Cnsider in Analysis. As yu perfrm price/cst analysis, cnsider the issues and cncerns identified in this sectin, whenever yu use net present value analysis. Is net present value analysis used when apprpriate? Net present value analysis shuld be used in any analysis supprting Gvernment decisins t initiate, renew, r expand prgrams r prjects which wuld result in a series f measurable benefits r csts extending fr three r mre years int the future.
21 Are the dllar estimates fr expenditures and receipts reasnable? The base fr all present value calculatins is estimated future cash flws. The ratinale fr thse estimates must be dcumented and supprted just like any cst estimate. This includes estimates f csts that will be included in the cntract r lease agreement and estimates f ther cash flws that are nt included. All may be used in present value calculatins. Are the times prjected fr expenditures and receipts reasnable? Discunt factrs depend n the discunt rate and the timing f the cash flw. The timing f any cash flw nt dcumented in the cntract r lease agreement must be clearly supprted. The fferr is respnsible fr estimating and defending cash flw estimates included in the prpsal. Gvernment technical persnnel have that respnsibility fr estimated csts related t item wnership. Are the prper discunt rates used in the net present value calculatins? Unless precluded by agency plicy, discunt rates shuld be taken frm Appendix C f OMB Circular A-94. If they are nt, the ratinale must be dcumented. The rate selected shuld be based n the number f time perids included in the analysis. If the perid f the analysis des nt match any f the discunt rate perids delineated in OMB Circular A-94, linear interplatin shuld be used t estimate a rate fr that perid f time. Nminal discunt rates shuld be used fr any analysis nt based n cnstant year dllars. Real discunt rates shuld be used fr any analysis that is based n cnstant year dllars. Are the prper discunt factrs used in analysis? The discunt factr shuld be calculated cnsidering the timing f the cash flw.
22 End-f-year discunt factrs (Appendices A-1 and A-3) shuld be used fr cash flws at the beginning r end f the year. Mid-year discunt factrs (Appendices A-2 and A- 4) shuld be used fr cash flws in the middle f the year r regularly thrughut the year (e.g., mnthly r quarterly). Are discunt factrs prperly calculated frm the discunt rate? End-f-year r mid-year discunt rates shuld be calculated fllwing the prcedures delineated in Sectin 9.4. Have all cash flws been cnsidered? Net present value analysis must cnsider all relevant cash flws thrughut the decisin life cycle.
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Understanding Current Procedural Technology (CPT) Codes
Current Procedural Terminology (CPT) is a code set developed and maintained by the American Medical Association (AMA) that describes medical, surgical, and diagnostic procedures. CPT codes allow for uniform communication, research, and data analysis across local, regional, state, and national bodies. CPT Codes are updated annually on January 1.
Unlike ICD codes, CPT codes are trademarked by the AMA, making it impossible to find a comprehensive list of CPT codes online. But you should still know how to use them to look up procedures and understand their role in the medical billing and coding industry. These five-digit numeric codes identify medical procedures and services in a standardized manner, and are used by physicians, coders, health insurance companies, accreditation agencies, and patients. CPT codes can be used for financial, analytical, and administrative purposes, and are divided into three categories.
CPT Category I Codes
CPT is organized into three distinct categories. The first category, which is by far the largest of the three, contains codes for six subtypes of procedures. Much like ICD-9 and ICD-10, these procedural codes are organized into clusters, which are then subdivided into more specific ranges. For instance, codes for radiology fall in the number range of 70010 to 79999, and codes for a diagnostic ultrasound procedure fall into the range of 76506 to 76999. Within that number range, procedures have a designated code, ensuring healthcare payers record exactly which procedure a patient has undergone. For example, the codes 99213 and 99214, which you may have seen on your medical bill following a checkup, correspond to routine doctor’s visits (of simple and medium complexity, respectively).
As is the case with ICD-9 or ICD-10, the goal of CPT codes is to condense as much information as possible into a uniform language. CPT codes are designed to cover all kinds of procedures and are therefore very specific. For example, the code for a 45-minute session of psychotherapy with a patient and/or family member is 90834, while the code for a 60-minute session with a patient and/or family member is 90837.
CPT Category II Codes
The second section of CPT (Category II, or CPT II) consists of optional supplemental tracking codes. These codes are formatted with a letter as their fifth character, and are coded after the initial CPT code. These Category II codes include information on test results, patient status, and additional medical services performed within the larger Category I procedure. Like Category I codes, they are divided into clusters. CPT II codes for Patient Management, for example, fall into the 0500F-0575F range. While optional, these codes reduce the need for record abstraction and chart review, and lower the administrative burden on healthcare professionals. In addition to increasing efficiency, Category II CPT codes facilitate research and the collection of data related to the quality of patient care. Some codes also relate to state or federal law, as in the case of the codes 3044F-3046F, which document the blood alcohol level of a patient.
These codes are a supplement, not a substitute, for the codes in Category I, and therefore must always be attached to an existing Category I code. An example of a CPT code with a Category II code attached is 80061-3048F, which describes a test of low-density lipoprotein cholesterol (CPT I code 80061), with a result of less than 100 mg of cholesterol per deciliter (CPT II code 3048F).
CPT Category III Codes
The third section of the CPT code is devoted to new and emerging technologies or practices. Note that this code does not indicate that the service performed is ineffectual or purely experimental. A Category III code simply means the technology or service is new and data on it is being tracked. Like Category II codes, Category III CPT codes are numeric-alpha, meaning the last digit is a letter. After a predetermined period of time (typically five years of data tracking), a procedure or technology described by a Category III code may move into Category I, unless it is demonstrated that a Category III code is still needed.
Understand How CPT and ICD-9-CM Codes Interact
CPT codes work in tandem with ICD-9-CM codes to create a comprehensive picture of medical services rendered. ICD-9-CM codes, discussed in detail in Course 10, are numeric (and in certain cases alphanumeric) diagnostic codes that describe the symptoms, area, and type of injury or disease in a patient. When listed together, ICD-9-CM and CPT codes present a picture of both the diagnosis of an injury or disease and the type of service provided to the patient by the healthcare provider.
In some cases, it may be necessary to convert CPT codes to ICD-9-CM codes. ICD-9-CM’s alphanumeric codes describe the services, tests, consultations, and any other way that that a healthcare provider has interacted with a patient. There is often significant overlap between this set of codes and CPT. For instance, the CPT code for two doses of Hepatitis A vaccine, of pediatric or adolescent dosage, for intramuscular use is 90633. The ICD-9-CM code for that same vaccine is V05.3. In general, CPT codes provide more specificity than their ICD-9-CM counterparts. For instance, three doses of the above vaccine is coded in CPT as 90634, while in ICD-9-CM it is still coded as V05.3. Medical coders should familiarize themselves with the equivalencies between these two code systems, and be able to freely translate one into the other.
In addition to converting between these two codes, medical coders must ensure that the code they enter for a medical procedure (the CPT code) makes sense with the diagnosis code (ICD-9-CM). The two codes work in tandem to show which procedure was done for what reason. By confirming that the codes correspond correctly, coders ensure that a claim will not be denied and returned by a health insurance company. For instance, if you submitted a claim for a Human Papilloma Virus vaccine (CPT code 90650), but list the diagnosis as acute appendicitis with generalized peritonitis (ICD-9-CM code 540.0), a health insurance company would catch this error, deny the claim, and return it to you for correction. Lastly, the upcoming switch to ICD-10-CM on October 1, 2014, means that coders should also be able to convert CPT codes into ICD-10-CM codes.
Use CPT Codes to Determine Doctor Fees
CPT codes can be used to assess the actual costs of a procedure in terms of the doctor’s fees. While medical billers and coders have access to this information already, the AMA allows non-professionals and students the ability to use a free CPT lookup for one procedure at a time. This is done through the CodeManager system on the AMA website, which allows patients to enter an existing CPT code to determine the procedure or treatment or look up a CPT code by entering the procedure, which will allow you to assess the cost paid by Medicare for this procedure in your area. In addition, you can also determine the average cost of this service throughout the U.S.
Step-by-Step process for looking up CPT codes
The steps for looking up the cost of a treatment or procedure using the CodeManager system are simple.
- Get Started. First, click the above link to enter the AMA CodeManager website.
- Agree to play by the rules. You will have to read and click an agreement that stipulates that you do not sell the information you receive from the website, and that the number of times you can use this service are limited. To continue, hit the “Agree” button.
- Specify your location. Next, the screen asks you to select the state and nearest city in which the procedure was performed,
- Specify your procedure. Enter either the CPT code or keywords that describe the medical treatment or procedure you wish to look up.
Your query may not return anything right away, so use these tips to search successfully:
- Try a few different search terms. For example, if you were trying to determine the cost of surgery to remove a ruptured appendix, you could enter the keywords “appendectomy” or even just “appendix”, which would lead you to several possible procedures and their costs, including code 44960 for a simple appendectomy, as well as other codes describing unlisted procedures involving the appendix, examinations of that organ, and related surgical procedures.
- Use medical terminology. In most cases, procedures and body parts are described by their medical terms, so while a search for “hip replacement” will give you no hits, a search for “hip arthroplasty” will give you several options of possible procedures. Of course, if you have the CPT code you can enter it outright and it will take you straight to the relevant procedure.
Note that in the costs column, the medical payment listed can either be “non facility” or “facility”, depending on where the procedure was conducted. Facilities include hospitals, including emergency rooms, ambulatory surgical centers (ASCs), and skilled nursing facilities (SNFs), while non facility means any other setting, such as clinics or private practice offices. You may also notice that some procedures can only be conducted in a facility or non-facility setting, which means that the other column will have an “NA” or non-applicable label and no price.
Using RVUs to determine average costs
The medical payments listed are an average of the Medicare cost throughout the U.S. multiplied by the relative value amount (RVU) of a region, which may be higher or lower than 1.0. For example, the same procedure, such as an appendectomy (44950), is priced at $722.57 in Manhattan but only $642.29 throughout Arizona. This is due to the relative costs of goods and services in a region, and is reflected in CPU pricing.
It is also very important to note that the prices listed on the CodeManager website reflect the cost of a procedure paid by Medicare based on the Medicare Physician Fee Schedule (MPFS), which is very close to its actual cost, though the prices patients or insurance providers are typically charged more to account for the costs of the facility and its staff; This is particularly true of private medical institutions. | <urn:uuid:2181f728-8eef-4f81-90b9-0aacafb855bc> | {
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Diagnosis Code A48.51
Information for Medical Professionals
The following edits are applicable to this code:
Pediatric diagnoses - Pediatric. Age range is 0–17 years inclusive (e.g., Reye’s syndrome, routine child health exam).
Convert to ICD-9
- 040.41 - Infant botulism
- Foodborne botulism
- Foodborne botulism, type A
- Infantile botulism
- Intestinal botulism
- Neonatal botulism
- Poisoning by skeletal muscle relaxant
- Toxicoinfectious botulism
Information for Patients
Botulism is a rare but serious illness. The cause is a toxin (poison) made by a bacterium called Clostridium botulinum. It occurs naturally in soil.
There are several kinds of botulism. Foodborne botulism comes from eating foods contaminated with the toxin. Wound botulism happens when a wound infected with the bacteria makes the toxin. It is more common in heroin users. Infant botulism happens when a baby consumes the spores of the bacteria from soil or honey. All forms can be deadly and are medical emergencies.
Symptoms include double or blurred vision, drooping eyelids, slurred speech, difficulty swallowing, dry mouth, and muscle weakness. Treatment may include antitoxins, intensive medical care, or surgery of infected wounds.
To prevent botulism:
- Be very careful when canning foods at home
- Do not let babies eat honey
- Get prompt medical care for infected wounds
Centers for Disease Control and Prevention
- Botulism (Medical Encyclopedia)
- Infant botulism (Medical Encyclopedia)
General Equivalence Map Definitions
The ICD-10 and ICD-9 GEMs are used to facilitate linking between the diagnosis codes in ICD-9-CM and the new ICD-10-CM code set. The GEMs are the raw material from which providers, health information vendors and payers can derive specific applied mappings to meet their needs.
- Approximate Flag - The approximate flag is on, indicating that the relationship between the code in the source system and the code in the target system is an approximate equivalent.
- No Map Flag - The no map flag indicates that a code in the source system is not linked to any code in the target system.
- Combination Flag - The combination flag indicates that more than one code in the target system is required to satisfy the full equivalent meaning of a code in the source system.
Present on Admission
The Present on Admission (POA) indicator is used for diagnosis codes included in claims involving inpatient admissions to general acute care hospitals. POA indicators must be reported to CMS on each claim to facilitate the grouping of diagnoses codes into the proper Diagnostic Related Groups (DRG). CMS publishes a listing of specific diagnosis codes that are exempt from the POA reporting requirement. | <urn:uuid:7afa99dc-1795-4da0-9a48-d2047beb6272> | {
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ICD-10: A Short Story
By: Sajeesh Jinaraj
ICD-10-CM is the 10th revision of an international coding system used around the world, the International Classification of Diseases. The United States, which as of now uses ICD-9, will be one of the last developed nations to move to ICD-10, which much of the world has been utilizing for over 12 years.
ICD-10 is a product of the World Health Organization (WHO) designed for official collection of diagnostic data. The United States uses the ICD system to code diagnoses for all healthcare encounters. When ICD codes are tied to the American Medical Association’s (AMA) Common Procedure Terminology (CPT) codes, appropriate payment can be returned to the practicing physician.
It is important to understand the major improvements and changes between ICD-9 and ICD-10 diagnosis codes.
|ICD-9-CM Diagnosis Codes||ICD-10-CM Diagnosis Codes|
|No-Laterality||Laterality -Right or Left account for >40% of codes|
|3-5 digits||7 digits|
|First digit is alpha (E or V) or numeric||Digit 1 is alpha; Digit 2 is numeric|
|Digits 2-5 are numeric||Digits 3–7 are alpha or numeric|
|No placeholder characters||“X” placeholders|
|14,000 codes||69,000 codes to better capture specificity|
|Limited Severity Parameters||Extensive Severity Parameters|
|Limited Combination Codes||Extensive Combination Codes to better capture complexity|
|1 type of Excludes Notes||2 types of Excludes Notes|
- Importance of Anatomy: Injuries are grouped by anatomical site rather than by type of injury.
- Incorporation of E and V Codes: The codes corresponding to ICD-9-CM V codes (Factors Influencing Health Status and Contact with Health Services) and E codes (External Causes of Injury and Poisoning) are incorporated into the main classification rather than separated into supplementary classifications as they were in ICD-9-CM.
- New Definitions: In some instances, new code definitions are provided, reflecting modern medical practice (e.g., definition of acute myocardial infarction is now 4 weeks rather than 8 weeks).
- Restructuring and Reorganization: Category restructuring and code reorganization have occurred in a number of ICD-10-CM chapters, resulting in the classification of certain diseases and disorders that are different from ICD-9-CM.
- Reclassification: Certain diseases have been reclassified to different chapters or sections in order to reflect current medical knowledge.
Replacing ICD-9-CM with ICD-10-CM and ICD-10-PCS, which handles procedure codes, will provide higher-quality information for measuring healthcare service quality, safety, and efficacy. This will give better information to:
- Quality measurement and medical error reduction (patient safety).
- Outcomes measurement.
- Clinical research.
- Clinical, financial, and administrative performance measurement.
- Health policy planning.
- Operational and strategic planning and healthcare delivery systems design.
- Payment systems design and claims processing.
- Reporting on use and effects of new medical technology.
- Provider profiling.
- Refinements to current reimbursement systems, such as severity-adjusted DRG systems.
- Pay-for-performance programs.
- Public health and bioterrorism monitoring.
- Managing care and disease processes.
- Educating consumers on costs and outcomes of treatment options.
Moving to the new code sets will also permit improved efficiencies and lower administrative expenses as a result of replacing a dysfunctional classification system. In turn, this allows:
- Increased use of automated tools to facilitate the coding process.
- Decreased claims submission or claims adjudication costs.
- Fewer rejected and improper reimbursement claims.
- Greater interoperability.
- Decreased need for manual review of health records to meet the information needs of payers, researchers, and other data mining purposes.
- Decreased need for large research organizations to maintain dual classification systems (one for reimbursement and one for research).
- Reduced coding errors.
- Reduced labour costs and increased productivity.
- Increased ability to prevent and detect healthcare fraud and abuse.
It has become clear that the benefits far outweigh the costs of implementation by evaluating the dollar estimation of the advantages in the following categories:
- More accurate payment for new procedures.
- Fewer rejected claims.
- Fewer fraudulent claims.
- Better understanding of new procedures.
- Improved disease management.
The transition will be tough. Even the well prepared office may run into problems directly following the transition. Be prepared to see a decrease in productivity and accuracy, as well as the need for additional training and education. Expect delays in claims processing and an increase in the number of rejected claims, but to continue with the quotable theme “no pain, no gain.” It is our responsibility to propel the healthcare industry forward, and ICD-10 is a very important step in that process.
As a broad outline, the following 8 steps will help ensure successful implementation of ICD-10 this year:
- Engage a team:The transition team should be headed by a physician and include the practice executive, coders, other office staff and medical assistants. Those who document the medical record must be involved and begin training soon.
- Establish a plan and then Execute it:These are multiple plans, including one for education and training, one for assessing current documentation, one for conducting a gap analysis, and one for implementation. Watch for and participate in the AAOS educational program on ICD-10 transition and implementation this year. Once the plans are made, execute them.
- Conduct a gap analysis:A skilled consultant or team should take the top 25 to 40 diagnoses seen in the practice. Using current documentation, the team should code the same cases to ICD-10-CM, and see what is missing.
- Get focused training:Send office staff to a seminar or hire a consultant to do specific onsite training, focused on orthopaedics and any specialty area of the practice.
- Follow through:Do this particularly on the clinical documentation improvement plan. Make the changes in your electronic health record system template. Capture the data you need for the specific and best code to be selected.
- Identify ICD code usage: Where does your practice use ICD codes? Identify all places where you use ICD codes, because all will need to be changed. Take advantage of the opportunity to make process improvements.
- Continue testing: Training is not a one-time exertion; it must be consistent.
- Champion the change: Be the physician champion in your office who is supportive of this change and demonstrate your ability to give a detailed diagnosis or diagnoses for coding.
This is not a Heart-breaking situation, and there is no reason to panic. Good clinical documentation is the foundation, and having coders trained in ICD-10-CM will help through the transition.
- 6 Benefits of Integrating ICD-10 Codes.
- ICD-10 Definition.
- ICD-10 Code Set to Replace ICD-9.
- ICD-10 Taskforce Bulletin.
- ICD-10-CM: It Is Not All That Bad
- Successful ICD-10 Testing Shows Industry Ready to Take Next Step to Modernize Health Care
- Cloud Based EHR software for Clinical Care in Emerging CountriesSep 18 , 2018
- 7 Things to do to Protect Against Ransomware AttacksAug 08 , 2018
- Oh EHR, how can we love thee?Apr 20 , 2018
- What’s in Store for Practice Fusion UsersJan 31 , 2018
- What is precision medicine? And how can EHR help?Jan 05 , 2018
- What’s the SOAPware alternative?Dec 15 , 2017
- Artificial Intelligence, EHRs and the future of health technologyNov 02 , 2017
- ACA Executive order’s impact on EMR and eHealth technologyOct 25 , 2017
- EHRs and Mental Health: What Needs to Change?Sep 29 , 2017
- American Medical Association (And Others) Unhappy With EHR ProvidersSep 22 , 2017 | <urn:uuid:0460fb08-7dfa-42df-b7de-18ae565b9e94> | {
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June 4, 2012
Coding for ‘Summertime Blues’
For The Record
Vol. 24 No. 11 P. 28
Coding for Lyme Disease
Lyme disease is a tick-borne bacterial disease characterized by a distinctive rash, flulike symptoms, and aching joints. A person can contract the disease when bitten by a deer tick infected with the spiral-shaped bacterium Borrelia burgdorferi. If the tick remains attached to the person for more than 48 hours, the bacterium passes into the person’s bloodstream; however, prompt removal of the tick may prevent infection. Also, not all ticks carry the bacterium, and not all infected tick bites cause Lyme disease.
The signs and symptoms of Lyme disease vary greatly and may involve more than one body system, such as the skin, joints, and nervous system. Common signs and symptoms include a bull’s-eye rash at the site of the tick bite; flulike symptoms such as fever, chills, fatigue, body aches, and headache; migratory joint pain that may develop a few months after the initial tick bite if the infection is not treated; and, in severe cases, neurological problems such as meningitis, Bell’s palsy, numbness or weakness in extremities, and impaired muscle movement.
Lyme disease is classified to ICD-9-CM code 088.81. In severe cases, other conditions may be associated with the Lyme disease. Sequence code 088.81 first followed by the code for the associated condition, such as the following:
• arthritis: 088.81 + 711.8x (The fifth-digit code assignment depends on the site of the arthritis.);
• cardiomyopathy: 088.81 + 425.8;
• encephalitis: 088.81 + 323.41;
• meningoencephalitis/meningitis: 088.81 + 320.7;
• myelitis: 088.81 + 323.42; and
• myocarditis: 088.81 + 422.0.
When coding the late effects of Lyme disease, sequence the late-effect code (139.8) first. “If the patient has been cured of Lyme disease, but still suffers from a residual (chronic) condition, code as a late effect” (AHA Coding Clinic for ICD-9-CM, 1991, fourth quarter, pages 14-16). If there is insufficient information in the medical record to identify late Lyme disease or a late effect of Lyme disease, ask the physician for clarification. The length of time between the initial diagnosis of Lyme disease and the current symptoms is not enough evidence to determine if the Lyme disease is current or a late effect/sequela.
Coding for Poison Ivy
Poison ivy, as well as poison oak and poison sumac, are types of allergic contact dermatitis that may cause a skin rash. Allergic contact dermatitis is caused by exposure to a material to which the person has become hypersensitive. Typically, the person will not have a reaction the first time he or she is exposed to the substance. However, repeated exposure may cause sensitivity to the allergen and therefore cause a reaction with subsequent exposure. Code 692.6, Contact dermatitis/eczema due to plants, is assigned for poison ivy, oak, or sumac. The symptoms of rash include itchy skin at the point of contact, red streaks/lines or general redness, small bumps or hives, and fluid-filled blisters.
Typically the rash occurs eight to 48 hours after the contact. However, it may occur as early as five hours or as late as five days after exposure to the plant.
Coding for Sunburn
A sunburn occurs after a few hours of exposure to the sun and causes red, painful skin that is warm to the touch. The common signs and symptoms of sunburn include pinkness or redness, warm to hot skin, pain and tenderness, swelling, fluid-filled blisters, headache, fever, and fatigue.
Code assignment for sunburn depends on the degree of burn as follows:
• 692.71, First-degree sunburn;
• 692.76, Second-degree sunburn; and
• 692.77, Third-degree sunburn.
Sunburn of unspecified degree is classified to code 692.71. A burn from UV rays other than the sun, such as a tanning bed, is classified to code 692.82. Code 692.82 also includes infrared rays; light, except from the sun; radiation not otherwise specified; and X-rays.
Coding and sequencing for Lyme disease, poison ivy, and sunburn are dependent on the physician documentation in the medical record and application of the Official Coding Guidelines for inpatient care. Also, use specific AHA Coding Clinic for ICD-9-CM and American Medical Association CPT Assistant references to ensure complete and accurate coding.
— This information was prepared by Audrey Howard, RHIA, of 3M Consulting Services. 3M Consulting Services is a business of 3M Health Information Systems, a supplier of coding and classification systems to more than 5,000 healthcare providers. The company and its representatives do not assume any responsibility for reimbursement decisions or claims denials made by providers or payers as the result of the misuse of this coding information. More information about 3M Health Information Systems is available at www.3mhis.com or by calling 800-367-2447.
ICD-10-CM Coding for ‘Summertime Blues’
In ICD-10-CM, combination codes are available for Lyme disease. Therefore, only one code may be necessary to identify the Lyme disease and the associated condition. Lyme disease is classified to code A69.2. A fifth character is needed to identify the commonly associated conditions such as follows:
• A69.20, Lyme disease, unspecified;
• A69.21, Meningitis due to Lyme disease;
• A69.22, Other neurologic disorders in Lyme disease (applicable to Cranial neuritis, Meningoencephalitis, Polyneuropathy);
• A69.23, Arthritis due to Lyme disease; and
• A69.29, Other conditions associated with Lyme disease (applicable to Myopericarditis due to Lyme disease).
Code L23.7, Allergic contact dermatitis due to plants, except food, is assigned to identify poison ivy, oak, and sumac.
Sunburn is classified to category L55 in ICD-10-CM. Similar to ICD-9-CM, a fourth character will identify the degree in ICD-10-CM as follows:
• L55.0, Sunburn of first degree;
• L55.1, Sunburn of second degree;
• L55.2, Sunburn of third degree; and
• L55.9, Sunburn, unspecified. | <urn:uuid:0db35c44-d339-4b8c-8605-6ad7ccebca2e> | {
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Geographic atrophy is a chronic progressive degeneration of the macula and can be seen as part of late-stage age-related macular degeneration (AMD). The condition leads to central scotomas and permanent loss of visual acuity.
- ICD-9-CM: 362.51 Nonexudative senile macular degeneration
- ICD-10-CM: H35.31 Nonexudative age-related macular degeneration
Geographic atrophy (GA) is a chronic progressive degeneration of the macula, as part of late-stage age-related macular degeneration (AMD). The disease is characterized by localized sharply demarcated atrophy of outer retinal tissue, retinal pigment epithelium and choriocapillaris. It starts typically in the perifoveal region and expands to involve the fovea with time, leading to central scotomas and permanent loss of visual acuity. It is bilateral in most cases. Over 8 million people are affected worldwide with GA, approximately 20% of all individuals with AMD. The incidence of GA is expected to rise as the age-burden of developed countries is increasing.
Several risk factors have been noted by several studies. The most pronounced risk factor is increasing age and family history of AMD. Smoking history increases the risk of GA significantly. Both active smokers, but also former smokers are at greater risk of developing geographic atrophy. One retrospective study through the Asian Eye Epidemiology Consortium found that GA is relatively uncommon in Asian populations when compared with those of European Ancestry. This study also showed that the ratio of GA to neovascular AMD, another complication of advanced AMD, in the Asian population is lower (1:3) compared to that of the European population (1:1). Studies focusing on the United States have not found any gender difference in the prevalence of geographic atrophy, but the Asian Eye Epidemiology Consortium found a higher prevalence of GA in men. The Age-Related Eye Disease Study also found an increased risk of GA in users of thyroid hormones or antacids. People with higher education were at a lower risk of GA. Other studies have pointed out an increase in risk of GA in patients with coronary heart disease as well as in patients with lens opacities or previous cataract surgery. The Comparison of Age-Related Macular Degeneration Treatments Trial (CATT) found that older age, hypercholesterolemia, worse visual acuity, larger choroidal neovascularization (CNV) area, retinal angiomatous proliferation (RAP) lesion, GA in the fellow eye, and intraretinal fluid were associated with a higher risk of incident GA. They also found that thicker subretinal tissue complex and presence of subretinal fluid were associated with slower development of GA. 3 One of the strongest risk factors was poor visual acuity at baseline, specifically visual acuity at or worse than 20/200 had almost a 3-fold risk of developing GA than those with a baseline of 20/25-20/40.
The pathogenesis of GA remains unclear. The natural course of AMD begins with early stages that are characterized by presence of drusen that are yellow deposits between the retinal pigment epithelium and Bruch’s membrane. Pigment displacement is also seen. Late stages of AMD is either characterized by choroidal neovascularization, or GA. GA is recognized as a sharply defined area in the posterior pole, with atrophy of the retinal pigment epithelium, the overlying photoreceptors and the choriocapillaris. The defect in structures allows the observer to see the larger underlying choroidal vessels. Reticular pseudodrusen are associated with the development of GA The progression rate of GA varies, but is relatively slow and progresses over years. As the atrophic area expands, visual function decreases. Clinically, the exudative and non-exudative AMD are very different, but these late stages of AMD are not mutually exclusive. Individuals with GA are at a high risk of developing choroidal neovascularizations, and patients with exudative AMD are at an increased risk of developing atrophic areas.
The cause of GA is not fully known, though it has been studied extensively. Genetic and environmental factors seems to contribute substantially. Complement factor H variant Y402H and ARMS2 have been associated with increased risk of GA development. Drusen are shown to contain multiple complement components, indicating that localized inflammation mediated by the complement system is an important element in AMD. This has been suggested to be a systemic immune-dysfunction, with retinal manifestation. Oxidative stress and low grade inflammation seem to play a role in AMD. . In donor eyes with GA, choroidal T-lymphocytes and macrophages are noted to produce proinflammatory cytokines. Furthermore, it has been found that mononuclear phagocytes are seen in abundance in the subretinal space in eyes with GA. Their possible role in photoreceptor rescue or degeneration is unknown. Another recent study found that choroidal thickness may have a role in the pathogenesis of the unilateral form of GA, whereas Müller cells and their supported photoreceptors may play a role in bilateral GA. New research is indicating that direct RNA toxicity, specifically Alu RNA mediated inflammation might play a significant role in the pathogenesis of GA.
The diagnosis of geographic atrophy is clinical and can be made by ophthalmoscopy.
The typical patient with geographic atrophy is above 60 years of age, with gradually progressing loss of visual function.
Ophthalmoscopy with visualization of the fundus, enables the trained ophthalmologist to observe drusen, as well as the atrophic area. In some cases, the atrophic area is unifocal, but in many cases, it shows as a multifocal disease within the macula area.
Geographic atrophy is one of the two forms of late stage AMD. The first sign is drusen, which can vary in size and number according to stage of disease. Small atrophic lesions begin to appear early on in the extrafoveal area that slowly expand into the fovea as the disease progresses.
In cases of GA, the fovea can be sparred for a long time, so that the measured visual acuity can remain nearly normal, but the contrast sensibility as well as the ability to read suffers. The patient experiences relatively rapid function loss, when the fovea is involved due to loss of visual acuity.
The diagnosis of geographic atrophy is clinical, and is made on ophthalmoscopy or on fundus photo. The ophthalmologist will see a macula decorated with drusen and a sharply demarcated area in the macular region with atrophic retina, lacking pigmentation and visible underlying choroidal vessels.
The clinical examination is key in diagnosing geographic atrophy, but other imaging techniques can be useful, especially in monitoring disease.
Fundus autofluorescense is currently the standard imaging technology to visualize the retinal pigment epithelium (RPE) in geographic atrophy. Vital RPE contains intracellular lipofuscin. When exposed to light at a specific wavelength, lipofuscin absorbs this, and emits light in another wavelength, from where the fluorescence signal originates. In the fovea, the signal diminishes physiologically, due to absorption by the macular pigment. If atrophy of RPE occurs, this causes a distinct dark area, due to absence of lipofuscin-containing cells, and therefore lack of fluorescent signal. These sharp contrasts between completely dark and light grey, has made it possible to introduce a semiautomated segmentation algorithm, to detect and quantify the size of the atrophic area. Previously the preferred method was to manually outline the borders. Besides helping quantify the atrophic lesion, fundus autofluorescense also provides important information on expected progression rate through the amount of hyperfluorescense noted in the junctional zone of the lesion. Hyperfluorescense is an accumulation of lipofuscin in the RPE cells and is thought to be due to suffering/dying cells, as it is typical to observe atrophy in the hyperfluorescent area. The amount of hyperfluorescense correlates well with the rate of GA progression.
Optical coherence tomography (OCT) also provides important information. The atrophy of the retinal layers can be clearly seen with this non-invasive imaging technique; it has been demonstrated that some morphologic changes, such as a split between RPE and Bruch’s membrane in the junctional zone may be an indication of fast progression. Patients suffering from geographic are at a highr risk of developing choroidal neovascularizations, which can cause an even faster loss of visual function. Therefore, OCT can help in early recognition of intraretinal fluid, which is important in order to initiate treatment early. Measurement of visual acuity with a reading chart often provides poor information on the actual function of the retina, due to foveal sparing, and parafoveal scotomas. A better tool to evaluate the visual function is Microperimetry, a technique that stimulates themacula over 20 degrees, in various spots, with varying intensity of light, and the result depends on the patient’s ability to report recognition of the stimuli. In this way, low-luminance visual acuity and contrast sensitivity can also be measured. Studies using microperimetry have shown that the sensitivity of non-atrophic retina is decreased, and that this loss correlates with progression of GA over time.
In Multifocal electroretinography, light stimuli is performed in patterns across the retina, and photoreceptor signaling is detected by an electrode. By varying the light stimuli, the retina is mapped with information on functionality and sensitivity. Reading ability, or reading speed, can be quantified by the number of correctly read words in a limited amount of time. Radner and MNREAD reading charts are validated in several languages. Patients with GA and BCVA≥20/50 have shown to be significantly slower at reading compared to patients with intermediate AMD.
Geographic atrophy is a clinical diagnosis, and so far, there are no laboratory tests as part of the diagnostic or monitoring of disease.
Atrophy of the retina due to other causes are in the differential of geographic atrophy, such as: atrophy secondary to anti-VEGF treatment, atrophy secondary to pattern dystrophy or central areolar choroidal dystrophy.
At this time, there is no treatment available, medical or surgical, that can halt or reverse the progression of geographic atrophy. Visual rehabilitation is often necessary, even in cases of tolerable visual acuity, as contrast sensibility and reading ability can suffer in cases of foveal sparring and parafoveal scotoma. Monitoring of intra or subretinal fluid is important in early diagnosis of choroidal neovascularization, as this group of patients are at higher risk. The AREDS study showed that patients with visual loss due to AMD were at high risk of developing neovascular AMD, and that AREDS2 vitamin supplements decrease the odds by 38% of developing neovascular AMD. The study did not show any beneficial effects on slowing down the progression of geographic atrophy. Several therapeutic agents for GA are in phase II and III clinical trials, targeting oxidative stress or inflammation or complement pathways to reduce the rate of GA progression. Recent Phase III trials found that lampalizumab, a selective complement factor D inhibitor, and tandospirone, a 5-HT1A agonist, were ineffective at reducing enlargement of lesions from GA secondary to AMD. Orally administered alpha-lipoic acid, an antioxidant, was evaluated in a phase 2 clinical trial but did not have any beneficial effects on GA lesion size nor best-corrected visual acuity. However, intravitreal brimonidine was shown to reduce GA lesion area growth within 3 months in a Phase 2 clinical trial. Ongoing treatment trials include neuroprotective agents (Ciliary neurotrophic factor, Tandospirone, tetracycline dervatives) and visual cycle inhibitors ( Fenretinide, Emixustat) as well as stem cell research; a few may hold future promise in the halting the progression of geographic atrophy.
The prognosis is poor, as there are no available treatment, and the disease is chronic and progressive. Progression of GA is associated with extensive decrease in visual acuity, a study has shown that 31% of patients with GA lose at least three lines of vision in 2 years, and the growth rate median is 2.1 mm2/year, but with variation up to 10.2mm2/year. The rate of progression differs between patients, but signs of fast progression is high amounts of hyperfluorescense shown on fundus autofluorescence, and a decrease retinal function regarding contrast sensitivity or reading ability.
- Fleckenstein, M., et al. The progression of geographic atrophy secondary to age-related macular degeneration. Ophthalmology 125, 369-390 (2018).
- Age-Related Eye Disease Study Research Group. Risk factors associated with age-related macular degeneration. A case-control study in the age-related eye disease study: Age-Related Eye Disease Study Report Number 3. Ophthalmology. 2000;107:2224-32.
- 1. Chakravarthy U, Augood C, Bentham GC, de Jong PT, Rahu M, Seland J, Soubrane G, Tomazolli L, Topouzis F, Vingerling JR, Vioque J, Young IS, Fletcher AE. Cigarette smoking and age-related macular degeneration in the EUREYE Study. Ophthalmology 2007 jun;114(6):1157-63.
- Rim, T.H., et al. Prevalence and pattern of geographic atrophy in Asia: the Asian Eye Epidemiology Consortium. Ophthalmology 127, 1371-1381 (2020).
- Smith W, Assink J, Klein R, Mitchell P, Klaver CC, Klein BE et al. Risk factors for age-related macular degeneration: Pooled findings from three continents. Ophthalmology 2001;108:697-704.
- Fraser-Bell S, Donofrio J, Wu J, Klein R, Azen SP, Varma R et al. Sociodemographic factors and age-related macular degeneration in Latinos: the Los Angeles Latino Eye Study. American Journal of Ophthalmology 2005;139:30-8.
- Grunwald, J.E., et al. Incidence and growth of geographic atrophy during 5 years of comparison of age-related macular degeneration treatments trials. Ophthalmology 124, 97-104 (2017).
- Young RW. Pathophysiology of age-related macular degeneration. Surv. Ophthalmol. 1987; 31:291-306.
- Schmitz-Valckenberg S, Fleckenstein M, Gobel AP, et al. Optical coherence tomography and autofluorescense findings in areas with geographic atrophy due to age-related macular degeneration. Invest Ophthalmol Cis Sci 2011;52:1-6.
- Marsiglia M, Boddu S, Bearelly S, et al. Association between geographic atrophy progression and reticular pseudodrusenin eyes with dry age-related macular degeneration. Invest Ophthalmol Vis Sci 2013;54:7362-7369.
- Holz FG, Pauleikhoff D, Klein R, Bird AC: Pathogenesis of lesions in late age-related macular disease. Am J Ophthalmol 2004;137:504-510.
- Sepp T, et al. Complement factor H variant Y402H is a major risk determinant for geographic atrophy and choroidal neovascularization in smokers and nonsmokers. Invest Ophthalmol Vis Sci 2006;47:536-540.
- Cameron DJ, et al. HTRA1 variant confers similar risks to geographic atrophy and neovascular age-related macular degeneration. Cell Cycle 2007;6:1122-1125.
- Hageman GS, Luthert PJ, Victor Chong NH, Johnson LV, Anderson DH, Mullins RF. An integrated hypothesis that considers drusen as biomarkers of immune-mediated processes at the RPE-Bruch’s membrane interface in aging and age-related macular degeneration. Prog Retin Eye Res 2001;20:705-732.
- Anderson DH, Radeke MJ, Gallo NB, Chapin EA, Johnson PT, Curletti CR, et al. The pivotal role of the complement system in aging and age-related macular degeneration: hypothesis re-visited. Prog Retin Eye Res 2010;29:95-112.
- Scholl HPN, Issa PC, Walier M, et al. Systemic complement activation in age related macular degeneration. PLoS ONE 2008;3:e2593.
- Beatty S, Koh H, Phil M, Henson D, Boulton M. The role of oxidative stress in the pathogenesis of age-related macular degeneration. Surv Ophthalmol 2000;45:115-134.
- Xu H, Chen M, Forrester JV: Para-inflammation in the aging retina. Prog Retin Eye Res 2009;28:348-368.
- Buschini E, Piras A, Nuzzi R, Vercelli A. Age related macular degeneration and drusen: neuroinflammation in the retina. Prog Neurobiol 2011;95:14-25.
- Camelo S. Association of Choroidal Interleukin-17-producing T Lymphocytes and Macrophages with Geographic Atrophy. Ophthalmologica 2016;236:53-58.
- Sennlaub F, Auvynet C, Calippe B, Lavalette S, Poupel L, Hu SJ, et al. CCR2(+) monocytes infiltrate atrophic lesions in age-related macular disease and mediate photoreceptor degeneration in experimental subretinal inflammation in CX3CR1 deficient mice. EMBO Mol Med 2013;5:1775-1793.
- Pilotto, E., et al. Müller cells and choriocapillaris in the pathogenesis of geographic atrophy secondary to age-related macular degeneration. Graefe's Archive for Clinical and Experimental Ophthalmology 257, 1159-1167 (2019).
- Mao, X. & Liu, Q. An emerging role of Alu RNA in geographic atrophy pathogenesis: the implication for novel therapeutic strategies. Discovery medicine 22, 337-349 (2016).
- Holz FG, Bindewald-Wittich A, Fleckenstein M, et al. Progression of geographic atrophy and impact of fundus autofluorescence patterns in age-related macular degeneration. Am J Ophthalmol 2007;143:463-472.
- Bearelly S, Khanifar AA, Lederer DE, et al. Use of fundus autofluorescense images to predict geographic atrophy progression. Retina 2011;31:81-86
- Owsley C, Jackson GR, Cideciyan AV, et al. Psychophysical evidence for rod vulnerability in age-related macular degeneration. Invest Ophthalmol Vis Sci 2000;41:267-273.
- Meleth AD, Mettu P, Agron E, et al. Changes in retinal sensitivity in geographic atrophy progression as measured by microperimetry. Invest Ophthalmol Vis Sci 2011;52:1119-1126.
- Sunnes JS, Rubin GS, Applegate CA et al. Visual function abnormalities and prognosis in eyes with age-related geographic atrophy of the macula and good visual acuity. Ophthalmology 1997;104:1677-1691.
- Schmitz-Valckenberg S, Fleckenstein M, Helb HM, et al. Invivo imaging of foveal sparring in geographic atrophy secondary to age-related macular degeneration. Invest Ophthalmol Vis Sci 2009;50:3915-3921.
- Sunness JS, Gonzalez-Baron J, Applegate CA, et al. Enlargement of atrophy and visual acuity loss in the geographic atrophy form of age-related macular degeneration. Ophthalmology 1999;106:1768-1779.
- The Age-Related Eye Disease Study Research Group: A randomized, placebo-controlled clinical trial of high-dose supplementation with vitamins C and E and beta carotene for age-related cataract and vision loss: AREDS report no. 9. Arch Ophthalmol 2001;119(10):1439-1452
- Holz, F.G., et al. Efficacy and safety of lampalizumab for geographic atrophy due to age-related macular degeneration: Chroma and Spectri phase 3 randomized clinical trials. JAMA ophthalmology 136, 666-677 (2018).
- Jaffe, G.J., et al. Randomized trial to evaluate tandospirone in geographic atrophy secondary to age-related macular degeneration: the GATE study. American journal of ophthalmology 160, 1226-1234 (2015).
- Kim, B.J., et al. Orally administered alpha lipoic acid as a treatment for geographic atrophy: A randomized clinical trial. Ophthalmology Retina 4, 889-898 (2020).
- Kuppermann, B.D., et al. Phase 2 study of the safety and efficacy of brimonidine drug delivery system (brimo dds) generation 1 in patients with geographic atrophy secondary to age-related macular degeneration. Retina 41, 144-155 (2021).
- Kandaswamy R, Wickremasinghe S, Guymer R. New Treatment Modalities for Geographic Atrophy. Asia Pac J Ophthalmol 2017;6(6):508-513.
- Sunnes et al. Enlargement of atrophy and visual acuity loss in the geographic atrophy form of age-related macular degeneration. Ophthalmology. 1999; 106:1768-1779.
- Sunnes JS, Margalit E, Srikumaran D, Applegate CA, Tian Y, Perry D, Hawkins B, Bressler NM. The Long-term Natural History of Geographic Atrophy from Age-Related Macular Degeneration : Enlargement of Atrophy and Implications for Interventional Clinical Trials. Ophthalmology 2007;114(2):271-277. | <urn:uuid:b915d32e-9ae5-4366-a1ea-0ec0e124afcd> | {
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CDC collects and reports TBI data to understand:
- How many people are affected by this injury
- Who is most at risk
- The leading ways a person may get a TBI
- Whether programs to prevent TBI are working
Based on the most recent data:
- There were approximately 223,050 TBI-related hospitalizations in 2018* and 60,611 TBI-related deaths in 2019.1
- This represents more than 610 TBI-related hospitalizations and 166 TBI-related deaths per day.
- These estimates do not include the many TBIs that are only treated in the emergency department, primary care, urgent care, or those that go untreated.2
- People age 75 years and older had the highest numbers and rates of TBI-related hospitalizations* and deaths.1 This age group accounts for about 32% of TBI-related hospitalizations and 28% of TBI-related deaths.
- Males were nearly two times more likely to be hospitalized (81.3 age-adjusted rate versus 44.4) * and three times more likely to die1 from a TBI than females (26.7 versus 8.2).
- Children (birth to 17 years old) had 16,480 TBI-related hospitalizations* in 2018 and 2,476 TBI-related deaths1 in 2019.
* This rate was calculated using the weighted number of hospitalizations with a primary diagnosis of injury (ICD-10-CM diagnosis codes S00-S99; T07-T34; T36-T50 with a 6th character of 1, 2, 3, or 4; T36.9, T37.9, T39.9, T41.4, T42.7, T43.9, T45.9, T47.9, or T49.9 with a 5th character of 1, 2, 3, or 4; T51-T76; T79; O9A.2-O9A.5; T84.04; or M97) and an ICD-10-CM diagnosis code for an initial medical encounter of TBI (S02.0. S02.1, S02.80-S02.82, S02.91, S04.02, S04.03, S04.04, S06, S07.1, T74.4) in any diagnosis field and dividing it by the corresponding civilian non-institutionalized population per 100,000. Data source: Healthcare Cost and Utilization Project’s National Inpatient Sample. 2018.
Please see the following CDC reports for more information on the leading causes of TBI and the groups of people at increased risk for TBI:
Surveillance and research to support data-driven solutions
CDC conducts research on preventing TBI before they happen and reducing the chance for disability and other potential effects of these injuries.
- Read TBI research published by CDC.
- Learn more about the National Concussion Surveillance System, a state-of-the-art data collection effort designed to learn how many Americans (children and adults) get a concussion each year and the leading causes of this injury.
- Centers for Disease Control and Prevention. National Center for Health Statistics: Mortality Data on CDC WONDER. Accessed June 2021, https://wonder.cdc.gov/mcd.html.
- Bell JM, Breiding MJ, DePadilla L. CDC’s efforts to improve traumatic brain injury surveillance. J Safety Res. 2017;62:253 -256. | <urn:uuid:2db8b5b6-7741-4014-852e-9e9a45139a26> | {
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Causes of Scoliosis
One question frequently asked by patients and their families after being diagnosed is how scoliosis is caused. Scoliosis is a type of spinal deformity that occurs in three dimensions. Instead of simply being a curve in two dimensions, there often is rotation, making scoliosis a three dimensional problem. In addition to being a 3D issue, there are different types of scoliosis which need to be treated differently. Some types only involve the spine and its muscles and connective tissues (ie. joints, ligaments and tendons) while others are what is known as “syndromic” meaning they are part of a larger syndrome of other symptoms and health problems. Additionally, other types of scoliosis include congenital scoliosis, neuro-muscular scoliosis (which often times is part of a syndrome, or syndromic), and last but not least, idiopathic scoliosis.
Now, you may have heard the term “idiopathic” or “idiopathic scoliosis” before. While the term “idiopathic” means that something “arises suddenly” or has an “unknown cause”; idiopathic scoliosis can be better thought of a case of scoliosis which does not fall under the other categories (ie. syndromic). This also highlights a myth: that adolescent idiopathic scoliosis has no cause.
This myth exists due to the doctors commonly calling a case of scoliosis “idiopathic” simply because they do not know the cause of a given case of scoliosis; often times because it is not immediately obvious. This is not to say that the scoliosis truly has some mystical unknown cause, but rather that the cause simply has not been identified YET. Here is an example: If you were to wake up with a sore neck, you could call your neck pain “idiopathic” because you don’t know what caused it. However, the real cause is not truly a mystery as you could have slept on it wrong, pulled a muscle, etc.; you simply have not figured out the cause YET.
The use (and over use) of the label “idiopathic” has somehow lulled the minds of doctors and clinicians into thinking that it is not possible to know what is causing scoliosis in most idiopathic cases. Unfortunately, sometimes parents and patients can misinterpret this to mean that “there is no cause” and that their case of scoliosis is caused by an absolute mystery; after all if the doctor says the case is idiopathic and the cause is unknown, who are we to question it?
The truth is, we can have a high level of certainty regarding how a scoliosis is caused; why the curve may be getting worse (progressing), and even what we might be able to do to address and control that “mysterious” cause.
Based on current medical and scientific research, scoliosis can be categorized into three major types; each with their own causes. For each type you can find the associated ICD 10 code as well. The ICD 10 codes which have been provided are scoliosis unspecified ICD 10 codes rather than specific (ie. thoracic) codes.
ICD 10 Code: 2018 ICD-10-CM Q67.5, Q76.3
Congenital scoliosis is a type of scoliosis that a child is born with. Typically with congenital patients, a morphological change (a physical, structural change) is present such as a structurally wedged vertebra, or an asymmetric vertebra. While not all congenital scoliosis cases have vertebra asymmetry, this is a very commonly understood reason why a child would be born with a scoliosis. The take-home lesson here is that the structural change (the asymmetry) may be how a congenital scoliosis is caused.
Structural asymmetry does not merely happen in the womb during a child’s development. These structural changes can also happen as a child develops and grows during childhood in an uneven or asymmetric way. One common developmental (happens with growth) asymmetry is when a child has one leg shorter than the other; also known as an anatomic short leg. In this case one leg grows faster than the other, leading to an uneven pelvis. The pelvis is no longer even or level, and as a result the spine becomes unlevel as well.
For the sake of simplicity and categorizing scoliosis types by what ultimately causes them, we would propose that instead of “Congenital” Scoliosis, referring to it as a “Structural Asymmetry Scoliosis” would be better. By doing this we more clearly state that a structural asymmetry is at the root cause of the problem.
ICD 10 Code: 2018 ICD-10-CM M41.40
Neuromuscular scoliosis is a type of scoliosis where a known neuromuscular problem ( a problem with the muscles and nerves) prevents the body from being able to hold the spine in an aligned position as the patient grows. This type of problem can be due to an issue somewhere in the muscles, in the nerves to the muscles, or somewhere in the brain as it orchestrates neuromuscular control. As we discussed earlier, neuromuscular scoliosis commonly occurs in individuals with other syndromes and can sometimes be thought of as “syndromic scoliosis” despite its neuromuscular nature. Some common conditions in this category are cerebral palsy, muscular dystrophy, or poliomyelitis. The list of genetic syndromes and diseases known to cause or be associated with scoliosis is a long one, which grows each year as new research is conducted and pours in. One thing is agreed upon by all experts is that neuromuscular disorders, such as cerebral palsy, appear to be the root CAUSE of some cases of scoliosis.
ICD 10 Code: 2018 ICD-10-CM M41.20
Idiopathic scoliosis is the classical “we don’t know” category:; the cause remains yet undiagnosed and so it is simply called idiopathic. Because of this, cases of idiopathic scoliosis can potentially represent a wide variety of underlying causes, possibly even including causes from the previously discussed categories (congenital and neuromuscular), simply because the underlying cause has not been properly diagnosed.
All sorts of varieties of scoliosis can end up in the idiopathic category when they are not yet diagnosed. In a perfect world, every patient that initially says “I don’t know the cause” would eventually be properly diagnosed and know how their scoliosis is caused. Unfortunately, most do not and their case is eternally referred to as idiopathic.
What is interesting about MOST cases of scoliosis that end up remaining in the idiopathic category, is that they clearly lack any obvious neuromuscular or structural asymmetry at their root. However, there is one more clue as to what causes most “idiopathic “ cases: The condition known as “tethered cord syndrome”.
Scoliosis Causes: Tethered Cord Syndrome
ICD 10 code: 2019 ICD-10-CM Q06.8
Tethered cord syndrome is a condition that occurs when the spinal cord becomes abnormally stuck to the bottom of the spinal canal during embryological development. So what happens as a result? Well, at birth the spinal cord is stuck, but in most cases no scoliosis occurs UNTIL the patient begins to grow. As the patient grows during their childhood, their spinal cord (which is stuck) begins to pull on the spine (because it is stuck or “tethered”) which causes the spine to coil down, causing a scoliosis that worsens with growth (you can learn more about scoliosis worsening due to growth here).
This is a wonderful explanation about why patients with tethered cord syndrome can get scoliosis and how it causes it, but how does this relate to idiopathic cases? Well, the lesson we can learn from tethered cord syndrome is this: Tension along the spinal canal or neuraxis can lead to scoliosis. This may sound like a new and radical idea, however you’ll be surprised to know this concept has been around for over 50 years!
How Scoliosis is Caused by Nerve Tension
Back in 1968, Dr. Milan Roth proposed that spinal cord tension, or a short spinal cord could be at the root cause of most idiopathic scoliosis, even if there was no obvious tethered cord syndrome. According to Dr. Roth’s research, the spinal cord and nerve roots may grow at a slower rate than the bones of the spine. Because the nervous system’s development is more complicated than the development of the spinal bones, it is more vulnerable to having issues. If the spinal cord and nerve roots lag behind, the spine grows faster than the nerves, the spine becomes longer, and thus needs to adapt to the shorter spinal cord.
Simply put, the bones of the spine are growing faster than the nerves can, which causes increased tension in the spinal cord, which then pulls down on the spine, ultimately causing scoliosis. What is interesting to note, is that during spinal fusion surgeries surgeons are often limited by a “stiff” spinal cord which restricts how straight they can make a spine during surgery. It is for exactly this reason why surgeons will monitor the spinal cord and nerves to make sure they don’t “over correct” the spine, accidentally causing paralysis.
This hypothesis on nerve tension has been growing in popularity. In fact, the nerve tension hypothesis has been placed as a possible central cause by some of the leading researchers in scoliosis causation. One such example is Dr. Burwell in his 2016 paper titled “Adolescent idiopathic scoliosis (AIS): a multifactorial cascade concept for pathogenesis and embryonic origin.”
In this scientific publication, Dr. Burwell also notes that other researchers have observed the spine growing faster than the spinal cord, supporting Dr. Roth’s studies. In the example cited, Dr. Chu et al. found that while the spinal cord was of normal length, the spine grew more than normal (overgrowth) which creates a tension or tethering effect, causing and also causing progression (worsening) of thoracic adolescent idiopathic scoliosis. The cause of this unequal growth of the spine and spinal cord is still being studied and likely has many contributing factors (multifactorial).
Scoliosis for Dummies: Closing Comments
While all cases of scoliosis are similar in some ways: a three dimensional deformity, lateral curve in the spine, etc. no two cases are the same and there are distinct types of scoliosis. Just as there are scoliosis types, how scoliosis is caused varies depending on the underlying cause and type. Scoliosis can be part of a syndrome while also being of a neuromuscular nature. Similarly, scoliosis can occur very early in childhood and be congenital due to structural abnormalities in the spine. Lastly, scoliosis can appear to have an unknown cause and be dubbed “idiopathic”, when in fact there IS a knowable underlying cause; the cause simply being undiagnosed.
We know that for over 50 years, scientists have thought that a tension in the nerves due to an unequal growth of the spine versus the nerves can be an underlying root cause of idiopathic scoliosis. This unequal growth, also known as uncoupled neuroosseous development creates tension along the spine, causing it to coil down into a scoliotic shape. Recent scientific studies have suggested many things are involved in this uncoupled development.
It does not matter what type of scoliosis a patient has. Whether it be congenital, neuromuscular, syndromic, or idiopathic, every case of scoliosis DOES have an underlying cause just WAITING to be discovered and diagnosed. With improved screening methods designed to look not only for scoliosis, but also for underlying nerve tension; and with radiation-free methods (MRI) to visualize the spine and help detect other underlying issues, the term “idiopathic” will hopefully be a thing of the past sooner rather than later. If we understand the cause, we can effectively treat it rather than the symptom, increasing quality of care. Additionally, if we know the cause, we can intervene earlier, potentially preventing a problem before it has time to occur.
After all, “An ounce of prevention is worth a pound of cure.” –Ben Franklin.
- Burwell, R. Geoffrey; Clark, Emma M.; Dangerfield, Peter H.; Moulton, Alan (2016): Adolescent idiopathic scoliosis (AIS): a multifactorial cascade concept for pathogenesis and embryonic origin. In Scoliosis and spinal disorders 11, p. 8. DOI: 10.1186/s13013-016-0063-1.
- Chu, Winnie Cw; Lam, Wynnie Mw; Ng, Bobby Kw; Tze-Ping, Lam; Lee, Kwong-Man; Guo, Xia et al. (2008): Relative shortening and functional tethering of spinal cord in adolescent scoliosis – Result of asynchronous neuro-osseous growth, summary of an electronic focus group debate of the IBSE. In Scoliosis 3, p. 8. DOI: 10.1186/1748-7161-3-8.
- Roth, M. (1968): Idiopathic scoliosis caused by a short spinal cord. In Acta radiologica: diagnosis 7 (3), pp. 257–271.
- Roth, M. (1981): Idiopathic scoliosis from the point of view of the neuroradiologist. In Neuroradiology 21 (3), pp. 133–138.
- van Loon, P. J. M.; van Rhijn, L. W. (2008): The central cord-nervous roots complex and the formation and deformation of the spine; the scientific work on systematic body growth by Milan Roth of Brno (1926-2006). In Studies in health technology and informatics 140, pp. 170–186. | <urn:uuid:903c67ba-ce87-4cbb-a59c-e83b885b9cb7> | {
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ICD-9-CM is the official system of assigning codes to diagnoses and procedures associated with hospital utilization in the United States. The ICD-9 was used to code and classify mortality data from death certificates until 1999, when use of ICD-10 for mortality coding started.
What is the difference between ICD-9 codes and ICD-10?
Code set differences
ICD-9-CM codes are very different than ICD-10-CM/PCS code sets: There are nearly 19 times as many procedure codes in ICD-10-PCS than in ICD-9-CM volume 3. There are nearly 5 times as many diagnosis codes in ICD-10-CM than in ICD-9-CM. ICD-10 has alphanumeric categories instead of numeric ones.
Why did ICD-9 change to ICD-10?
ICD-9 follows an outdated 1970’s medical coding system which fails to capture detailed health care data and is inconsistent with current medical practice. By transitioning to ICD-10, providers will have: Improved operational processes by classifying detail within codes to accurately process payments and reimbursements.
What is the meaning of ICD-9?
The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) is the U.S. health system’s adaptation of international ICD-9 standard list of six-character alphanumeric codes to describe diagnoses.
What does ICD-9 code mean in medical terms?
The International Classification of Diseases Clinical Modification, 9th Revision (ICD-9 CM) is a list of codes intended for the classification of diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or disease.
When did we stop using ICD-9 codes?
No updates have been made to ICD-9 since October 1, 2013, as the code set is no longer being maintained.
What are the differences between ICD-9 codes and CPT codes?
In a concise statement, ICD-9 is the code used to describe the condition or disease being treated, also known as the diagnosis. CPT is the code used to describe the treatment and diagnostic services provided for that diagnosis.
What is the ICD code for Covid?
For individuals with MIS and COVID-19, assign code U07. 1, COVID-19, as the principal/first-listed diagnosis and assign code M35. 81 as an additional diagnosis.
What is an ICD-10 diagnosis code?
Used for medical claim reporting in all healthcare settings, ICD-10-CM is a standardized classification system of diagnosis codes that represent conditions and diseases, related health problems, abnormal findings, signs and symptoms, injuries, external causes of injuries and diseases, and social circumstances. | <urn:uuid:b475f394-e8f3-4b61-b540-64feeeae2503> | {
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ICD-10 Codes for the ZIKA Virus - Let Your EHR Assist You
Read results from our latest ZIKA Virus Survey about providers perceptions regarding the ZIKA Virus.
Neither ICD-9 nor ICD-10 include specific codes for the Zika virus, making it more difficult than necessary for the WHO, the Centers for Disease Control and Prevention (CDC), and others to track the illness worldwide. The recent spread of Zika virus disease necessitated the need to monitor the disease with a separate code that allows tracking cases of the Zika virus disease. In ICD-9, coders reported code 066.3 (mosquito-borne fever NEC) and in ICD-10, coders report code A92.8 (other specified mosquito-borne viral fevers).
As part of the regular update process, WHO has proposed a new code for the Zika virus, A92.5, Zika virus disease. The adoption of the code will be voted on during the WHO-FIC annual meeting in October 2016. NCHS/CDC is therefore proposing the new code for inclusion in ICD-10-CM, effective October 1, 2016, to be consistent with the planned WHO ICD-10 update. According to the experts at CDC, the science has not been confirmed regarding the relationship between Zika and congenital deformities such as microcephaly. For that reason, an ICD-10-CM code will not be created until the relationship can be scientifically confirmed.
Proposed New Code:
A92.5 Zika virus disease
The ZIKA virus is a flavivirus that causes flu like symptoms in patients. Spread by infected Aedes mosquitoes, the virus poses a big risk to pregnant women and their unborn babies. How would the condition be coded under ICD-10-CM? The most seemingly applicable ICD-10 code would be A92.8 “Other specified mosquito-borne viral fevers”— which includes “Zika (viral)” in its list of fevers . However, not all ZIKA infections result in elevations of body temperature. Besides fever, common ZIKA virus symptoms to code for include maculopapular rash, arthralgia (joint pain), conjunctivitis (pink eye), myalgia (muscular pain) and headache.
For pregnant women who have contracted the virus, 098 is the ICD-10 code for “all maternal infectious and parasitic diseases classifiable elsewhere but complicating pregnancy, childbirth and the puerperium.” Included in this code series is 098.5, “other viral diseases complicating pregnancy, childbirth and the puerperium,” with an additional character to specify the trimester. If the patient has contracted the Guillain-Barré syndrome as a result of the virus, then the ICD-10 diagnosis code would be G61.0.
Infected newborns may develop microcephaly, resulting in unusually small heads and other medical complications. Microcephaly would be coded as Q02, specifying a “congenital abnormality in which the cerebrum is underdeveloped, the fontanels close prematurely, and, as a result, the head is small.”More details about this code can be found in the ICD-10 monitor.
There is a code freeze for any new ICD-10 codes until October 2016 and it is unlikely that the CDC will update the code base for the Zika virus. Thus, while not perfect, the noted ICD-10 codes above are sufficient billable codes. The Practice Fusion EHR has a very intuitive interface to easily find and report on ICD-10 codes. You can sign up and see how you can be charting with new ICD-10 codes in minutes. Don’t worry about memorizing codes — natural language search and refinement filters will help you narrow in on the correct ICD-10 codes quickly.
Update October 2016:
Within the Chapter-Specific Coding Guidelines there are several new additions and revisions. Of particular interest to the ZIKA virus is Chapter 1, Certain Infectious and Parasitic Diseases (A00-B99), where we see “Zika virus infections guidance.” Code only a confirmed diagnosis of Zika virus (A92.5, Zika virus disease) as documented by the provider. In this context, “confirmation” does not require documentation of the type of test performed; the physician’s diagnostic statement that the condition is confirmed is sufficient. This code should be assigned regardless of the stated mode of transmission. If the provider documents “suspected,” “possible,” or “probable” Zika, do not assign code A92.5. Assign a code(s) explaining the reason for encounter (such as fever, rash, or joint pain) or Z20.828, Contact with and (suspected) exposure to other viral communicable diseases.
|ZIKA ICD-10 Code||Description|
|A92.5||Zika virus disease, Zika virus fever, Zika virus infection, Zika NOS|
|098.5||Other viral diseases complicating pregnancy, childbirth and the puerperium|
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Health Policy Basics for Residents and Medical Students
The information on this page has been adapted from The Health Care Handbook by Elisabeth Askin and Nathan Moore and from the EMRA Emergency Medicine Advoacy Handbook (Free E-book available for download).Download the EMRA Emergency Medicine Advocacy Handbookpdf 4.74 MB
- General Things To Know
- Entitlement Programs
- Health Care Reform
- Common Health Policy Acronyms
How A Bill Becomes A Law
- The legislative process
- Watch this video for a concise overview of legislative system. The process is basically the same at the federal and state level.
- The adventure begins when a member of the House of Representatives or the Senate files a bill on an issue he or she wishes to change within current law or newly add to law. Elected representatives sometimes think of and write their own bills, but more often ideas are suggested to them by others, such as non-profit organizations, private industry, and government executive agencies (the Department of Health, Department of Education, etc.).
- After the bill is filed, it must be vetted by one or several committees which have special expertise in the bill’s subject. Committees are comprised of a small number of Representatives or Senators who often have previous experience with the subject material of the committee (former teachers on the Education Committee, etc.). Staff of the committee analyze each bill, point out any errors or unintended consequences, and suggest amendments to its language to ensure the bill best achieves its intent. Elected representatives on the committee discuss bills at a public meeting, incorporate amendments as they see fit, and vote on whether to allow them to continue the journey to becoming laws.
- Once the bill has passed through all the committees it has been assigned to, it is placed on a calendar to be heard on the House or Senate floor. On the floor, the entire House or Senate has the opportunity to debate the merits of the bill, offer and vote on amendments, and vote on whether the bill should become a law. The entire chamber has to vote on the bill twice (called second and third reading) before it may be passed by that chamber.
- The House and Senate must both pass identical versions of the bill. This requires careful timing and also much political give and take between the leadership of both chambers.
- Once a bill has passed both chambers, it goes to the President’s or Governor’s desk for final approval. The President or Governor can sign the bill into law, veto the bill, or ignore it for long enough (varies by state) that the bill automatically becomes law. The Legislature can override a veto and pass the bill into law anyway if enough members (again, varies by state) vote to do so.
- Response to change
- Less than 10% of all bills filed each year will become law. In fact, it is not uncommon for the same bill to be filed for several years in a row before finally passing. The lawmaking process is further impeded by the fact that many state legislatures are only in session for a few months each year. (Although, the United States Congress is in session year round, and many complain that they don’t get much done either.) The complexity and slowness of the legislative process helps to maintain status quo but also makes the government slow to respond to change.
- One way to help the government respond more quickly to pressing changes is through rulemaking. Governmental executive agencies, such as the Department of Health, fall under the purview of the executive branch but are given rulemaking authority by the legislative branch. Rules are like mini-laws which the agencies write themselves and which allow the agencies to formalize details related to implementation of the duties assigned to them. For example, a state’s Department of Health may be assigned the responsibility by law to license physicians, but the law may not describe the exact criteria needed for licensure; rather, this information is elucidated in rules written by the department. Rules can be changed at any time of the year and require the approval of far fewer people.
- Executive orders are issued by the President or the Governor and direct agencies to behave a certain way. Since they only require the approval of the President or Governor, executive orders can also help the government respond more quickly to change.
- Lobbyists are paid by all kinds of organizations, from the American Medical Association to Verizon, to ensure that bills which would help the organization become law and those that would hurt it don’t. Lobbyists write bills and amendments and find elected representatives to sponsor them, convince Representatives and Senators to vote for or against bills on behalf of their clients, and ask legislative leadership to make sure certain bills are heard in committees and on the floor. Lobbyists also remind elected representatives of the campaign contributions their clients have made. Just like for Big Pharma, there are laws preventing lobbyists from giving lavish gifts, but they still exert considerable influence over lawmaking. Health-related lobbying accounts for more spending than any other industry sector.
Facts About The Uninsured
- Courtesy of the Kaiser Family Foundation, 2011.
- 61% of the uninsured are from families with at least one full-time worker, and 16% are from families with at least one part-time worker. 90% have a family income below 400% of the federal poverty level.
- Young adults (age 19-25) have the highest uninsured rate of any age group: 30%.
- 60% of uninsured, nonelderly adults have no education past high school.
- 81% of the uninsured are U.S. citizens. They comprise 32% of Hispanics, 14% of Whites, and 22% of African-Americans.
- They are more than twice as likely to report being in fair or poor health as those with private insurance. Almost half of all uninsured, nonelderly adults have a chronic medical condition.
- More than 70% have gone without health coverage for over a year.
- Access to care
- About 26% of uninsured adults have forgone care in the past year (with more than 25% not filling a drug prescription) because of cost, compared to 4% of the insured.
- The uninsured are diagnosed in later stages of diseases, includ¬ing cancer, and die earlier than those with insurance. They are also more likely to be hospitalized, where they receive fewer diagnostic and therapeutic services, and are more likely to die in the hospital than the insured.
- When uninsured patients turn 65 and gain Medicare coverage, their access to care improves, their use of preventive care increases, and their overall health improves.
- Hospitals frequently charge uninsured patients two to four times what insurers actually pay for services. Less than half of low-income uninsured adults report that they have received free or reduced-cost care in the past year.
- In 2010, 27% of uninsured adults used up all or most of their sav¬ings paying medical bills. Half of uninsured households had $600 or less in total assets, compared to median assets of $5,500 for insured households.
- Care compensation
- In 2008, the average uninsured individual incurred $1,686 in health costs (compared to $4,463 for the nonelderly insured).
- The uninsured paid for about a third of this care out of pocket. About 75% of the remaining, uncompensated cost was paid by federal, state, and local funds appropriated for care of the uninsured, which accounts for about 2% of total health care spending.
- 60% of uncompensated care costs are incurred by hospitals. Most government dollars are paid indirectly based on the share of uncompensated care each hospital provides.
- The percent of all physicians who provide charity care fell from 76% in 1996-97 to 68% in 2004-05.
- Health care reform’s expansion of health insurance to millions of previously uninsured, coupled with the nation’s aging population requiring greater medical care, has caused many entities to warn of an upcoming physician shortage.
- The Association of American Medical Colleges (AAMC) predicts that there will be a shortfall of 130,000 physicians by the year 2025.
- The unequal distribution of the workforce, with most doctors practicing in metropolitan areas, will exacerbate the problem in rural and inner-city locations. The federal government already tracks parts of the country where medical care is scarce; these are known as Health Professional Shortage Areas (HPSAs). Locations and types of HPSAs (lacking in primary care practitioners, mental health services, dental services, or a combination of these) can be found here.
- The shortage of primary care physicians is particularly concerning to many policymakers. Primary care is the easiest way for most patients to access health services, both for ongoing wellness or disease management and referral to specialists, and a lack of primary care physicians in an area almost always indicates a concurrent shortage of specialists. Primary care has also been associated with better health outcomes for a wide range of illnesses, primarily through greater access to needed services, increased focus on prevention, earlier management of health problems, and reduction of unnecessary and potentially harmful specialist care.
- The rate-limiting step in producing more physicians is the amount of residency positions available nationally. Funding for residency positions comes principally from Medicare, and the number of residency positions has been capped at 1997 numbers by the federal Balanced Budget Act passed that year. While hospitals are free to create additional residency positions using private funds, few do. Any new residency programs must be approved by the Accreditation Council for Graduate Medical Education (ACGME, for allopathic programs) or the American Osteopathic Association (AOA, for osteopathic programs).
- Licensure is legal approval from a state government to practice a profession. Specific requirements for medical licensure vary from state to state, but all basically include graduation from medical school, passage of all parts of the USMLE, and completion of one or two years of residency training. Licenses must be renewed every few years by paying a fee and completing a certain number of hours of continuing education. State licensure is not transferrable; a physician who moves to another state must reapply for licensure in his or her new home.
- Certification is a formal recognition of competence from a non-governmental, national professional organization. Most physicians who seek certification do so from member boards of the American Board of Medical Specialties or from the American Osteopathic Association. Certification is generally not required for state licensure, but many physicians take the certification exams after completing residency to improve their credentials for potential employers. Some certifying boards require renewal every few years through completion of continuing education courses, while others grant permanent certification after passing the entrance exam.
- Insurers negotiate contracts with individual health care facilities as well as with individual providers. These contracts can mix and match any of the reimbursement systems listed here, and at different rates, depending on the situation.
- Entitlement programs such as Medicare and Medicaid rarely provide sufficient reimbursement to completely cover the costs of treating their beneficiaries. (Or so say hospitals—this may not actually be the case).
- Types of reimbursement
- Bundled payments for episodes of care: insurer will pay one lump sum, per diagnosis, for the entirety of a patient’s care, from laboratory tests and nursing assistance in the hospital to placement in a rehabilitation facility after discharge.
- Capitation: insurer pays a flat rate per patient served, regardless of the severity or complication of the illness or the length of hospital stay.
- Diagnosis-related group (DRG): DRGs were originally developed as a classification scheme to relate the types of patients a hospital treats to the costs incurred by that hospital. DRGs are used primarily by Medicare for hospital payment purposes but may also be used by other insurers. Insurers provide prospective payment for treatment of a patient based on the DRG which best described his or her condition. Reimbursement for treating essentially the same illness can vary widely depending on what DRG the patient falls into. A list of current DRGs can be found here.
- Fee-for-service: insurer pays a set price for a given health care action. This type of payment tends to incentivize providers to perform more procedures and tests than might otherwise be necessary.
- Pay for performance: insurer reimburses providers and facilities based on measures of clinical quality, safety, efficiency, and patient satisfaction.
- Per diem: insurer pays a flat fee for each day the patient is admitted to the hospital to cover any care therein.
- Relative value unit (RVU): like a DRG, but for physicians instead of hospitals. Medicare calculates the RVU for each action a physician performs based on work of the physician, expense to the practice, and cost of malpractice insurance. As you might imagine, this system rewards specialists who perform risky, costly procedures more than practitioners of primary care. RVUs are updated frequently by the Relative Value Update Committee of the American Medical Association, which suggests reimbursement rates to Medicare.
- Sustainable Growth Rate (SGR): a formula established in 1997 and used by Medicare to determine how payments to physicians should be adjusted to control costs. The SGR was meant to correct for inflation and ensure that the yearly increase in expense per Medicare beneficiary does not exceed the growth in GDP. However, medical costs have been increasing much faster than GDP, and physicians will be reimbursed for a smaller and smaller fraction of what they do if Medicare adheres to SGR-predicted rates. Physicians reacted with fury in 2002 when the SGR recommended a 4.8% cut to their reimbursement, and since then, Congress has been enacting laws to prevent this pay cut from kicking in. Such laws have often been passed within days or hours of the next scheduled SGR cut, or sometimes even after the cuts have taken place, and every time the cut is forestalled, the potential percentage drop in physician reimbursement increases. However, Congress is loath to completely repeal the SGR for fear of the perceived multi-billion-dollar cost. Many national physician organizations have been working with the government to propose another solution.
How Residency Is Funded
- Medicare is the largest single program providing explicit support for graduate medical education (GME). Medicare pays teaching hospitals in two major ways, direct GME funding (DME), and indirect GME funding (IME).
- DME covers a portion of the direct costs of training residents, such as residents’ stipends and benefits, teaching physicians’ salaries, accreditation fees, and related overhead expenses. The amount of DME funding a teaching hospital receives is related to the share of the hospital’s patients who are Medicare beneficiaries and to how many residents in ACGME-accredited programs (or AOA, for osteopathic programs) train there.
- IME helps cover increased patient care costs associated with treating more complex cases, requiring standby capacity in burn and trauma centers, etc. These costs do not directly relate to resident training, but hospitals that have such characteristics make for better teaching environments. IME payments are based in part on the hospital’s ratio of residents to beds (the intern and resident-to-bed ratio or IRB ratio).
- Special conditions apply to trainees who switch residency programs or do research years. In these situations, Medicare might not fund the entirety of their training.
- In addition to funding physician training, Medicare also supports residencies in dentistry and podiatry.
- Since pediatric hospitals receive very few Medicare patients, their residency programs are funded differently. The Children’s Hospitals GME Payment Program is funded with general federal appropriations dollars and administered by the Health Resources and Services Administration (HRSA).
- The Emergency Medical Treatment and Active Labor Act (EMTALA) is a federal law which requires all hospitals participating in Medicare to evaluate every patient who presents to the ED for an emergency condition and stabilize such a condition if it is found, regardless of the patient’s ability to pay.
- Emergency departments are generally money-losing enterprises for hospitals. Although the ED does serve as an entry point for admission to the hospital, only a fraction of patients get admitted. The groups with the highest rates of ED usage are Medicaid recipients, individuals with incomes under the federal poverty level, and the elderly. These groups also have higher than average rates of chronic medical conditions, which are expensive to care for in the ED, and are more likely to be insured by the government, which reimburses medical services at less than cost.
- For a variety of reasons, including their inability to turn patients away, many EDs are overcrowded and patients often must wait several hours to see a physician. Since up to one-third of ED visits are for non-urgent or semi-urgent issues, one suggested solution to ED crowding is to increase access to primary care and urgent care.
State Specific Issues
- Scope of practice
- In every state and for each licensed profession, laws regulate what members of that profession can and cannot do. This is termed “scope of practice” and determines what diagnoses, treatments, and procedures a health care professional may perform in each state. Scope of practice regulations may differ significantly from state to state for the same profession. For example, in some states, nurse practitioners are allowed to practice independently and prescribe controlled substances, while neither practice is allowed in other states.
- Bills aiming to expand or reduce the scope of practice of various health care practitioners are part of a state’s legislative agenda almost every year.
- Certificate of Need (CON).
- CON laws are present in many states to help local governments control the planning of and access to new health care services. Before construction on a new hospital, nursing home, or other health care facility may begin, the facility must prove to the government that there is a need for such services in the region.
- Proponents state that CON helps policymakers ensure that care is equally distributed across the state, rather than concentrating resources in a few areas. Detractors state that CON turns the construction of hospitals into a political game and that the laws are inconsistently applied.
- Established in 1965 to insure the elderly and some disabled individuals. It is the largest insurer in the nation and is run by the Center for Medicare and Medicaid Services (CMS), part of the federal Department of Health and Human Services.
- Medicare is funded by federal general revenue, payroll taxes, and beneficiary premiums.
- Be at least 65 years old, have been a U.S. citizen or permanent resident for at least five years, and have paid (or have a spouse who has) Medicare taxes for at least ten years.
- Be under age 65, be permanently disabled, and have received Social Security disability benefits for at least the previous two years.
- Be under age 65 and receive Social Security benefits for amyotrophic lateral sclerosis (ALS).
- Be under age 65 and need continuous dialysis or a kidney transplant.
- Part A: inpatient insurance, covering stays in hospitals and nursing homes, home health visits, and hospice. These benefits have a limit on the number of days they will pay for in a facility and are subject to co-pays and deductibles.
- Part B: outpatient insurance, covering physician visits, preventive services, and home health visits. Also subject to co-pays and deductibles.
- Part C: also called Medicare Advantage, this allows beneficiaries to enroll in a private insurance plan which will cover all regular Medicare benefits and may cover additional benefits or require co-pays and deductibles. Medicare pays these private insurers a fixed amount per month, per beneficiary. About 25% of all Medicare beneficiaries are enrolled in a Medicare Advantage plan.
- Part D: for purchasing prescription drugs. This program is voluntary, operates through contracted private insurers, and is subsidized for low-income beneficiaries. There is, however, a coverage gap called the "donut hole:" Part D covers 75% of annual prescription costs up to $2700 and 95% of prescription costs over $6154, but costs in between $2700 and $6154 are not reimbursed at all. Those who are dual eligible for Medicare and Medicaid don't fall into this hole.
- Supplemental insurance
- Medicare requires somewhat high co-pays and deductibles, doesn't have a limit on out-of-pocket costs, and doesn't pay for long-term care (like a permanent nursing home), eye services, or dental services. Thus, many beneficiaries purchase additional insurance to reduce their medical expenses.
- Employer-sponsored retirement benefits are one way to supplement Medicare.
- Medicaid is another, for those that are eligible for both programs.
- Medigap is voluntary insurance offered by CMS in addition to Medicare Parts A and B.
- Medicaid is a joint federal-state program established in 1965 to insure the poor.
- States must cover all citizens in the groups listed below whose incomes are less than a certain level set by each state (at a minimum, 20% of the federal poverty level).
- Parents with dependent children.
- Pregnant women.
- People with severe disabilities.
- Seniors. This provision allows many people, called “dual eligibles,” to receive benefits from both Medicare and Medicaid.
- Medicaid programs are also required to offer certain basic health benefits to its beneficiaries but may offer more at each state’s discretion.
- Federal and state governments share Medicaid costs, with the federal government contributing at least 50%.
State Children's Insurance Program (S-CHIP or CHIP)
- The purpose of CHIP is to expand the number of children eligible for government health insurance beyond those covered by Medicaid. Eligibility and benefits vary broadly from state to state.
- Funding comes both federal and state governments. Federal contributions make up a larger proportion of the overall cost for CHIP than for Medicaid.
Health Care Reform
The Patient Protection and Affordable Care Act (ACA) and the Health Care Education and Reconciliation Act (HERA) were signed into law by President Obama on March 23, 2010. These laws represent the most sweeping changes to the government’s role in the United States health care system since Medicare and Medicaid passed in 1965.
Changes for the Federal Government
- Access to care
- Expands eligibility to cover adults under age 65 who have developed health conditions following environmental hazard exposure in an emergency declaration area. However, only certain health conditions are covered, and only for emergency declarations after June 17, 2009.
- Covers more preventive care without co-pays and deductibles.
- Closes the Medicare Part D “donut hole” through rebates and subsidies. Pharmaceutical companies that participate in Medicare will be required to offer discounts to beneficiaries who fall into the donut hole.
- Pilots new delivery programs such as Accountable Care Organizations, the Patient-Centered Medical Home, and home visits by physicians and nurses to some underserved beneficiaries.
- Freezes payments to some facilities and providers at 2010 levels for several years, while providing bonuses to primary care providers.
- Pilots a program, starting in 2013, to switch Medicare reimbursement from fee-for-service to bundled payments for episodes of care. An episode of care will begin three days prior to a hospital admission and last for one month after discharge.
- Adjusts payments to hospitals and other health care facilities based on productivity and performance.
- Increases the number of beneficiaries who pay higher premiums due to income.
- Decreases support for Medicare Advantage plans.
- Research and policy
- Establishes the Center for Medicare and Medicaid Services Innovation (CMS Innovation) to design, model, and test new delivery and payment systems for federal insurance programs with the goal of decreasing cost and increasing quality.
- Creates the Medicare Independent Payment Advisory Board (IPAB) to recommend ways to reduce per capita spending on beneficiaries. IPAB recommendations automatically become law unless Congress acts to override them. The board’s first report, initially due in January 2014, has been delayed because Medicare spending has not risen fast enough to trigger IPAB intervention.
- Access to care
- New oversight
- Develops numerous institutes and boards which focus on national quality and prevention strategies, greater coordination between institutions, comparative effectiveness research, and health care workforce research.
- Creates the Federal Coordinated Health Care Office, which will identify dual eligibles (those eligible for both Medicare and Medicaid) and coordinate reimbursement and care between the two programs. Currently, everything is managed separately.
- Establishes new levels of oversight to prevent fraud and abuse of Medicare, Medicaid, and CHIP. Increased fees are levied on providers, hospitals, and suppliers to fund these fraud prevention services. In 2009, 18.6 of Medicaid, 10.4% of Medicare, and 6.8% of Medicare Advantage spending was due to waste, fraud, or abuse.
- The federal government will also provide additional money to states for Medicaid and CHIP and will subsidize some health insurance purchased through Exchanges. Requirements concerning Medicaid and CHIP have also been changed as discussed below.
- The ACA reauthorizes the Indian Health Care Improvement Act, which expired in 2001, to insure Native Americans and to help reduce health disparities between this group and the general population.
Changes for States
- Health insurance exchanges
- Exchanges are clearinghouses which certify and list all the health insurance plans available in a state and help people determine which ones are right for them. Exchanges assign a rating to each plan based on relative quality and price.
- States are given the option to develop and administer their own Exchanges, or the federal government will do so if a state refuses. Either way, Exchanges must be up and running by 2014.
- Each health insurance plan participating in the Exchange must state its specifications in plain language, such as claims payment, policies and practices, payments for out-of-network coverage, and which services have co-pays or deductibles. All plans must cover basic services such as ambulatory care, hospitalizations, prescription drugs, laboratory testing, rehabilitation services, and pediatric services and must include a variety of covered providers in both rural and urban areas.
- Exchanges must set up certain tools to help potential beneficiaries compare different insurance plans. These include creating an easy-to-use website; using a standardized format for presenting benefit options; allocating employees or volunteers to guide potential beneficiaries through the process; and creating a calculator to determine the actual cost of a plan, taking into account individualized tax credits, deductions, and co-pays for each person.
- Exchanges must help anyone eligible for an entitlement program to enroll in that program.
- Grant money must be made available to community organizations for purposes of educating the public about the Exchanges.
- The ACA originally required states to expand Medicaid eligibility to include childless adults and to cover all individuals with incomes less than 133% of the federal poverty level; states which refused to comply would lose all federal support for their Medicaid programs. However, the Supreme Court found this provision unconstitutional. States are no longer forced to expand Medicaid or lose their existing funding, but those which do increase eligibility will get 90% of the costs for newly eligible beneficiaries indefinitely covered by the federal government. (Federal support for the newly eligible starts out at 100% and gradually decreases to 90% by 2020).
- Federal payments to states
- As of 2013, Medicaid matching payments will increase to states in which Medicaid covers preventive services without co-pays or deductibles.
- The federal government will increase funding for long-term care, preventive care, and testing new delivery systems. This includes providing grants for development of Medicaid programs to incentivize healthy lifestyles and piloting bundled Medicaid payments for episodes of care.
- Hospital reimbursement
- Hospitals will be able to employ “presumptive eligibility” and bill Medicaid appropriately. That is, if a hospital treats a patient who is eligible for Medicaid but is not enrolled, the hospital may assist the patient to enroll in Medicaid and then bill the program retroactively for his or her care.
- Federal Medicaid payments for disproportionate share hospitals (DSH, pronounced “dish”) will be reduced to make funds available for new ACA programs. DSH payments are special payments allotted to hospitals which care for an above-average (“disproportionate”) percentage of uninsured patients. They are intended to partially reimburse such hospitals for the large amount of uncompensated care they provide. Originally, the decrease in DSH payments was to be counterbalanced by an increase in Medicaid eligibility (and thus Medicaid reimbursement) to cover many of the previously uninsured. If a state chooses not to pursue Medicaid expansion, hospitals in underserved areas may experience financial trouble.
- The federal government will no longer provide matching payments for care related to hospital-acquired infections.
- Other changes in payments
- Medicaid reimbursement rates will be raised, using federal dollars, to equal Medicare rates for 2013 and 2014.
- States must provide rebates to help lower prescription drug costs for Medicaid beneficiaries.
- Piloting the Patient-Centered Medical Home: Medicaid beneficiaries can designate specific primary care providers as “health homes,” and the federal government will offer 90% matching payments for two years for health home-related services. This concept is heavily based on the Patient-Centered Medical Home, a physician-led care team which coordinates all of a patient’s health care needs.
- CHIP programs receive additional federal support under the ACA. The amount varies by state.
- States are required to maintain eligibility for children in Medicaid and CHIP at pre-ACA levels until 2019. This provision is intended to prevent states from cutting coverage to children to offset the costs of insuring additional adults under Medicaid expansion.
- The federal government will provide $50 million in grants for states to design and test alternatives to the current medical malpractice system.
Changes for Insurers
- Coverage restrictions
- Insurers can no longer deny people coverage for pre-existing conditions, end coverage when policyholders get sick (called recission), or charge higher premiums based on current or projected health status.
- Rating risk groups can now only focus on age, geographic location, family composition, and tobacco use.
- Annual deductibles, the amount a beneficiary must pay before insurance kicks in and pays the rest, are capped at $2000 for individuals and $4000 for families.
- Insurers may not place annual or lifetime limits on the amount they will pay out for beneficiaries.
- Dependents up to age 26 must be covered under their parents’ policies.
- Insurers may not require co-pays or deductibles for preventive services.
- The waiting period for new insurance to take effect is capped at 90 days.
- Industry structure
- Insurers must keep their medical loss ratios (MLRs) at 85% or more for large-group insurers and 80% for small-group insurers, or else they must provide rebates to policyholders. The MLR is the percentage of insurance premiums that the insurer spends on health care and health services for patients; the remaining percentage goes to overhead and profits.
- Insurers must develop an appeals process and external review of health plan decisions. If a beneficiary has a complaint about an insurance plan, it may go through the internal appeals process, or the state may review the plan for compliance to law.
- Consumer-driven insurance plans, such as flexible spending accounts (FSAs) and health saving accounts (HSAs), are de-emphasized and restricted.
- Several new taxes are levied on insurers to help fund health care reform.
- Federal tax breaks for several types of high-cost and consumer-driver insurance plans, such as FSAs and HSAs, end.
- Insurance plans operating in 2010 may be exempted from many of the industry changes made by the ACA as long as the plan does not reduce benefits; raise co-insurance, co-pay, or deductible charges; lower the employer contribution to insurance, or introduce or lower an annual limit on coverage. If a plan makes any of these changes, it qualifies as a “new” insurance plan and must comply with all the insurance provisions of the ACA. All plans, regardless of whether they existed in 2010, must end lifetime limits, annual limits, and recission and allow dependents up to age 26 to remain on their parents’ policies.
Changes for Employers
- Small employers (<50 employees) receive tax credits if they offer insurance, and they will be allowed to purchase insurance through the Exchanges. They will also be able to apply for grants to establish employee wellness programs.
- Large employers (51-200 employees) are required to offer health insurance and are fined if they don’t. Employers that do offer insurance may be penalized if premiums cost more than 8% of any full-time employee’s income.
- Very large employers (>200 employees) must automatically enroll employees in the company’s health insurance plan, though employees may opt out.
- All employers may offer certain rewards to their employees for participating in wellness programs and meeting health benchmarks.
- Employers who have been receiving tax deductions on Medicare Part D drug subsidy payments for their retirees will no longer receive such deductions, as the federal government will be providing its own subsidies to close the donut hole.
- The Early Retiree Reinsurance Program helps employers continue to offer health insurance to retired employees over age 55 who aren’t yet eligible for Medicare by reimbursing 80% of claims between $15,000 and $90,000. This program will last until 2014, after which point the beneficiaries can seek insurance through the Exchanges.
Changes for Individuals
- The ACA offers expanded access to health insurance for everyone except undocumented immigrants. In fact, the ACA’s individual mandate states that people who don’t have some form of health insurance will be fined. Fines start out at $95 or 1% of income, whichever is greater, in 2014 and will rise each year until becoming $695 or 2.5% of income in 2016. Thereafter, the fine will increase with cost of living adjustments. The individual mandate was upheld as constitutional by the Supreme Court.
- Who will not have to purchase insurance?
- People with financial hardship. These people will be covered under existing entitlement programs or may receive subsidies to participate in the Exchanges.
- People with religious objections.
- Native Americans. Native Americans will receive care through the newly reauthorized Indian Health Services.
- Those who are uninsured for three months or less.
- Those who are incarcerated. Prisoners will continue to receive care from within the correctional system.
- Tax changes
- The Medicare payroll tax rate will increase by 0.9% on incomes above $200,000 for individuals or $250,000 for married couples. There will also be a 3.8% tax on unearned incomes (i.e., interest and stocks) for these groups to help finance various parts of healthcare reform.
- Beginning in 2013, individuals will only be able to deduct out-of-pocket medical expenses from their taxes if these expenses are higher than 10% of income. The pre-ACA cutoff for such expenses was 7.5% of income, and individuals aged 65 or older may deduct at this level until 2016.
- The Pre-Existing Condition Insurance Program, which began in 2010, insures individuals who have pre-existing conditions and have been uninsured for at least six months. This program aims to provide some coverage for people with pre-existing conditions until the Exchanges can be created and the various changes to the insurance industry can take effect.
- More taxes
- 10% tax on indoor tanning.
- New taxes on medical device companies and pharmaceutical companies.
- Not-for-profit hospitals must conduct community needs assessments and develop plans for financial assistance to the needy or face a $50,000 annual tax.
- Restaurants with more than 20 locations must post caloric content on their menus and make information about saturated fats, sodium, and cholesterol available on request.
- Emphasizing primary care
- Medicare provides bonus payments for primary care services, at least for a few years.
- The ACA redistributes unfilled residency positions in specialty fields (surgical internships, etc.) to residencies in primary care. It also creates funding for “teaching health centers,” the ambulatory equivalent of teaching hospitals, and allows primary care residencies to be based there.
- More money is allotted for Federally-Qualified Health Centers (clinics which receive federal funding to provide comprehensive primary care, dental, and behavioral health services and employ a sliding fee scale based on patients’ incomes) and the National Health Service Corps.
- There is additional financial support for training low-income individuals who wish to enter the primary care workforce.
- The ACA expands the federal 340(b) Drug Discount Program to include safety net hospitals. This program requires pharmaceutical manufacturers to provide outpatient drugs to eligible health care organizations at significantly reduced prices.
- A shorter FDA approval pathway is established for biosimilars, which are the generic version of biologics. This abbreviated pathway will be similar to the one for generic versions of chemical drugs.
- New sunshine laws: the ACA requires disclosure of financial relationships between health entities, such as between hospitals and distributors of medical devices. Any gift, sponsorship, or ongoing financial relationship must be made available to the general public.
Common Health Policy Acronyms
- ACA: The Patient Protection and Affordable Care Act. Passed in 2010 and otherwise known as federal health care reform.
- ACGME: Accreditation Council for Graduate Medical Education. An independent agency which accredits all M.D. residency and fellowship programs. It also writes rules and regulations that all programs must follow, such as work hour limits.
- AOA: American Osteopathic Association. Accredits D.O. residencies and fellowships.
- CHIP: State Children’s Insurance Program. Federal-state partnership to expand the number of children eligible for government health insurance beyond those covered by Medicaid.
- CMS: Center for Medicare and Medicaid Services. Runs Medicare and the federal portion of Medicaid.
- CON: Certificate of Need. A law on the books in some states which requires a potential health care facility to prove to the government that there is a need for its services before it is built.
- DME: Direct GME funding. Money paid to a hospital from Medicare which directly supports residency training (paying resident salaries, teaching physicians’ salaries, accreditation fees, etc.).
- DRG: Diagnosis-Related Group. A classification scheme developed by Medicare to related the types of patients a hospital treats to the costs incurred by that hospital. Medicare provides prospective payments to hospitals based on what DRG a patient falls into; reimbursement for treating essentially the same illness can vary widely based on what DRG the patient falls into.
- DSH: Disproportionate Share Hospital. Federal Medicaid payments made to hospitals which provide a larger-than-average amount of uncompensated care, intended to help these hospitals balance their books so they can continue to serve the uninsured. The ACA significantly reduces these payments; the plan was for the loss in DSH payments to be compensated for by an increase in Medicaid payments for beneficiaries newly eligible under expansion. Since the Supreme Court made Medicaid expansion optional, however, some safety net hospitals could soon face financial problems.
- Dual eligibles: not really an abbreviation, but it means people who are eligible for both Medicare and Medicaid.
- EMTALA: Emergency Medical Treatment and Active Labor Act. A federal law which requires any hospital which participates in Medicare to evaluate every patient who presents to the ED for an emergency medical condition and stabilize such a condition if it is found, regardless of the patient’s ability to pay.
- FQHC: Federally-Qualified Health Center. A clinic which receives federal funding to provide comprehensive primary care, dental, and behavioral health services. FQHCs are open to all patients, insured or uninsured, and employ sliding fee scales for payments based on patients’ incomes.
- GME: Graduate Medical Education. Residency and fellowship programs.
- HERA: Health Care Education and Reconciliation Act. Federal health care reform is really made of two laws, the ACA and HERA. There is a little bit of health care reform in HERA, but most of it is in the ACA, which is why this law gets all the attention.
- HPSA: Health Professional Shortage Area. Refers to an area of the United States designated by the federal government as not having enough primary care providers, mental health services, or dental services. Find out where they are here.
- HRSA: Health Resources and Services Administration. A division of the federal Department of Health and Human Services which aims to improve access to health services for people who are uninsured, isolated, or medically vulnerable.
- IME: Indirect GME funding. Money paid to a hospital from Medicare for things which make the hospital a great place for residents to train, such as increased care costs related to treating more complex patients, standby capacity in burn and trauma centers, etc.
- IPAB: Independent Payment Advisory Board. An independent board established by the ACA and tasked with recommending ways to reduce per capita Medicare spending. The controversial part is, IPAB recommendations automatically become law unless Congress acts to override them.
- MLR: Medical Loss Ratio. The percentage of its premiums that an insurer must spend on health care services for its beneficiaries. The ACA set the MLR at 85% for large-group insurers and 80% for small-group insurers (the remaining 15-20% goes to profits and overhead).
- NHSC: National Health Service Corps. A federal program which offers some educational loan repayment to physicians who spend a few years working in medically underserved areas (inner cities, rural areas, etc.).
- PPACA: same as the ACA.
- RVU: Relative Value Unit. How Medicare calculates reimbursement for various practitioner services. RVUs are based on the work of the practitioner, expense to the practice, and the cost of malpractice insurance. As you can imagine this system rewards procedure-drive specialties much more than primary care specialties.
- S-CHIP: same as CHIP.
- SGR: Sustainable Growth Rate. A formula used by Medicare, intended to determine how payments to physicians should be adjusted to control costs. The SGR was meant to correct for inflation and ensure that the yearly increase in spending per beneficiary does not exceed the growth in GDP. However, the reality is that medical costs have risen much faster than growth in GDP, and providing reimbursement at SGR-predicted rates would result in huge pay cuts for physicians. Congress has instead been passing a series of laws over the last eleven years to bypass using the SGR, but it is loath to completely repeal it because of the perceived multi-billion-dollar cost.
Health Affairs (journal). This is the premier journal of health service research and policy commentary. It’s printed monthly, so check back often for new information.
The Health Care Blog. This blog includes submissions from physicians, economists, PhDs, and pundits on a huge range of topics across the political spectrum. As with Health Affairs, we recommend reading periodically to stay informed and up to date.
Kaiser Family Foundation Health Reform Source. A huge resource with all kinds of explanations and details on various parts of the ACA.
Mama Might Be Better Off Dead by Laurie Kaye Abraham. The author followed a poor Chicago family with a host of medical financial problems for a year in 1989. Though some of the obstacles presented are now outdated (and more will be after 2014), a surprising number are still relevant. It gives an excellent view into what it’s like to be sick and on Medicaid.
Medicare Payments for Graduate Medical Education: What Every Medical Student, Resident, and Advisor Needs to Know. Published by the Association of American Medical Colleges (AAMC), this document provides a detailed explanation of how residency is paid for and why that is important.
Patient Protection and Affordable Care Act (full text of the law). For those that want to know beyond a shadow of a doubt exactly what is in the ACA. A light, 974-page beach read.
The Social Transformation of Medicine and Remedy and Reaction by Paul Starr. The first is a history book which describes how health care in America was shaped from colonial times until today (today being 1980, when this book was published). Although it is twenty years old, this book is still the definitive text on the subject. The second book was written in 2011 and details the history of health care reform in America.
The Uninsured: A Primer. Updated annually by the Kaiser Family Foundation, this resource provides a through overview of issues and statistics concerning the nation’s uninsured.
Compiled by Elizabeth Davlantes, M.D.
Learn how to have a profound impact on your patients, your specialty, and the greater house of medicine by becoming an informed and active health policy advocate. EMRA's Emergency Medicine Advocacy Handbook, 4th edition, walks you through the main policy issues affecting EM in today's legislative and regulatory climate, and it offers simple ways to get involved at every level.
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The International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) is a system used by physicians and other healthcare providers to classify and code all diagnoses, symptoms and procedures recorded in conjunction with hospital care in the United States.
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Like its predecessor ICD-9-CM, ICD-10-CM is based upon the International Classification of Diseases, which is published by the World Health Organization (WHO) and which uses unique alphanumeric codes to identify known diseases and other health problems. According to WHO, physicians, coders, health information managers, nurses and other healthcare professionals also use ICD-10-CM to assist them in the storage and retrieval of diagnostic information. ICD records are also used in the compilation of national mortality and morbidity statistics.
The ICD-10-CM revision includes more than 68,000 diagnostic codes, compared to 13,000 in ICD-9-CM. In addition, ICD-10-CM codes include twice as many categories. ICD-10-CM diagnosis codes consist of three to seven digits, compared to the three to five digit system of ICD-9-CM. The increase in the amount and length of ICD-10-CM codes will allow for greater coding specificity.
Despite not being used in American hospitals, the ICD-10-CM code set has been revised yearly since 2003 to keep up with alterations made to ICD-10 by WHO. In preparation for ICD-10-CM implementation, a partial code freeze stopped the regular annual updates to ICD-10-CM codes in October 2011. Since then, there have been limited yearly changes made to the ICD-10-CM coding set with the normal updates scheduled to resume in 2016.
All Health Insurance Portability and Accountability Act-covered entities must begin using ICD-10-CM codes by Oct. 1, 2015, as mandated by the U.S Department of Health and Human Services. The ICD-10-CM implementation deadline has been delayed several times. ICD-10-CM guidelines were initially set to replace ICD-9-CM on Oct. 1, 2013. Two separate year-long extensions to the ICD-10-CM implementation date pushed it back to 2015.
The structure of ICD-10-CM codes is as follows. The first character must be an alpha character, excluding "u." The second and third characters are numeric and characters four through seven can be a combination of numeric and alpha characters. The first three characters categorize the injury and the fourth through sixth characters describe in greater detail the cause, anatomical location and severity of an injury or illness. The seventh character is an extension digit and used to classify an initial, subsequent or sequela (late effect) treatment encounter. | <urn:uuid:7fb91dc2-ba0b-4259-a9b4-3dc90ae0f064> | {
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Fears and anxiety disordersSpecialized treatment of anxiety disorders with hypnotherapy and Hypnobalancing™ in Berlin
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Hypnosis and hypnotherapy can affect the symptoms of anxiety. Learn more about help with fears, anxiety disorders. Details about the specialized treatment of anxiety disorders with hypnotherapy and Hypnobalancing™ in Berlin.
- Fears and anxiety disorders
- Differences between anxiety and anxiety disorders
- Kinds of anxiety disorders
- Causes of anxiety disorders
- Perfectionism and anxiety
- ICD-10-CM Coding
- Why you should see a medical doctor
- Myths about managing anxiety
- Risk factors for developing an anxiety disorder
- A little anxiety is healthy
- Perception and fear
- Anxiety and expectations
Let life happen to you.
Believe me: life is in the right, always.
Rainer Maria Rilke
Not all fear is bad
Apart from the moments when we voluntarily put ourselves in situations that send a shiver down our spine, fears are probably less welcome guests. But there are different forms of fear. Not all fear is bad. Fear is primarily a necessary and normal affect. Anxiety is a feeling of alarm and fear, a reaction to anticipated danger. Fear, for example, can be seen as a realistic appropriate warning signal of real danger. This protects us from risk, whereas anxiety disorders such as phobias and panic disorders significantly limit personal options. Just as a little stage fright awakens the senses, it does harm in its exaggerated form as speech anxiety or performance anxiety.
The cause of fear doesn’t matter for our brain. When it senses danger, it starts the automatic programs we acquired in ancient times. Our physical reactions to fear have remained the same as those of people in the Stone Age. The heart beats faster and faster, the blood pressure rises so that more oxygen is pumped into the muscles, the airways dilate, the pupils become larger, we sweat, tremble, and even feel dizzy and nauseous.
The good intentions behind the fear
Fear reactions are supposed to help us either defend ourselves better or escape more successfully. However, many things and situations we fear today are either not associated with a relevant danger, the fear reaction is inappropriate, or the fear does not contribute to the solution and becomes the actual problem itself. Frequent or even constant anxiety limits life and has a negative impact on the immune system. People affected by anxiety know what it means when it is said: Anxiety eats the soul.
When does an anxiety become an anxiety disorder? An anxiety disorder is characterized primarily by:
- Exaggerated states of anxiety
Anxiety without a real threat, in which the external, at least recognizable conditions in partnership, family, neighborhood, or profession do not provide a sufficient explanation for this emotional strain
- Extraordinary manifestation
Anxiety states have a longer duration and occur more frequently.
Inability to resolve or even alleviate the anxiety states through one’s own coping strategies.
- Recognizable more or less characteristic pattern of complaints (symptomatology of anxiety) or sudden occurrence (for example, panic states) with mainly physical symptoms.
In advanced stages, anxiety disorders include:
- Extensive fear of expectation.
Fear of anxiety becomes increasingly debilitating or even paralyzing.
- Avoidance and withdrawal behavior
Increasing attempts to avoid situations or places associated with anxiety. While avoidance of unpleasant sensations is basically normal, it is exaggerated in anxiety disorders. If it is something everyday, affected persons tend to withdraw completely from everyday life under contrived or at least objectively untenable pretexts. As a result of the avoidance behavior, interpersonal contacts are increasingly lost. This has drastic consequences for private and professional life and can even lead to isolation.
- Attempts at self-treatment
Attempts to reduce anxiety with stimulants such as alcohol, nicotine, caffeine, medications such as tranquilizers, sleeping pills and painkillers, and possibly narcotics such as hashish, cocaine, opiates and designer drugs. Such attempts to find solutions carry a high risk of addiction. In addition, those affected then cope with everyday life only with such means and the drive to actually solve the causes increasingly weakens.
Attempts to overcompensate in the interpersonal, professional and even recreational spheres with regard to partners, family, circle of friends, neighborhood, workplace.
Anxiety disorders can be classified very generally into psychologically induced anxiety disorders, organic anxiety disorders, and substance-induced anxiety disorders. Organic anxiety disorders are triggered by a physical illness such as hyperthyroidism, while substance-induced anxiety disorders are triggered by the use of certain medications or drugs. Psychologically induced anxiety disorders can be categorized as phobias, panic disorders, and generalized anxiety disorders. These pages are exclusively about mental anxiety disorders.
Types of fears and anxiety disorders
There are several anxiety disorders. They tend to overlap considerably and it is not uncommon for people to have features of several of the disorders.
Phobias are pathological fears of a real or barely threatening situation, a specific object, or activity. The term phobia is not always very explicit. There are also phobias that are not necessarily pathological, such as the fear of swallowing (phagophobia). Typical for phobias is that they are predictable, i.e. they always occur in certain situations and are inappropriate.
A phobia is an excessive and persistent fear of a specific object, situation, or activity. These fears cause such distress that some people go to extreme lengths to avoid what they fear. There are three types of phobias:
Agoraphobia was originally the fear of wide places. In the meantime, the term describes all situations in which there is already a fear of expectation before they occur and in which escape seems impossible or only possible to a limited extent. People affected fear to throw up there, to panic, to faint. Therefore, the fearful situations are avoided or suffered through only under great anxiety. Typical places or situations are crowds and shopping malls.
Agoraphobia often occurs together with panic attacks. It usually begins in the 2nd decade of life and affects mostly women.
b. Social phobia (also called social anxiety disorder)
A social phobia is the fear of triggering an embarrassing situation through awkward behavior.
Social phobia usually begins during puberty and is often accompanied by severe self-doubt and a tendency to abuse substances.
Different forms of social phobia are the fear of blushing (erythrophobia), gynecophobia (fear of the feminine), very exaggerated stage fright, speech anxiety or performance anxiety and fear of failure.
c. Specific phobia
Specific phobias describe a persistent fear of a certain object such as an animal (zoophobia) or a special situation such as thunderstorms or visiting the dentist. In the case of specific phobia, anxiety symptoms already appear when thinking about the trigger.
Specific phobias often begin in childhood.
Examples of specific phobias:
Fear of the dark
The exaggerated fear of heights
Fear of vomiting.
Fear of dentists
- Fear of flying
- Stage Fright, Fear of Public Speaking, Glossophobia
- Test anxiety
The exaggerated fear of animals such as spiders, snakes, and dogs.
2. Panic Disorder
Panic disorders are characterized by repeated severe panic attacks, which are either associated with certain situations or triggers (panic disorder with agoraphobia) or appear unpredictably and suddenly (panic disorder without agoraphobia).
The core symptom of panic disorder is the panic attack, an overwhelming combination of physical and psychological distress. They are accompanied by a strong fear of dying or losing control and pronounced physical symptoms. Often those affected find themselves as an emergency with the suspicion of a physical ailment such as a heart attack in the ambulance again. Even repeated examinations without findings do not reduce the fear of a new attack. Physical changes are perceived as dangerous and rock upwards until the vegetative reactions increase to panic attacks. Therefore, many sufferers strive to protect their circulation. If physical exercise opportunities are avoided, the body will be even more sensitive in the future.
Typical fears experienced in panic disorder are:
- The exaggerated fear of death
- Exaggerated separation anxiety
- Expectation anxiety
- Fear of anxiety or the unknown occurs in both panic disorder and phobias.
3. Generalized Anxiety Disorder
It is typical for this anxiety disorder that different everyday situations are coupled with inner tension, anxiety, and anxiety. In addition, there are also physical complaints such as palpitations, sweats, and feelings of tightness as well as mental symptoms such as dreadfulness, restlessness, concentration and sleep problems. People with a generalized anxiety disorder can be irritable and often have problems concentrating and working effectively.
People with generalized anxiety disorder have ongoing, severe tension that interferes with daily functioning. They worry constantly and feel helpless to control these worries. Often their worries focus on job responsibilities, family health, or minor matters such as chores, car repairs, or appointments.
For the diagnosis to be justified, the symptoms must persist for at least half a year.
The causes of anxiety disorders are currently unknown, although research has provided several clues. Areas of the brain that control fear responses may have a role in some anxiety disorders. Anxiety disorders can run in families, suggesting that a combination of genes and environmental stresses can produce the disorders. The role of brain chemistry is also being investigated.
There is no one cause for anxiety; many factors likely contribute to a person’s chances of developing anxiety. There are a few potential causes; genetics and early learning, brain biochemistry, and the fight or flight mechanism.
Many factors contribute to anxiety, and some may apply in each particular case.
List of the causes most often associated with the development of anxiety disorders:
- Early Life Experience
- Environmental and external factors
- Thinking Patterns
- Brain Chemistry
Anxiety problems stem from a combination of factors. When these factors add up, anxiety disorder might be more serious.
We live in a very competitive world and it is important to have high personal and professional standards. However, when people reach for extreme perfection, they may not realize that they are setting themselves up to experience more frustration, anxiety, and disappointment than it is necessary. The goal of perfection is unrealistic. A much better goal is excellence!
Hypnotherapy is an excellent modality to help the perfectionist replace that goal with a more realistic goal, excellence, that is achievable daily. This leads to the experience of less anxiety, frustration, and disappointment.
This way they become generally happier and happier people who operate with peace of mind live longer, experience less stress and anxiety, and are more successful in their relationships and other endeavors.
Unfortunately, many people with anxiety disorders don’t seek help. They don’t realize that they have an illness that has known causes and effective treatments. Other people fear their family, friends or coworkers might criticize them if they get help.
Although each anxiety disorder has its unique characteristics, most respond well to two types of treatment: psychotherapy and medications. These treatments can be given alone or in combination. Treatment can give significant relief from symptoms, but not always a complete cure.
Hypnotherapy can be an effective treatment for many anxiety disorders. It aims to seek out the root cause of the anxiety and change an individual’s perception of a past event or release emotion from it.
Anxiety, dissociative, stress-related, somatoform and other nonpsychotic mental disorders.
F40 Phobic anxiety disorders
F40.1 Social phobias
F40.2 Specific (isolated) phobias
F40.8 Other phobic anxiety disorders
F40.9 Phobic anxiety disorder, unspecified
F41 Other anxiety disorders
F41.0 Panic disorder (episodic paroxysmal anxiety)
F41.1 Generalized anxiety disorder
F41.2 Mixed anxiety and depressive disorder
F41.3 Other mixed anxiety disorders
F41.8 Other specified anxiety disorders
F41.9 Anxiety disorder, unspecified
F42 Obsessive-compulsive disorder
F42.0 Predominantly obsessional thoughts or ruminations
F42.1 Predominantly compulsive acts (obsessional rituals)
F42.2 Mixed obsessional thoughts and acts
F42.8 Other obsessive-compulsive disorders
F42.9 Obsessive-compulsive disorder, unspecified
F43 Reaction to severe stress, and adjustment disorders
F43.0 Acute stress reaction
F43.1 Posttraumatic stress disorder
F43.2 Adjustment disorders
F43.8 Other reactions to severe stress
F43.9 Reaction to severe stress, unspecified
F44 Dissociative (conversion) disorders
F44.0 Dissociative amnesia
F44.1 Dissociative fugue
F44.2 Dissociative stupor
F44.3 Trance and possession disorders
F44.4 Dissociative motor disorders
F44.5 Dissociative convulsions
F44.6 Dissociative anesthesia and sensory loss
F44.7 Mixed dissociative (conversion) disorders
F44.8 Other dissociative (conversion) disorders
F44.9 Dissociative (conversion] disorder, unspecified
F45 Somatoform disorders (See our main page on Hysteria)
F45.0 Somatization disorder
F45.1 Undifferentiated somatoform disorder
F45.2 Hypochondriacal disorder
F45.3 Somatoform autonomic dysfunction
F45.4 Persistent somatoform pain disorder
F45.8 Other somatoform disorders
F45.9 Somatoform disorder, unspecified
F48 Other neurotic disorders
F48.1 Depersonalization-derealization syndrome
F48.8 Other specified neurotic disorders
F48.9 Neurotic disorder, unspecified
If you experience anxiety with absolutely no apparent cause, please ask a medical doctor.
Anxiety can have several physical causes, such as side effects from a prescription medication or over-the-counter medications and supplements, excessive caffeine, and physical problems.
Don’t try to diagnose yourself.
Many people who experience chronic feelings of anxiety about social situations, work, and relationships, or other aspects of everyday life often reach for a beer or a glass of wine to quell their unease.
Good intent and not the best results
There is some truth to the belief that alcohol can reduce stress. Alcohol is both a sedative and a depressant that affects the central nervous system.
At first, drinking can reduce fears and take your mind off your troubles. It can even help you feel less shy. You might experience a boost in mood, but the overall result is relaxation. The effects of alcohol can be similar to those of anti-anxiety medications. The problem is that once you start drinking, you can build a tolerance to the distressing effects of alcohol. This can make anxiety and stress even more difficult to cope with.
Alcohol may help anxious people cope in the short term, but over time this strategy can backfire. Self-medicating with alcohol or drugs can increase the risk of alcoholism and other substance-abuse problems, without addressing the underlying anxiety.
Self-medication for anxiety symptoms is common. Many people probably believe that this kind of self-medication works. What they do not realize is that this quick-fix method makes things worse in the long term. Serious consequences can develop very quickly. People can develop alcoholism and anxiety disorders within time, and these are illnesses that can have a devastating impact on a person’s health, their relationships, and their financial situation.
People with anxiety disorders are vulnerable to substance abuse, and vice versa, but they haven’t been able to determine whether one problem precedes the other.
What’s right and wrong with drinking? Alcohol may worsen anxiety.
Having a glass of wine to ease the tension of a stressful day doesn’t necessarily put a person at risk for becoming an alcoholic, of course. Substance abuse is heavily influenced by a person’s genes and environment, But habitually relying on alcohol or drugs to ease anxiety is at the expense of healthier coping strategies. It’s a very slippery slope.
Unfortunately, so many people suffering from anxiety drink alcohol to cope with their anxiety. But alcohol itself may worsen anxiety. Alcohol doesn’t cause anxiety with everybody, but as an anxiety sufferer you should be aware of the possible pitfalls of alcohol consumption, so pay close attention.
There are a few reasons why alcohol consumption and hangovers make many people anxious. A lot of people say that anxiety sufferers should not drink alcohol because it makes you more nervous than you already are. Is this true?
How alcohol cause anxiety
Alcohol causes or at least increases anxiety in these ways:
Alcohol can affect our mood because it can affect the level of serotonin in the brain. Serotonin is a feel-good brain chemical (neurotransmitter) that when in short supply can cause feelings of anxiety and depression.
2. Drop-in blood sugar
A low blood sugar level can cause anxiety-like sensations, including shakiness, dizziness, confusion, and difficulty speaking.
3. Nervous System
Because of alcohol changes levels of serotonin and other neurotransmitters in the brain. This can worsen your level of anxiety. You might feel more anxious after the alcohol wears off. The nervous system is affected because for the body to fight off the sedative effects of alcohol it puts the body into a state of hyperactivity to counteract this effect. This hyperactivity can lead to shaking, light and sound sensitivity and sleep deprivation.
This has been known to cause nausea, dizziness, fatigue, light-headedness and muscle weakness. These symptoms wouldn’t cause anxiety per se, but they add to a sense of illness which fosters anxiety.
5. Heart Rate
Your heart rate can become elevated as a result of consuming alcohol which can cause a palpitation false alarm and put you into a state of anxious anticipation. Is it a heart attack or isn’t it if you might ask. This “what if” questioning can increase your general state of anxiety.
Watching a movie about people having a hangover is funnier than having one yourself. A hard night of drinking can also make you hazy, bring on headaches and create a sense of disorientation.
For more details ask your medical doctor. As a therapist, I will focus on the psychological consequences.
If you’re going to have a glass of wine with dinner I guess you shouldn’t be concerned. On the other hand, if you’re a heavy drinker or binge drinker, then this might cause a real problem for you.
Even scientists don’t know exactly why all this happens. Some suggest that you eat before drinking, drink water in between drinks, and stay in bed if you are hungover to avoid all the typical problems. Some would say that maybe you shouldn’t drink at all if you have an anxiety disorder – that’s debatable. I would, in case I suffer from an anxiety disorder. Do you think that alcohol should be avoided at all costs when someone has an anxiety disorder? How about reducing it? So you can see if it makes any difference for you.
And if you know that you’re a lightweight, or if you already know that alcohol makes you anxious; maybe I don’t need to write it, but some people just don’t know when to say it is enough.
Some people try to soothe their anxiety with alcohol. When dealing with stressful days or nervous situations, you may be tempted to have a glass of wine or a beer to calm your nerves. But alcohol is not a medication. Although alcohol does have a sedative effect it should not be used as a coping tool. This type of behavior can lead to alcoholism and worse yet, more anxiety.
Alcohol isn’t a source of anxiety treatment. Instead, seek help from a mental health professional – not from a bottle of alcohol – if you have an anxiety disorder. If you think you have a problem with alcohol, seek help from your medical doctor right away. And if you want to get rid of your anxiety I can help you.
Why not asking for help instead?
The shame some people feel about their anxiety and a reluctance to seek help for psychological problems are likely major factors contributing to self-medication.
Unfortunately, people often do not seek the help they need because of the stigma around mental illness. People are likely to stay at home and use the resources that they have at their disposal, which in this case would be alcohol or drugs. Some kind of psychotherapy like Hypnobalancing™ and hypnotherapy are effective and can even solve the problem for good, but some of them can be time-consuming and others aren’t always covered by insurance. Because anxiety disorders are still a tabu, we usually don’t talk about it. Therefore, many people experiencing anxiety may not even be aware of these treatments.
Many people hold various myths that can stall and sabotage their anxiety treatment. In fact, some beliefs can even fuel and perpetuate anxiety.
Here are some myths about managing anxiety disorders and anxiety in general.
Snap a rubber band on your wrist
Some say that one way to get rid of bad or disturbing thoughts is to snap a rubber band on your wrist every time you have the thought.
This was once popular as a behavioral intervention. My experiences as a therapist tell me that suppressing thoughts makes them stronger and more predominant. The thoughts we resist persist.
Feelings of apprehension or dread that cannot be traced to any particular source are called free-floating anxiety.
There are some risk factors for developing an anxiety disorder.
Anxiety disorders can happen at any stage of life. Anxiety is as common among older adults as among the young. Depending on the kind of anxiety disorder there is a tendency when it typically starts.
Women are more likely to have an anxiety disorder than men.
Stressful life experiences may increase your risk. Symptoms may begin immediately or years later. Traumatic events can trigger anxiety disorders, particularly post-traumatic stress disorder.
Children who endured abuse or trauma or witnessed traumatic events are at higher risk of developing an anxiety disorder at some point in life.
Adults who experience a traumatic event also can develop anxiety disorders.
4. Medical condition
Having a serious medical condition can also lead to anxiety disorder. Certain medical conditions have been associated with an increased risk of panic disorder. They include migraines, obstructive sleep apnea, mitral valve prolapse, irritable bowel syndrome, chronic fatigue syndrome, and premenstrual syndrome.
5. Substance abuse
Drug and alcohol use or abuse or withdrawal can cause or worsen anxiety.
6. Genetic factor
Having a family member with anxiety or depression. Anxiety disorders can run in families.
People with certain personality types are more prone to anxiety disorders than others.
8. Stress buildup
A big event or a buildup of smaller stressful life situations may trigger excessive anxiety. Examples are a death in the family or ongoing worry about finances.
9. Other mental health disorders
People with other mental health disorders, such as depression, often experience anxiety disorder as well.
Anxiety gets a lot of bad press. There’s nothing wrong with a bit adrenaline. It is probably healthy to be a little anxious when we have to be awake. Just like a good alarm clock, anxiety can signal that it’s time to act. Adrenaline creates a sudden burst of energy that supports us to perform best in a challenging situation. A manageable level of anxiety can be an asset, serving as a motivator for change and improvement and making us more alert and attentive. But there is a threshold of anxiety that is healthy for us. If the anxiety is too intense it may interfere with task completion and instead lead to avoidance.
Too much anxiety harms performance. The key is to find that middle ground. The right amount of anxiety can motivate a person to succeed and enable multi-tasking, whereas too much anxiety can make even the simplest task difficult. When everyday stress gives way to phobias, until worries, fears, and depression threaten the ability to cope or even get out of bed in the morning, intervention is required.
How much is too much anxiety?
Many people have too much anxiety, as evidenced by the rise in anxiety disorders. Some signs that you may have too much anxiety:
- You live in a constant state of aroused worry or fretting.
- You’re addicted to caffeine or cigarettes.
- You need alcohol or medication to relax.
- You experience a constant stream of negative self-talk.
- You can’t sleep.
- You overspend, run late, or miss deadlines.
For your optimal health and performance, you want to strike the right anxiety balance. Look for anxiety that energizes rather than paralyzes you. Everyone experiences some anxiety—it’s what you do with it, that counts. The most successful people are those who have learned to harness and channel their anxiety into positive action.
There are more things to alarm us than to harm us, and we suffer more in apprehension than in reality.
It is a rare person who lives without fear of one kind or another. I guess we all have fears. Every single person I have seen had some kind of fears. Even the toughest of the tough. We’re supposed to have fears, it’s what allows us as humans to survive. It is a normal and natural part of the human experience of life. Fear is a defense mechanism that was devised way back when we were mainly hunter-gatherers and living in caves. The fight-or-flight response evolved to enable us to react with appropriate actions: to run away, to fight, or sometimes freeze to be a less visible target. Fear is the normal emotion to feel in response to a danger or threat. But for most of us, life isn’t about fighting or escaping predators or enemies anymore.
The problem is that so many people allow fear to rob them of their reasoning, halt their happiness, or derail their dreams. Fear can be paralyzing for some people. When I allow perception and fear to occupy too much space in my mind, I am in trouble.
However, when we change our perception of what we fear, we can lessen or overcome that fear, thereby enjoying life even more.
Through psychotherapy like hypnotherapy, offending triggers can be removed to enable the client to take back control of their life. We seek and identify the root cause of the anxiety, and then change an individual’s perception of a past event. Once the emotion involved in these experiences has been released the client is freed from anxiety or panic. The emotion was the driving force for the fear and once the client understands this, the anxiety no longer has a driving force.
I am an old man and have known many troubles, most of which never happened.
Expectation can be the root of anxiety. Anxiety is designed to keep you safe but sometimes it leads to more harm than good.
High expectations of yourself and others can keep you anxious by telling you that you are inadequate, that things are out of control, and that you cannot handle them. This will start the spin cycle of anxiety. You have more and more negative self-talk. This additionally reduces your confidence and gives you more evidence that you can’t cope with challenges.
Overestimating the probability that things will go wrong or that something bad will happen may be the most common thinking error associated with anxiety. Constant worrying takes a heavy toll.
It keeps you up at night and makes you tense and edgy during the day. Negative beliefs, or worrying about worrying, add to your anxiety and keep you worry even more.
For about two decades I am specialized in the field of fears and anxiety disorders. I spend about 20 hours a week helping people to free themselves from their limitations and thereby gain a better quality of life. If you want to know how it all started and what you should know about me, please read my profile. And yes, therapy is a very personal matter: Because it is a very intensive collaboration, I reveal some details about myself. So you can get a first impression of me. Trust is important and that is why I focus on transparency.
The sessions are conducted either in German or English.
Answers to frequently asked questions can already be found on the homepage, such as the fees. There are also find numerous articles and details about me (profile) helping you to get an impression of me. This will also make it easier for you to decide whether I am the right therapist for you and your issue.
Before contacting me, please read the detailed information on fees, booking, contraindications of hypnotherapy, and the answers to other common questions (FAQ). I would be happy to discuss your specific needs with you in a free preliminary telephone consultation.
These pages are intended to provide information to those interested in psychotherapy with hypnotherapy. They are neither intended to replace psychotherapy nor a personal consultation, examination, or diagnosis by a licensed physician. I am not a medical doctor. I am specialized to help people with fears and anxiety disorders. The profession of a hypnotherapist (official permission to practice psychotherapy according to the HPG) is fundamentally different from the practice of a medical doctor. Medical diagnoses are not made, nor are promises of healing made or medications prescribed. A medical or psychiatric intervention, if necessary, is not to be replaced by hypnotherapeutic treatment under any circumstances.
If you have questions about psychotherapy with hypnosis, please do not hesitate to contact me. I am happy to inform you.
I am frequently asked about the origin and duration of treatment for anxiety and anxiety disorders. Here is my personal response.
We often hear that fear is purely a matter of the head. And if it is only a thought, it can’t be that bad, can it?
What about the relationship between anxiety and being overweight? Some evidence suggests that obesity is positively associated with anxiety disorders in adults.
Friends and family members can help those with anxiety and anxiety disorders. Here are 10 tips.
Sometimes I get telephone calls or emails with the question if I have heard about this specific type of fear before. Most of the time I can say „Yes!“ and other times I am surprised. Truth is that the list of fears and phobias is endless.
Many of my clients reported that they felt a bit better when they learned that they are not alone. Anxiety disorders are very common and very treatable.
Anxiety results from many factors and they can all interact. There is a biopsychosocial theory of anxiety’s origins; anxiety has sources in our biology, our psychological strategies for coping with stress, and life events, including our most important human relationships.
Not only people with a generalized anxiety disorder worry about worry. You are in trouble, when you get into a conflictual relationship with your own thoughts.
Neurotransmitters and anxiety The relation between Neurotransmitters and anxiety.Overview Neurotransmitter Just ask me personally Neurotransmitter Neurotransmitters are endogenous signaling molecules that alter the behavior...
Learn how psychotherapy with hypnotherapy like Hypnobalancing™ address fears by empowering the client, to see more options, allowing to transform the behaviors and engage in new behaviors.
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Myofascial pain syndrome (MPS), also known as chronic myofascial pain (CMP), is a syndrome characterized by chronic pain caused by multiple trigger points and fascial n MPD A subset of the TMJ pain dysfunction syndrome that presents with the triad of symptoms of unilateral pain in the muscles of mastication, c of the joint MDGuidelines is the most trusted source of clinical information on definition for myofascial pain syndrome.
Myofascial pain syndrome icd 9 code
Read about myofascial pain dysfunction syndrome treatment, diagnosis, symptoms (trigger points, chronic pain) and causes (tissue injury). Welcome ; Myofascial Release ; Testimonials ; Services and Prices ; Indy's Guests ; About Dr. Jeren ; Business Cards and Ads ; MFR in USA ; Sharings i haven't been 'diagnosed' or anything with this because for me it's because of magnesium deficiency, so i'm diagnosed deficient in magnesiu | <urn:uuid:9e55f45b-95b5-44cd-b55c-4abc01643a04> | {
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Coming soon to a courtroom near you:
“Mr. Expert, can you tell us what upcoding is and whether you found it in Dr. Smith’s billing for treating the plaintiff?” the defense lawyer asked her medical coding expert.
“Upcoding is an industry term. We sometimes see doctors use more expensive billing codes, known as ICD codes. Billing can be nuanced. Many procedures can be coded different ways. Here, I reviewed the treating doctor’s billing. Prior to the injury, he performed a meniscal repair surgery on the plaintiff’s left knee. It was coded under a standard reimbursement rate. In this case, the doctor performed a meniscal repair surgery, which he opined was caused by the accident. He coded this surgery differently—with a code that is reimbursed at twice the prior rate. This triggers our suspicions.”
The plaintiff’s lawyer squirmed. A treating doctor, typically above reproach, was being hammered.
A brief history of the ICD
The International Statistical Classification of Diseases and Related Health Problems (called ICD), classify medical events and treatment, and are used for billing. They date back to 1893, when a doctor introduced a list of cause of death classifications. His system expanded. In 1948, the World Health Organization took it over, releasing ICD-6. Since then, the ICD has been updated several times. ICD-10 was released in 1994. Most countries use ICD-10. ICD-11’s release is scheduled for 2015. But the U.S. is still using ICD-9.
Within a version are variants. These variants use abbreviations. For example, the U.S. uses ICD-9-CM, where CM stands for Clinical Modification. The U.S. was supposed to switch to ICD-10-CM in October 2013. The Department of Health and Human Services delayed the transition to ICD-10-CM to October 2014.
Health care providers chart information about a patient. The chart is then given to medical coding. The coding is not done by the treater who did the care. Coders are separate professionals trained to read charts and code the treatment. Coders work apart from medical professionals. Some work for a doctor’s practice group or a hospital. Others are outsourced. They have a set amount of records they are expected to get through per day. They do not typically interact with the treater who charted the information. This creates an opportunity for errors.
Coders use software to do their coding. About 200 different programs exist to do coding. The programs have an impact. If coding becomes an issue in your case, you will want to know the program used, the version, and who does the coding.
ICD-10’s expanded coding
There is a greater selection of codes for a specific injury in ICD-10. For example, ICD-9 may have had one code for a femur fracture. ICD-10 has many: they specify the fracture location, distal or proximal, and type of fracture. Helpful, yes?
Yes and no. Medical charting is currently not detailed enough for coders to accurately code in ICD-10. A survey found 1/3 of records were sufficiently charted to code the record. This translates to significant growing pains when ICD-10-CM is implemented. Treaters will have to take more time to chart (a good thing). Records will be kicked back when the information is lacking. The industry expects a six-month industry-wide slowdown—marginally—to adjust to ICD-10-CM’s impact (so if you think Kaiser’s billing takes a long time now, just wait.)
ICD-10’s third-party billing codes
ICD-10 also built in cause codes and third party billing codes. So now when your client presents at a hospital, the paramedics list the cause of injury as car crash, and the coders capture the data. The lien notice hits the patient’s mailbox before she’s home.
Third party billing codes are fertile ground for coding bias. Coding can be nuanced. Several codes might apply to the same injury. Hospitals are reimbursed at one rate by HMOs. But they are usually reimbursed at higher rates from third party coverage like automobile insurance. The coder may experience a bias to upcode incidents where reimbursement rates might be higher.
This brings us to billing experts. Defense lawyers, particularly those with medical billing fraud exposure, have started using billing experts. These experts look for billing inconsistencies. At first, they sought to reduce the past medical costs. Now, they aim to tarnish your treating doctor as a fraudster. Neither is good news. When a medical billing expert appears on an expert disclosure, you have a problem.
Taking a stand
Back to our squirming plaintiff’s lawyer. On rebuttal, he called the doctor’s office manager. She demonstrated that all medical coding was outsourced to a company that the office did not directly contact. She acknowledged the error in the billing, apologized, and corrected the billed amount. Deflection and deflation. The treating doctor’s reputation restored.
A shout out to Amy Eddy, Bottomly, Eddy & Sandler, PLLP for covering this interesting issue at the Belli Society Seminar in July 2013. | <urn:uuid:d77b3366-fc7e-40f9-bdf7-4ae5bd37e637> | {
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