Chapter 3

CHAPTER 3: ANATOMY, TERMINOLOGY AND DIAGNOSES
INTRODUCTION
Human anatomy refers to the way the body is structured. Physiology is the term used for the study of how the body functions. In order to understand the diseases that affect our patients and the equipment and services we provide to address their needs, it is important to understand not only the parts that make up the body, but the ways in which they work together.
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ANATOMY In this section you will learn how cells are structured, the way cells group together to form tissues, how similar tissues combine to form organs, and the way organs work together as systems to carry out body functions. The information in this section will help you: Become familiar with the names of the parts of the anatomy. Understand the way the different parts work together in a healthy person. Recognize some of the common diseases that affect different organs and systems.
APRIA HEALTHCARE Employee Handbook: Customer Service Orientation & Certification Program
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Before you begin the study of the structure and function of the human body and its many parts, it is important to think about how those parts are organized and how they might logically fit together into a functioning whole. CELLS Cells are the smallest structural units of living things. Cells are composed of protoplasm or living matter, a substance that exists only in cells. It consists mostly of water. In the water are four main compounds found only in protoplasm. They are carbohydrates, fats (lipids), salts, and nucleic acids. Protoplasm also contains small amounts of ordinary table salt and a few other kinds of compounds. All cells, whether plant or animal, have a common basic structure. The outer cell membrane contains the main substance or cytoplasm. This semi-permeable membrane allows nourishment to enter the cell and eject waste products. Within the cell, the process of life goes on through its organelles (little organs). Among these are the mitochondria, sometimes called the powerhouse of the cell, where heat and energy are provided. The center of the cell, or nucleus, enables a cell to reproduce through a process called mitosis. There are numerous types of cells that differ in size and attributes according to function. When a group or collection of similar cells acts together to perform a particular function, they are called tissues. Tissues Tissues are classified into four main groups: Epithelial tissuetissue that forms the skin and lines the body cavities, tubes, and passageways leading to the outside of the body. Connective tissue tissue that supports and connects other tissues.
Skull Clavicle Mandible Scapula Humerus Radius Ulna Sacrum
Muscle tissuetissue with the ability to shorten or contract. Nerve tissuetissue with the ability to conduct impulses. It also possesses properties of irritability and conductivity. Skeletal System The adult skeleton is composed of 206 bones. The spinal column, along with the skull and rib cage, is called the axial skeleton. The bones of the arms, hands, legs, and feet, plus the shoulder and pelvic bones make up the appendicular skeleton. Bones function to provide a framework to stabilize and support the body. Although bone is extremely strong, it is also light and flexible. Its rigidity enables us to bear our own weight, as well as the ability to lift and carry. The bones provide protection for internal organs, such as the brain, heart, and lungs. They also store minerals necessary for the body and make red blood cells.
Ribs
Femur Pelvis Fibula Patella Tibia
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The red blood cells are produced in the bone marrow of such bones as the vertebrae, femur, and ribs. Bones provide a surface for muscle, ligament, and tendons. Ligaments, bands of tough tissue, connect the bones when they come together to form a joint. The joints provide smooth, gliding surfaces at the ends of bones so that movements can be carried out easily and painlessly. Tendons are joint attachments similar to ligaments, but serve to connect muscles to bones and contract the muscle to produce movement. Finally, bones and joints act as levers to assist in mobility, which is the principal function of the muscles. Muscular System The muscular system is composed of over 650 muscles, providing the body with mobility, due to their ability to expand and contract. Muscles that are under our direct, conscious control are known as voluntary muscles. Because this type of muscle tissue is usually attached to the bone, it is also called skeletal muscle. Muscles over which we have little or no conscious control are called involuntary muscles, or smooth muscles. They propel food along the intestinal tract, control our breathing, and perform many other automatic functions. The fibers of these smooth muscles are controlled by a different part of the brain than that which governs the voluntary muscles. Bones, joints, and muscles are so closely interrelated in function that they are collectively called the musculoskeletal system. Nervous System The nervous system is the bodys communications network, receiving, sorting out, and responding to both internal and external messages. The nervous system as a whole is divided into the Central Nervous System (CNS), consisting of the brain and the spinal cord, and the Peripheral Nervous System, made up of the cranial and spinal nerves. The whole of the central nervous system functions with billions of neurons, which are specialized cells, each composed of a cell body and nerve fibers that carry impulses to and away from the cell body. Central Nervous System The brain, which lies in the cranial cavity of the skull, is a kind of control center for the nervous system. It links with the sense organs and the muscles of the head by means of 12 pairs of cranial nerves. The brain consists of three main parts: the cerebrum, the cerebellum, and the brain stem. The cerebrum is the largest part of the brain and consists of two hemispheres, which are separated by a deep cleft. Each hemisphere is divided into different sections, or
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Cerebrum
lobes. The surface of the cerebrum has a layer of gray matter, known as the cortex. Areas for dealing with sense impressions and coordinating muscular movement are found in the cortex. The cortex also has areas associated with thought, memory, emotion, and where decisions controlling conscious activity are made. The cerebellum plays an important role in the coordination of voluntary muscle movements such as maintaining proper posture and balance, walking, running, writing, dressing, and eating.
Pons Midbrain Medulla Oblongata
Cerebellum
The brain stem is a bundle of nerve tissue at the base of the brain, consisting of the midbrain, the pons and the medulla oblongata, which have centers controlling respiration, heart rate, and digestion. The spinal cord is continuous from the brain down through the vertebrae that make up the backbone. It is a communication and association center. Many reflex centers are located in it. Its fiber tracts carry impulses from one level of the cord to another, and to and from the brain. Peripheral Nervous System The peripheral nervous system controls both general and special sense impulses. Impulses travel to and from the brain along the nerves. Each nerve consists of many bundles of fibers wrapped in connective tissue. There are two types of fibers, each carrying a different kind of message. Sensory fibers carry messages such as hot, cold, and pain to the brain. The brain interprets these messages, then motor fibers carry the information back to the muscles. Certain nerves and centers in this system are grouped together as the autonomic nervous system because they control activities that go on more or less automatically, regulating the actions of glands, smooth muscles, and the heart. There are two major divisions to the autonomic nervous system. Sympathetic nerves mobilize the body for action to meet possible danger. When a person is confronted with situations of emotional stress involving fear or anger, the brain sends messages along the sympathetic nerves to change the activity of the organs to prepare the body for emergency action. Breathing becomes faster so that the body gets more oxygen, the heart pumps faster to supply more blood to the muscles, and the adrenal glands secrete the hormone adrenaline, which prepares the body to fight or run away. Parasympathetic nerves restore the body to peaceful activity after an emergency, such as when the heart slows down and blood pressure falls after the danger is over. Neurological diseases may result in the need for mechanical breathing support when they affect the muscles used for breathing. The muscles may be weakened by the disease, or the way the muscles receive the signal from the brain may be affected. This can happen, for example, with polio or muscular dystrophy.
Peripheral Nervous System
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Some common diseases* affecting the neuromuscular system include: Cerebral Palsy Multiple Sclerosis Muscular Dystrophy Myasthenia Gravis Parkinsons Disease Neurologic disorders include conditions that affect the brain and spinal cord. Injury and disease, affecting parts of the brain that control breathing, can interfere with the signal that would normally stimulate breathing. If the signal becomes irregular or absent, mechanical support for breathing may be necessary. Damage to the spinal cord can hinder or completely stop the signal from reaching the breathing muscles. Mechanical support for breathing will become necessary if the signal for breathing is not transmitted to the muscles. Common diseases* affecting the nervous system include: Alzheimers Disease Amyotrophic Lateral Sclerosis (Lou Gehrigs Disease) Aneurysm Paralysis Hemiplegia Paraplegia Quadriplegia Spinal Cord Injury Stroke *Please refer to the Diagnoses Section for information on specific diseases. -
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Respiratory System
Lungs
Trachea
Oxygen (O2) is supplied to the tissue cells and carbon dioxide is removed from them through an arrangement of passageways known as the respiratory system. The organs of the respiratory system are designed to perform two basic functions: (1) an air distributor and (2) a gas exchanger for the body. The respiratory system ensures that O2 is supplied to the bodys cells, and that carbon dioxide is removed from them. In addition to air distribution and gas exchange, the respiratory system filters, warms, and humidifies the air we breathe. This system can be understood by dividing it into three separate areas: 1) the upper airway, comprised of the nose, mouth, trachea or windpipe; 2) the lower airway which includes the trachea, bronchi, and alveoli or air sacs, within the lungs; 3) the respiratory muscles of the diaphragm, the major breathing muscle that separates the abdomen from the chest, and the intercostal muscles between the ribs. When we breathe, fresh air enters the upper airway through the mouth and nose where it is warmed and moistened. The heated, moistened, and filtered air enters the trachea. The trachea then divides into two main branches, or bronchi, which deliver the air into the lungs. Once the trachea reaches each lung, these airways divide into smaller branches. Eventually these small airways end in the alveoli. The alveoli are surrounded by tiny blood vessels that pick up the oxygen that the tissues must have and carry it throughout the body. Carbon dioxide, which is released by the tissues as a waste product, is carried back to the lungs and expelled. Respiratory disorders can affect any portion of the passageways that allow the flow of air into the lungs. If the capacity to breathe normally is compromised, oxygen or medications may have to be administered to ensure adequate oxygen is directed to the cells and to open airways. Some common diseases* associated with the respiratory system include: Chronic Obstructive Pulmonary Disease (COPD) Chronic Bronchitis Pulmonary Emphysema Chronic Asthma Bronchiectasis Pneumonia Cystic Fibrosis Lung Cancer *Please refer to the Diagnoses Section for information on specific diseases. -
Alveoli
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Many Apria patients suffer from one of the above conditions. Circulatory System The function of the circulatory system is transportation. Food and oxygen are carried by it to the tissues. Carbon dioxide and other waste products of metabolism are carried from the tissues to the proper organs of excretion. Hormones are distributed through the body, temperature is regulated, and many of the bodys defenses against disease are centered in this system. The circulatory system consists of the heart, blood vessels, and the blood. Heart The heart is a hollow muscular organ that lies in front of the lungs in the chest cavity and is protected by the surrounding rib cage. Without a continuous supply of blood, the body cannot function. To maintain this supply, the heart has to work nonstop, receiving deoxygenated blood on the right side and pumping it into the lungs to be oxygenated. The left side of the heart receives oxygenated blood which is pumped by the heart to the rest of the body. Blood vessels The blood vessels are classified according to function as arteries, veins, or capillaries. The arteries can be likened to a tree with a trunk and large and small branches that carry the blood into the capillaries where exchanges between the blood and the tissue fluid occur. The walls of the arteries are thick in order to withstand a comparatively high pressure from the blood being pumped from the heart. By the time blood enters the veins for its return journey to the heart, it is under less pressure; the walls of veins are accordingly thinner than those of arteries. Some veins, particularly those in the lower limbs, have valves that close after every heartbeat to prevent blood from flowing backward. Blood Blood is the cell-containing fluid that carries oxygen to the organs and tissues and removes the carbon dioxide from them. The white blood cells protect the body from infections by devouring dangerous bacteria. Red blood cells carry oxygen to the tissues by means of their hemoglobin. Tiny bodies called platelets help the blood to coagulate, that is, to form blood clots so that serious bleeding will not result from a cut or wound. All these cells travel through the body suspended in plasma, a clear liquid that conveys important enzymes, proteins, and hormones, to all parts of the body. The blood also serves as a thermostat, keeping temperature equal throughout the body.
R. Pulmonary Artery L. Pulmonary Artery L. Pulmonary Veins
Aorta Superior Vena Cava R. Pulmonary Veins Inferior Vena Cava
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The circulatory system provides a route to deliver the medications and nutrition many of our patients need (see infusion therapies in the Product and Services chapter). Some common diseases* that affect the cardiovascular system include: Acute Myocardial Infarction (MI) (heart attack) Congestive Heart Failure (CHF) Atherosclerosis * Please refer to the Diagnoses Section for information on specific diseases.
Esophagus Stomach
Digestive System The complex process by which the food we eat reaches the cells throughout the body is accomplished through digestion and absorption. The components of the digestive system are the alimentary canal and the accessory organs. The alimentary canal consists of the mouth, pharynx, esophagus, stomach, and large and small intestines. This 30-foot continuous passageway is responsible for preparing food to be used by the body and collecting wastes to be eliminated. The liver, gallbladder, and pancreas, which comprise the accessory organs, manufacture various substances needed to regulate food metabolism and serve as storage areas for certain substances that are released as needed. The first action when food enters the body takes place in the mouth, where the process of food breakdown is begun by chewing and the secretion of enzymes by the salivary glands. Food then passes down a long muscular tube called the esophagus into the stomach. The stomach rests in the upper part of the abdominal cavity. The strong muscular action of the stomach churns up the food and mixes it with digestive enzymes and acids that help break down food into forms that the body can absorb. Additional juices from the pancreas, liver, and gallbladder are mixed in when the food enters the duodenum, the first portion of the small intestine. Proteins, carbohydrates, and fats are converted to simpler substances and absorbed into the bloodstream through the walls of the small intestines. At the end of the small intestines, all that is left of the food are waste solids that pass through the large intestines and are eliminated. Liver The liver has about 500 known functions. Products of digestion that are absorbed into the bloodstream from the stomach and intestines travel straight to the liver for further processing. The liver completes the transformation of sugars into glycogen for storage, breaks down proteins and synthesizes new ones, and stores vitamins. The liver also helps detoxify harmful substances in the blood.
Liver
Gall Bladder (under liver) Small Intestines Large Intestines
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Bile, a greenish fluid that is extremely important to the digestion of fats, is produced by the liver. Gallbladder The gallbladder, a kind of pocket in the channel through which bile flows from the liver into the intestine, acts as a storage place for the bile. Digestive disorders may result in the need for enteral nutrition when portions of the gastrointestinal (GI) tract are obstructed. Common diseases* affecting the digestive system include: Ulcerative Colitis Esophageal Obstruction or Stricture Cancer Crohns Disease Intestinal Obstruction Pancreatitis *Please refer to the Diagnoses Section for information on specific diseases. Urinary System The urinary system includes two kidneys, two ureters, one urinary bladder, and one urethra. This system is usually thought of as the bodys main excretory mechanism and is commonly called the excretory system. In addition to removing waste products, the urinary system regulates water balance and acid-base balance in the body. Kidneys A kidney is located on each side of the backbone, just above the hips. They filter about 15 gallons of blood per hour, eliminating waste production and excess water from the blood, as well as extra sodium (salt), potassium, urea, and other substances. These wastes are deposited in the urinary bladder as urine. The kidneys aid in water balance as well. When a person drinks a large amount of water, the kidneys excrete the excess, but in hot weather, when extra fluid is lost by perspiration, the kidneys excrete relatively less. Urinary Bladder The urinary bladder receives waste products from the kidneys through two tubes called ureters. After a sufficient quantity has collected, it is eliminated by urination through a tube called the urethra.
Kidney Ureter
Bladder Urethra
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High blood pressure, heart failure, and infections can harm the kidneys. Great strides have been made in recent years in helping people with kidney failure to lead normal lives. Kidney transplants have had considerable success, particularly when patients can receive the care they need in their homes after receiving their new organ. Endocrine Glands and Hormones Glands are organs that manufacture and release secretions essential for the proper functioning of the body. They are divided into two types: The exocrine glands have ducts that carry the secretions to other parts of the body; the endocrine glands have no ducts and release their substances, called hormones, directly into the bloodstream. The endocrine glands and hormones help to regulate growth, development, and reproduction, as well as control the balance of salt and water in the body and the level of sugar in the blood. The endocrine glands form a complete, interdependent system. Removal or under-functioning of one gland may seriously affect the functioning of others. Similarly, an increase in the functioning of one gland will change that of the others. Pituitary Gland The function of the pituitary gland, or master gland, is to stimulate, regulate, and coordinate the functions of certain endocrine glands. About the size of a pea, the pituitary lies in a small hollow in the skull. It is connected to the part of the brain called the hypothalamus. This link gives the brain direct control over the pituitarys hormone production. Thyroid Gland The thyroid is a u-shaped gland that is in front of the throat. The thyroid controls the rate of metabolism in the body. Parathyroid Glands There are four parathyroid glands, two on each side of the thyroid gland in the neck. Each parathyroid is the size of a small pea. These glands help to regulate the level of calcium in the bloodstream which, in turn, helps to control the way the muscles receive nerve impulses from the brain. Adrenal Glands These two glands fit like small cups, one on the top of each kidney. Each adrenal gland consists of two major parts: the cortex or outer portion and the medulla, or central section. The two main functions of the hormones of the adrenal cortex are: 1) the control of the proper salt and water content of the body; and 2) the regulation of carbohydrate, fat, and protein metabolism. The medulla of the adrenal gland produces the hormone called adrenaline, or epinephrine.
Pineal Gland Hypothalamus Pituitary Gland Parathyroid Thyroid Gland Thymus Adrenal Glands Pancreas Ovaries (Female)
Testes (Male)
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Adrenaline is responsible for activation of the nervous system in emergency situations. Diseases of the endocrine glands are numerous and varied. Tumors or other abnormalities frequently cause the glands to secrete either too much or too little of their hormones. Common diseases* affecting the endocrine system include: Addisons Disease Cretinism Diabetes Mellitus *Please refer to the Diagnoses Section for information on specific diseases.
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MEDICAL TERMINOLOGY
Medical terminology is the language used in the health care industry. This terminology deals with the parts of the body and their functions as well as diseases and injuries to the body. Although the vocabulary is large, similarities exist among many words that make it possible to understand and use the language. The first part of this section addresses medical words. Most medical words are made up of two or more parts. The root or combining form, the prefixes (coming before the root) or suffixes (coming after the root) and adjective or noun endings (indicating a relationship to the root). A compound word is made up of two or more roots plus one or more of the parts just mentioned. Understanding reimbursement concepts requires a fundamental working knowledge of the words used by medical professionals, government agencies, and insurance carriers to describe services, benefits, and policies. The next part of the terminology section provides the terms used within the medical billing industry and/or the Medicare program. The last part of the terminology section provides the terms for the diagnoses most commonly used at Apria Healthcare. TERMINOLOGY In this section you will learn some of the common components of the words used in the field of medicine to help you provide good service to Apria Healthcares customer base. The information in this module will help you: Become familiar with common word roots, prefixes, suffixes, and adjective or noun endings. Understand the combined forms of word components. Use terminology for verification, coding, and completing claim forms. Recognize the most common words associated with Apria Healthcares products and services. Become familiar with terms used by the government (i.e., Medicare).
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Common Word Roots

ROOT
abdomen(o) angi(o) arteri(o) arthr(o) brady bronch(o) carcin(o) cardi(o) cerebr(o) cervic(o) chem(o) crani(o) cry(o) cyt(o) derm(o) enter(o) erythr(o) gastr(o) hem(o)(a) hepat(o) hydr(o) laryng(o) later(o) leuk(o) lymph(o) my(o) myel(o) nas(o) neuro oste(o) ox, oxy path(o) ped(o) pharmaco phleb(o) phot(o) pleur(o) pneum(o) pulmo scler(o) scolio thorac(o) thromb(o) trache(o) ur(o) vas(o) ven(o) vertebr(o)
MEANING
abdomen vessel artery joint slow bronchus cancer heart cerebrum neck chemical skull cold cell skin intestine red stomach blood liver water larynx side white lymph muscle marrow/spinal cord nose nerves bone oxygenation disease child drug vein light pleura, rib, side lung lung hard crooked chest clot trachea urine, urinary vessel vein vertebra
EXAMPLE
abdominal angiography arteriosclerosis arthritis bradycardia bronchiectasis carcinoma cardiology cerebrovascular cervical chemotherapy craniofacial cryogenic cytoplasm dermatitis enteral erythrocyte gastritis hemophilia hepatitis hydrotherapy laryngectomy laterodeviation leukemia lymphocyte myocardium myelogram nasopharnyx neuralgia osteomyelitis hypoxia pathology pediatric pharmacy phlebotomy photophobia pleurodynia pneumonia pulmonary sclerosis scoliosis intrathoracic thrombophlebitis tracheostomy urology vasodilator venipuncture vertebrocostal
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Common Prefixes
PREFIX a(n) ab circum contra dys hyper hypo infra inter intra mal meg, mega micro neo semi sub trans uni
MEANING absence, without away from around opposite difficult, painful above, extreme less than, below beneath between, among within, into bad, abnormal great, large small new half under across, through one
EXAMPLE anemia abduction circumduction contraindicated dysphagia hyperextension hypoglycemia infrasternal intracostal intracranial malabsorption cardiomegally microscopic neonate semicircular subcutaneous transfusion unilateral
Common Suffixes
SUFFIX ectomy gram graph itis ology oma ostomy plasia plegia pnea MEANING removal letter, drawing write, record inflammation the study of tumor opening into growth paralysis breathing EXAMPLE appendectomy electrocardiogram electroencephalograph laryngitis cardiology melanoma colostomy neoplasia paraplegia apnea
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The following vocabulary reflects the basic terminology commonly used in the homecare business and will be a resource until many of these terms become familiar. Basic Medical Terminology Abduct: Abductor: Acute: Additive: Adduct: Adductor: Adhesion: ADLs: Administer: Aerosol Therapy: Afebrile: AK: Alcohol Swab: Alcohol Swabstick: Ambulation: Amino Acids: Ampule: Amputation: Anaphylactic Reaction: Angiocath: Anterior: Antibiotic: To move away from the body. Muscle which when activated moves an extremity or limb away from the body. Having rapid onset, severe symptoms, and a short course; not chronic. Drug, medication, or vitamin added to Total Parenteral Nutrition (TPN) solution. To draw close to the body. Muscle which when activated draws or moves a segment inward toward the body. A holding together or uniting of two surfaces or parts, as in healing. Activities of Daily Living. Refers to normal daily routine. To give/take a solution or medicine by mouth, through a vein, or feeding tube. Changing liquid medication into a fine mist so the patient can inhale the medicine into the lungs. Without fever. Above the knee. Usually in relation to location of amputation. Small pad that contains alcohol used to clean and inhibit bacterial growth. Same as alcohol swab, except swab pad is attached to a 3 to 4 inch stick. The act of walking. A source of protein. Small sealed glass container of medication used one time only. The surgical removal of a limb. A serious hypersensitive reaction to a protein or drug that requires immediate emergency attention. Plastic catheter inserted in the hand or arm for administering solutions or medications. Toward the front of the body. Medication (drug) used to fight a specific infection by killing bacteria.
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Antiseptic: Arterial Blood Gas:
Aseptic: Ataxia: Atresia: Atrophy: Bacteremia: Bacteria: Bilirubinemia: BK: Bolus:
Bronchodilators: Bronchospasm: Burns: Butterfly Needle: Carbohydrates: Cassette: Catheter Injection Cap: cc: Chemotherapy: Chronic:
Solution that when applied to the skin inhibits the growth of bacteria. A blood test that identifies the amount of oxygen that is being carried in the patients blood. The result is used to determine if the patient requires supplemental oxygen. Free of germs. Lack of muscular coordination. A congenital absence or closure of a normal body opening or tubular structure. Reduction in size or loss of muscle tone, usually resulting from disease. Bacteria in the blood. Small microscopic organisms that may cause infection. Presence of bilirubin in the blood resulting in jaundice. Below the knee. When used with pain management, an extra dose of medication that is given only if needed to control pain. For enteral therapy, an administration method in which oral syringes are used to administer the solution at prescribed intervals (an alternative to continuous pump or gravity feeding). Medications that cause the airway to relax and expand. An airway condition where the spiral muscles that surround the airway constrict and make it harder for the patient to breathe. Tissue injury resulting from excessive exposure to thermal, chemical, electrical, or radioactive agents. Sterile, stainless steel IV needle inserted into a vein, in the hand or arm, to administer solutions or medications. Sugars and starches important for the body as basic sources of energy. A plastic container the pharmacist/pharmacy technician fills with medication for use with CADD infusion pumps. Injectable rubber cap that attaches to the end of IV catheters or extension tubing. One part of a heparin lock. Cubic centimeters. A unit or measurement for liquids. [Same as (ml) milliliters]. Drugs that destroy cancer cells. Denoting a disease showing little change or of slow progression; the opposite of acute.
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Chronic Obstructive Pulmonary Disease (COPD): Colostomy:
Congenital: CNS: Contaminated: Content: Contraction: Corpulmonale: CVA: Cyclic: Cytoxic: Decubitus Ulcer: Degenerate: Dextrose: Digestion: Diluent: Distal: Dorsal: Dorsiflexion: Dressing: Duodenal Stenosis: Duodenum: Dysphagia: Dyspnea:
Identifies a collection of respiratory diseases that occur over a long period of time. These diseases cause the patient to have a progressively harder time exhaling air from the lung. The opening of a portion of the colon through the abdominal wall to its outside surface. This is performed when the feces cannot pass through the colon and out the anus because of a pathological condition or surgical removal of the distal bowel. Present and existing at the time of birth. Central Nervous System. Objects that have come in contact with unsterile, dirty, soiled, or infected particles. Refers to oxygen as a product contained in a liquid vessel or compressed gas cylinder. Shortening of muscle tissue. Right heart failure due to lung problems. Cerebrovascular accident; stroke. Occurring during the same interval each day (e.g., 8:00 am to 6:00 pm) as during administration of a solution (like TPN). Compounds that cause cell damage. Bed or pressure sore. Normally at bone prominences. To deteriorate or get progressively worse in mental or physical condition. A sugar or glucose; an intermediate in carbohydrate metabolism. Mechanical and chemical breakdown of food in preparation for absorption into the bloodstream. Agent that dilutes a substance or solution to which it is added. Further away from the midline of the body. Underside or back of a surface. Foot up. Covering used to protect an area of the skin from infection. The constriction or narrowing of the first part of the small intestine, between the pylorus and the jejunum. First segment of the small intestine. Inability to swallow or difficulty in swallowing. Difficulty breathing; shortness of breath.
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Dystrophy: E-Cylinder: Edema: Electrolytes: Enteral Feeding: Enteral Feeding Tubes: Enteral Nutrition: Esophagus: Exit Site: Extension: Extensor Muscle: Extensor Thrust: External Rotation: Febrile: Filter: Fistula: Flaccid: Flexion: Flexor: Flowmeter: Flush: Formula: Fracture: Fusion: Gait: Gastric:
Degenerative or progressive loss of muscle function. A small portable cylinder that is used to supply oxygen to the patient for a short period of time. Swelling due to excessive accumulation of fluids in the tissues. Important chemical components of body fluid and cells. Formula given into the stomach or intestines via a feeding tube. Hollow tubing used to deliver enteral nutrition formulas when inserted into the gastrointestinal tract. The administration of commercially prepared liquid formulas consisting of carbohydrates, proteins, fats, vitamins, electrolytes, and minerals. Passageway through which food and fluid travel from the mouth to the stomach. Point where catheter or feeding tube leaves the body. To open or straighten out. Muscle which straightens or extends a limb. Tightening of extensor muscle group, forcing the body into a straightened position. Abduction. Turning a body part away from the midline of the body. With fever. Eliminates air, bacteria, and particles from solutions or medications. An abnormal tubelike passage from a normal cavity or tube to a free surface or to another cavity. Lack of muscle tone. Bend or being bent. Muscle which bends a limb or part of a limb. An adjustable oxygen regulation device that controls the flow of oxygen to the patient. Solution used to flush existing solution from an IV catheter or feeding tube. Contains nutrients the body requires including carbohydrates, fats, proteins, minerals, and vitamins. A broken bone. Locking two bones in one position. The pattern or style of walking. Pertaining to the stomach.
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Gastric Bypass: Gastrointestinal Tract: Gastrostomy Tube: Growth Hormone: H-Cylinder: Heparin: Heparinization: Heparin Lock:
Humidifier: Hyperalimentation: Hyperextension: Hyperglycemia: Hypoglycemia: Hypoxemia: Ileum: Ileus: Inferior: Infiltration: Infusion Device: Insertion Site: Intermittent: Internal Rotation: Intravenous (IV):
A means of circumvention; a shunt placed in the stomach. The mouth, throat, esophagus, stomach, and intestines. A tube that is surgically implanted through the abdominal wall into the stomach. A hormone secreted by the anterior pituitary that regulates the cell division and protein synthesis necessary for normal growth. A large metal oxygen container about 5 feet tall that is used to supply oxygen to a patient. Used to prevent blood from clotting in an IV catheter. Putting Heparin solution into the catheter with a syringe to prevent clotting or catheter blockage. Used to keep an IV catheter from clotting between infusions. The IV catheter, extension tubing, and an attached injection cap are filled with a small amount of Heparin solution for this purpose. A small container that is used to provide moisture to the patients inhaled oxygen. Term used to describe Total Parenteral Nutrition (TPN). Overextending past the point of being normal. High blood sugar. Low blood sugar. Insufficient volume of oxygen in the blood. The third segment of the small intestine. An intestinal obstruction. The under surface of an organ, or indicating a structure beneath another structure. Seepage of IV fluid into the surrounding tissues. Controls the speed (rate) at which a solution or medication is delivered. Location where a catheter or feeding tube enters the skin. Infusion or feeding that is not administered continuously, only occasionally. Adduction. Turning of a body part toward the midline of the body. Injection of a solution or medication into a vein.
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IV Catheter:
A plastic or stainless steel hollow tube placed in a vein to deliver fluid and medication directly into the bloodstream. IV Infusion: The administration of a solution or formula through an IV catheter. IV Push: Medication manually injected from a syringe directly into an IV catheter. Jejunostomy Tube: A tube that is surgically implanted through the abdominal wall into the jejunum (a section of the small bowel). It introduces food into the small intestine. Jejunum: The second segment of the small intestine. Lesion: An injury or wound. Lipids: Any one of a group of fats or fat like substances. Milky, white solution given to patients through a vein. Liquid Oxygen (LOX): Oxygen that is stored in a liquid form. The liquid state condenses the oxygen and creates a supply system that lasts longer than a cylinder supply system of the same size. Liters Per Minute: The volume of oxygen that a patient receives identified as the number of liters provided to the patient each minute. Lumen: The opening in tubing used for IV access or suction. Malformation: Deformity, abnormal shape or structure, especially congenital. Metered Dose A portable hand held device that contains medication Inhaler (MDI): that can be delivered to the patient from its small portable compressed air supply system. Milliliter (ml): Unit of measure for medications and solutions. The term cc and ml are equal; 30 cc (ml) equals one fluid ounce. Minibag: A transparent polyvinyl bag that comes in different sizes and is filled with intravenous solution or medication. Mucosa: The first layer of tissue or membrane in the bowel. Nasal Cannula: An oxygen administration device that supplies oxygen to the patients nose by a length of tubing that ends with two small prongs at the entrance to the patients nose. Nasogastric (NG) Tube: A small flexible tube that is passed through the nostril, down the throat and esophagus, and into the stomach. Nebulizers: Small medical devices that deliver aerosol medication. Necrosis: Death of areas of tissue or bone surrounded by healthy parts. Neonatal: Concerning the first 28 days after birth. Neuromuscular: Pertaining to both nerve and muscle.
3.20
Obstruction: Occlusion: Occlusive: Opportunistic Infection: Osteoporosis: Oxygen Saturation: PO: Parenteral: Pediatric: Percussor: Peripheral: Peripherally Inserted Central Catheter: Phlebitis: Pleurisy: Pneumocardiogram: Pneumonectomy: Pneumonitis: Posterior: Post-Op: Postural Drainage: Pounds Per Square Inch (PSI): Povidone Swab: Povidone Swabstick: Pre-Op: Pressure Sore:
Blockage of a structure that prevents it from functioning normally. Clotting or blockage in an IV catheter or feeding tube. To manually seal an IV dressing on all four sides and make it airtight. Any infection that results from a defective immune system that cannot defend against pathogens normally found in the environment. Brittle bones resulting from the aging process. The volume of oxygen that the patients red blood cells are carrying. By mouth/oral. Administration of fluids, nutrients, or medications via an IV catheter into a vein. Concerning the treatment of children. A device that is used to loosen secretions from the lungs by pounding on the chest wall. Located away from the center. Area where an IV is placed, usually arms or hands. A type of IV catheter that is inserted into a peripheral vein and ends in a central vein for long-term IV therapy. An inflammation of the vein. Inflammation of the pleura. A graphically recorded evaluation of an infants respiration and depth rate during a 12 hour period. Surgical removal of part of the lung. A condition of the lung that results in inflamed airways. Toward the back of the body. Care after or following a surgical operation. A process where the patient is placed in body positions that assist in draining the lung of congestion. The amount of operating pressure being used by a medical device to function. Small pad soaked with povidone antiseptic. Similar to a povidone swab, but swab is on a 3 to 4 inch stick. Care preceding an operation. Skin tissue which has become damaged due to unnatural pressure. Such pressure restricts or prevents normal flow of blood to tissue cells causing breakdown of the skin. (See also Decubitus Ulcer.)
3.21
Prognosis:
Prosthesis: Proteins: Pulmonary: Pulmonary Function Tests: Pulmonary Insufficiency: Purge: Pursed Lip Breathing:
Purulent: Range of Motion (ROM): Rate: Regulator: Resection: Saline: Saline Flush: Sclerosis: Sepsis: Septicemia: Spinal Cord: Sterile:
A prediction of the duration, extent, and probable course, based upon experience, all available facts/ information in an individual case, and knowledge of how a disease generally behaves. Artificial body part. Necessary nutrients for growth of all cells and repair of the body. Referring to the lungs. Special breathing exercises that are graphically recorded and then analyzed for identification of respiratory disorders. The inability of the patient to breathe deep enough to supply the body with proper breathing gasses. To fill IV or external administration tubing with solution and expel air. A special breathing technique where a patient inhales through the nose and exhales through almost closed lips. This technique is used when a COPD patient is having trouble breathing. Forming or containing pus. Capability to rotate, extend, or move a joint. Movements of joints through their full range of motion. Can be used to prevent loss of this ability or to regain the full range of motion after injury. The speed a solution infuses. An oxygen administration device that is used to control and deliver oxygen from a gas cylinder. Partial excision of a bone or other structure. A prepared sterile salt water solution that contains the same salt concentration as the human body. Sterile salt water solution injected into an IV catheter to flush out medication or solution. Hardening of tissue due to inflammation or disease. Widespread infection in the body caused by bacteria or germs entering the bloodstream. Generalized infection of the bloodstream. Medium for transmitting nerve sensations to the brain. Free from bacteria or contamination.
3.22
Stricture: Subcutaneous: Submucosa: Suction Catheter: Superior: Supine: Syndrome: Syringe: Therapy:
Thoracic: Total Parenteral Nutrition (TPN): Trace Elements: Trachea: Tracheostomy Tube: Traction: Ulcer:
A narrowing or constriction of the lumen of a tube, duct, or hollow organ such as the esophagus, ureter, or urethra. Under the skin. The second layer of tissue or membrane in the bowel, just under the mucosa. A small thin plastic tube that is connected to a suction machine and placed in a patients mouth, nose, or airway to remove fluids. Above; one part in relation to another, e.g., the eyes are superior to or above the nose. Lying flat on the back. A set of symptoms which occur together. A hollow barrel fitted with a plunger. Any program, medically supervised, whose purpose is to improve or maintain the health of the patient. Designed to assist in improvement or recovery from any illness, accident, or adaptation to a permanent handicap. Referring to the chest. Solution that provides nutrients required to maintain weight and health of individuals incapable of deriving these nutrients through the normal eating process. Metals and other elements present in the body in small amounts necessary for proper functioning. The first portion of the airway leading to the lungs. This airway starts at the throat and ends at the middle of the chest. (Refer to the Anatomy Section. ) A small tube about the size of the index finger that is inserted into a surgical opening in the neck and provides a pathway for air or oxygen to enter the trachea. The act of pulling or stretching. Sore or lesion of skin or mucous membrane.
3.23
The following is a list of abbreviations commonly used in the home health industry. Those marked with an * are Apria Healthcare specific. Abbreviations AAH AARC ABGs ABN American Association of Homecare American Association of Respiratory Care Arterial Blood Gasses Advance Beneficiary Notice. A provision that protects providers from liability in denial cases, under certain conditions, when items or services they received are found not to be reasonable and necessary for the diagnosis and/or treatment of an illness or injury. Also known as Waiver of Liability. Apria Customer Information System (RT/HME computer system) American Hospital Association. An organization of over 5,500 hospitals and related institutions headquartered in Chicago. Acquired Immune Deficiency Syndrome. AIDS is an immune deficiency syndrome caused by the human immunodeficiency virus, or HIV. This virus permits opportunistic infections and malignancies, and can injure the cells of the nervous system. In the very early period following infection, there may or may not be signs of acute, brief, nonspecific viral infection with fever, malaise, rash, and joint pain. Following this, evidence of AIDS in the blood appears. After the infection, the patient may have no symptoms but be a carrier of the disease. The time from infection to diagnosis varies from several years to more than five. AIDS is considered a fatal disease. The Food and Drug Administration has approved drugs such as AZT to treat HIV infection in certain AIDS patients, but this medicine does not cure AIDS. For this reason, it is important to educate the public about ways HIV can be spread so that they can practice methods of prevention. HIV is transmitted by: unprotected sex with an infected partner; sharing needles; receiving a contaminated blood product; or birth or breast feeding from an infected mother. Administrative Law Judge. Individual responsible for reviewing Medicare appeals of providers or beneficiaries who are not satisfied with the results of a Carrier Fair Hearing. The Administrative Law Judge (ALJ) review is the third level in the appeals process.
ACIS* AHA AIDS/HIV
ALJ
3.24
AOB
AP APN/RespiMed* APP AR ARU
ASC* AUTHS* AWP
CCN CHF
CMN
Assignment of Benefits. A procedure whereby the subscriber authorizes the provider to release information to the carrier. This allows the carrier to make payment of allowable benefits directly to the provider and accepts those allowable benefits as payment in full. Accounts Payable Apria Pharmacy Network Respiratory Medications program Alternating Pressure Pad Accounts Receivable Audio Response Unit. A device providing voice response, data and transaction capability that allows a Medicare beneficiary (patient) or provider, through a touch-tone telephone, to directly access information regarding current benefits or claim status. Apria Systems Change Request (ACIS related) Authorizations Average Wholesale Pricing. An average wholesale price is the average of all prices nationally for a particular drug/manufacturer. The information to determine the averages are provided by companies such as Medispan, Redbook and other pharmaceutical resources who publish reference books illustrating the national average wholesale prices based on information received from manufacturers, distributors and other suppliers. Claim Control Number. A number, usually 14 digits, assigned to each Medicare claim automatically at the time of imaging the claim for processing. Congestive Heart Failure. Congestive Heart Failure is a condition in which the heart is so weakened that it is not strong enough to pump blood to maintain normal circulation. The lungs may become congested, and the blood may push back into the veins supplying blood to the heart. Fluid may escape from the blood into the tissues, causing the ankles to become puffy and swollen. Causes of CHF include high blood pressure, coronary heart disease, and congenital birth defects to the heart. Certificate of Medical Necessity. This is an essential tool in determining coverage. This form is used by the physicians office to document the patients physiological need for specified DMEPOS services.
3.25
CMS
COB
COD CON COPD
Centers for Medicare & Medicaid Services. Formally called HCFA. An agency within the Department of Health and Human Services that administers the Medicare program. CMS is responsible for developing Medicare payment regulations, implementing Medicare law and overseeing Medicare carrier operations. Coordination of Benefits. A method to determine whether or not payment of benefits will be reduced because of group coverage with another insurance company (carrier). It is an attempt to avoid double payment on a claim, yet assure full payment for benefits provided on either or both coverages. Collect on Delivery Certificate of Need Chronic Obstructive Pulmonary Disease. Pulmonary emphysema, chronic bronchitis, and severe asthma are three diseases that are becoming more and more common in the United States. Typically, they produce a long-term illness that is frequently accompanied by physical disability. They are commonly referred to as Chronic Obstructive Pulmonary Disease (COPD) or Chronic Obstructive Lung Disease (COLD), simply because each of the three diseases causes an obstruction to the air as it tries to leave the chest, making breathing difficult. Bronchitis is a disease that affects the bronchial tubes. The tubes become inflamed and produce a great amount of mucus. The combination of the swelling and the excess mucus interferes with the air flowing in and out of the lungs. Emphysema is a disease that results from the destruction of the alveoli, the air cells of the lungs. The alveoli lose their shape and eventually rupture. When this happens, the exchange of oxygen and carbon dioxide is compromised. A chronic recurring productive cough (moist and wheezing) is the first symptom of emphysema, but it is often ignored. Emphysema usually develops gradually over a long period of time. Often, the patient cannot recall the time of onset. Factors such as cigarette smoking, air pollution, chronic infection, allergies, dusty environments, and inherited factors may contribute. As the disease progresses and irreversible changes occur within the lungs alveoli, symptoms become severe and debilitating. Symptoms of emphysema include difficulty in breathing; anxious and strained facial expression; puffing out of cheeks during exhalation; barrel-shaped chest; and
3.26
CPAP CPI CPT
CS CSR* CST* CVA
CVR* CWF
bluing or dusty color to skin (lips, fingers, and toes are most notable). Daily routine tasks such as dressing oneself or walking from bedroom to kitchen may prove extremely difficult and overwhelming physically for a patient with COPD. COPD also affects a persons arterial blood gases (ABGs). A healthy persons blood gases stay balanced at a ph value of between 7.35 and 7.45. If the blood has too much acid, the ph value decreases. The lungs are the organ primarily responsible for maintaining the proper amount of acid in the blood, and for eliminating the carbon dioxide (CO2), which is an acid waste product. Also, the alveoli in the lungs of a person with COPD are not able to efficiently transport oxygen and carbon dioxide. A person with COPD breathes more slowly or shallowly. Because of this, the amount of CO2 in a COPD patient increases, since he or she is not blowing off the CO2. A blood test to determine ABGs indicates the level of oxygen and CO2 in the blood. ABGs are important in the diagnosis and treatment of disturbances of acid-base balance. In COPD cases, ABGs can indicate the need for oxygen therapy. Continuous Positive Airway Pressure Consumer Price Index Current Procedural (Procedure) Terminology. A system of procedure codes, descriptions, rules, and conventions used for medical procedures to classify and report services and procedures. This procedure coding system is accepted by commercial insurance carriers and is mandated by federal law for Medicare, Medicaid, and other government health programs. Customer Service Customer Service Representative Clinical Support Technician Cerebrovascular Accident. A Cerebrovascular Accident, or stroke, results when there is damage to brain tissue caused by a sudden interruption of the blood supply, a tumor, or trauma. This results in loss of consciousness, paralysis, or other symptoms depending on the site and extent of brain damage. Coverage Verification Representative Common Working File. A regional data base used for obtaining, maintaining, and distributing beneficiary (patient) specific Medicare data.
3.27
DA/BCC DEA DHHS DL DME DMEPOS DMERC
DOB DOD DOT DSO DUTs:
DX ECS EDI EFT EGHP EIN EMC
ENF* EOB EOMB
Discount Agreement/Billing and Collection Contract Drug Enforcement Agency Department of Health & Human Services Double Lumen (catheter) Durable Medical Equipment. Special medical equipment used to aid patients movement and/ or to give specific therapy to a patient. Durable Medical Equipment, Prosthetics and Orthotics Supplier Durable Medical Equipment Regional Carrier. Medicare regional payors for DME/IV. Medicare contractor for regionalized processing of claims for Durable Medical Equipment and Infusion Services. Date of Birth. The day a beneficiary (patient) was born. Date of Death. The day a beneficiary (patient) died. Department of Transportation Days Sales Outstanding Days, Units, Times. A unit of measurement. For example, days=number of days in hospital, units=number of services rendered, and time=anesthesia time. Diagnosis Electronic Claims Submission Electronic Data Interchange. The electronic exchange of information using standard formats. Electronic Funds Transfer. A payment policy for a direct deposit option for those providers meeting the qualifications for electronic payment. Employer Group Health Plan. A health insurance or benefit plan that is offered through an employer of 20 or more employees. Employer Identification Number. Also referred to as a tax identification number. Electronic Media Claim. Claims for health services transmitted to the DMERC by electronic media ( i.e., computer to computer, tape to tape, or remote terminal). Remittance notices sent to providers electronically. Education Notification Form Explanation of Benefits. A form included with a check from the insurance carrier which explains the benefits that were paid and/or charges that were rejected. Explanation of Medicare Benefits. A form sent to a Medicare beneficiary/patient after a claim has been processed that explains the action taken on the claim.
3.28
EPO
ERN/ERA
FDA FFS FOIA
FOS-IV/ IV-400 FR FY H,E,D,C HCFA
HCFA 1500 HCPC
HEDIS
Exclusive Provider Organization. A provider network similar to a PPO wherein a patient must pay the entire cost of any care obtained outside the EPO network of providers. EPO providers typically are paid for services rendered. Electronic Remittance Notice/Advice. A provider who submits claims electronically can choose to receive their Government or Non-Government remittances electronically. Food and Drug Administration. The governmental body responsible for testing, approval and regulation of food and pharmaceutical products. Fee for Service Freedom of Information Act. Established in 1967 as an amendment to the Public Information section of the Administrative Procedure Act. The purpose of the act was to reach a workable balance between the publics right to know and the need of the government to keep information in confidence to the extent necessary without permitting indiscriminate secrecy. Field Operating System, Infusion (IV computer system). Federal Register. The publication which makes available to the public regulations and legal notices issued by federal agencies. Fiscal Year. A 12 month period for which Medicare plans the use of its funds (October 1 through September 30). Cylinders for compressed O2 (by size of the cylinder) Health Care Financing Administration. Agency within the Department of Health and Human Services that administers the Medicare program. HCFA is responsible for developing Medicare payment regulations, implementing Medicare law, and overseeing Medicare carrier operations (now known as CMS-Centers for Medicare & Medicaid Services). A universal insurance claim form that is mandated for Medicare billing and generally accepted by all insurance carriers. HCFA Common Procedure Coding System. Coding system based on CPT, but supplemented with additional codes for non-physician services; required for coding by Medicare carriers. Health Plan Employer Data and Information Set. A report card that measures an HMOs quality, service, and use.
3.29
HIC #
HHA HIDA HIPAA
HME HMO HIMR
ICD-9-CM
IPA
IM INS IS ISR* IST* IV IVFOS*/IV 400 JCAHO JDE
Health Insurance Claim Number. The social security number shown on the Medicare card which identifies the beneficiary is eligible for Medicare benefits. It is required on all Medicare submitted claims. Home Health Agency. A health care agency engaged in providing skilled nursing services to patients in their homes. Health Industry Distributors Association Health Insurance Portability and Accountability Act of 1996. An act of Congress that guarantees health insurance access, portability and renewal as well as prohibits discrimination based on health status. Home Medical Equipment Health Maintenance Organization. An organization that provides comprehensive health services to its members in return for a fixed prepaid fee. Health Insurance Medical Records. The CWF data that shows entitlement, utilization, and claims payment. It contains the beneficiarys (patients) name, sex, birth date, status, HIC number, deductible status claims history, Medicare Secondary Payor (MSP), Health Maintenance Organization (HMO) and hospice enrollment status. International Classification of Diseases. A standard system of describing diagnoses by code numbers developed and maintained by the World Health Organization. Independent Practice Association. An HMO that contracts with individual physicians to provide services to HMO members in a negotiated per capita or fee-forservice rate. Intramuscular Intravenous Nursing Society Information Services Information Services Request (IV-FOS/400 related) Infusion Service Technician Infusion (Intravenous) Infusion Field Operating System (IV computer system). Joint Commission on Accreditation of Healthcare Organizations. An independent self-governing commission to ensure quality of health care. JDEdwards. An inventory management computer system.
3.30
LCL
LIB LMN LOPICS LPM LPN/LVN LOX MAPS* MCM
MCO
MS
MSP NAPS* NCQA
NSC
Lowest Charge Level. The charge at the 25th percentile, based on data derived from claims processed during the preceding months of July through September prior to the annual Fee Screen Pricing update. Stationary Liquid Oxygen Unit Letter of Medical Necessity Level of Patient Intensity Classification System Liters per Minute Licensed Practical Nurse/Licensed Vocational Nurse Liquid Oxygen Medicare Account Processing System Medicare Carriers Manual. Publication which provides the practical operating instructions needed by Medicare contractors responsible for administration of Medicare Part B. Managed Care Organization. Any insurer which provides members with financial incentives to use contracted providers and assumes at least partial responsibility for directing their care. Multiple Sclerosis. Multiple Sclerosis is a progressive inflammatory disease of the central nervous system that destroys nerve tissue throughout the brain and spinal cord in a patchy, irregular fashion. The disease generally occurs in young adults. Symptoms vary due to the diseases irregular course, but include: vision difficulties, loss of sensation, slurred speech, loss of memory, mood swings, and difficulty concentrating. As the disease progresses, motor function deteriorates, resulting in: poor muscle coordination; an unsteady slow gait; and involuntary muscle movements. MS becomes more severe and debilitating with time. There is evidence of remissions that may last for a year or more, which accounts for the slow progression of this disease. Medicare Secondary Payor National Account Processing System National Committee on Quality Assurance. A national organization that accredits prepaid MCOs (HMOs, POSs) if they have organized comprehensive quality assurance programs. National Supplier Clearinghouse. The national contractor who is responsible for identification and ownership data for all DMEPOS providers in the Medicare program. NSC also issues supplier numbers to providers for the purpose of billing services to the DMERC.
3.31
NSF
O2 OBRA OIG OOP OSHA PA PCP PEN PHO
PICC PID PMG PMPM PO POS POT PPO
National Standard Format. Format developed to facilitate the electronic submission of claims and reduce the incidence of paperwork. The NSF can capture data required to establish medical necessity for DME and PEN claims. It includes the electronic version of the paper CMN and is accepted as full documentation. Oxygen Omnibus Budget Reconciliation Act. Legislation mandating physician payment reform, as well as mandating other health care reform. Office of Inspector General. The governmental office which investigates suspected fraud and abuse. Out-of-pocket Expense. Maximum amount that the patient must pay prior to a change in the level of benefit (family or individual out-of-pocket). Occupational Safety and Health Administration Prior Authorization. An authorization that permits a medical necessity decision before certain products can be delivered to the beneficiary (patient). Primary Care Physician Parenteral and Enteral Nutrition Physician-Hospital Organization. A separate legal entity owned by a hospital and participating physicians which can contract with insurance companies, HMOs or selfinsured employers for the provision of medical services. The PHO may also undertake utilization review, credentialing, and quality assurance. Physicians retain ownership of their own practices, maintain significant business outside the PHO, and typically continue in their traditional practice style. Peripherally Inserted Central Catheter Pelvic Inflammatory Disease. An infection of the uterus, fallopian tubes, and adjacent pelvic structures that is not associated with surgery or pregnancy. Primary Medical Group Per Member, Per Month Purchase Order Point of Service Plan of Treatment Preferred Provider Organization. An indemnity plan that operates under a contract with a group of providers to provide coverage under special financial arrangements.
3.32
PST* PU* PULSEOX QAC* RAD RIM* RIPC* RN RQ RRB
RT Rx SADMERC
SATs SBE
SerDoc* SIDS
SNF
SNV SQ
Patient Service Technician Pick Up Finger test that measures the amount of O2 saturation in the blood. Quality Assurance Coordinator Respiratory Assist Device Regional Infusion Manager Regional Inventory Purchasing Coordinator Registered Nurse Revenue Qualification Railroad Retired Board. A governmental agency which is responsible for the administration of benefits for beneficiaries/patients of the Railroad Retirement System. Respiratory Therapist Prescription. A written order from a physician for medication or a DMEPOS item. Statistical Analysis DMERC. The DMERC that is responsible for the statistical analysis and distribution of data related to procedure codes/modifiers, pricing files and DMEPOS claims history. O2 Saturation Level (patients O2 level, non-invasive measurement) Subacute Bacterial Endocarditis. A condition usually caused by colonization of Streptococcus viridans group of bacteria in an abnormal heart or in valves damaged previously by rheumatic fever. Service Document (IVFOS/400 delivery document) Sudden Infant Death Syndrome. The completely unexpected and unexplained death of an apparently well infant. SIDS is the most common cause of death between the second week and first year of life. This syndrome occurs more frequently in the third and fourth months of life, in premature infants, in males, and in infants living in poverty. These deaths usually occur during sleep and are more likely to happen in winter than in summer. Skilled Nursing Facility. An institution which provides continuous and comprehensive skilled nursing care on an inpatient basis at a lesser level than a hospital, but a greater level than a nursing home. Skilled Nursing Visit Subcutaneous
3.33
SSA
STD SVN TPA
TPN UPIN
UR
UTI VA VAD WO* WOPD
Social Security Administration. The largest subdivision of the Department of Health and Human Services (DHHS) established by the Social Security law which provides retirement, survivor, disability, and Medicare benefits. Sexually Transmitted Disease. A disease acquired as a result of sexual intercourse with an infected individual. Small Volume Nebulizer Third Party Administrator. An administrative organization other than the insurance company or healthcare provider that collects insurance premiums, pays claims and provides administrative services. Total Parenteral Nutrition Unique Physician Identification Number. Identification number assigned to the referring or ordering physician by Medicare. UPINs consist of an alpha character and five numerics equaling a total of six characters. Utilization Review. The process of reviewing services provided to determine if those services were medically necessary and appropriate. May be performed on a concurrent or retrospective basis. Urinary Tract Infection. A long lasting or recurring bacterial infection of the urinary tract caused by the presence of abnormal populations of microorganisms. Veterans Administration. The governmental agency which establishes rules/policies and administers programs for veterans. Venous Access Device Work Order (ACIS delivery document) Written Order Prior to Delivery
3.34
The following is a list of terms and phrases used within the medical billing industry and/or the Medicare program. Health Insurance Terminology Abuse: Improper or excessive use of program benefits or services by providers or beneficiaries. Abuse can occur, intentionally or unintentionally, when services are used which are excessive or unnecessary; which are not the appropriate treatment for the patients condition; when less expensive treatment would be as effective; or when billing or charging does not conform to requirements. It should be distinguished from fraud, in which deliberate deceit is used by providers or consumers to obtain payment or services which were not actually delivered or received, or to claim program eligibility. See also Fraud. A change or correction to a previously settled (paid or denied) claim history record. Individual responsible for reviewing Medicare appeals of providers or beneficiaries who are not satisfied with the results of a Carrier Fair Hearing. The Administrative Law Judge (ALJ) review is the third level in the appeals process. A provision that protects providers from liability in denial cases, under certain conditions, when items or services they received are found not to be reasonable and necessary for the diagnosis and/or treatment of an illness or injury. Also known as Waiver of Liability. The amount Medicare approves for payment to Apria. Typically, Medicare pays 80 percent of the approved charge and the beneficiary (patient) pays the remaining 20 percent after the annual deductible is met. An organization of over 5,500 hospitals and related institutions headquartered in Chicago. The beginning of a benefit year for a subscriber group. A procedure available to a beneficiary (patient)or supplier to contest an adverse decision made on a claim. Entity responsible for reviewing Medicare appeal decisions made by an Administrative Law Judge. It is the fourth level in the appeals process. Claims that have been designated as payable directly to the provider of service. Acceptance of payment by a third party directly to a health care provider for services rendered to a beneficiary/patient.
Adjustment: Administrative Law Judge (ALJ):
Advanced Beneficiary Notice (ABN):
Allowed charge (Approved charge): American Hospital Association (AHA): Anniversary: Appeal Procedure: Appeals Council: Assigned Claims: Assignment:
3.35
Assignment of Benefits (AOB):
Audio Response Unit (ARU):
Average Wholesale Pricing (AWP):
Beneficiary: Bundling: Capitation: Carrier: Carrier Fair Hearing:
Case Management:
Case Manager:
A procedure whereby the subscriber authorizes the provider to release information to the carrier. This allows the carrier to make payment of allowable benefits directly to the provider and accepts those allowable benefits as payment in full. A device providing voice response, data and transaction capability that allows a Medicare beneficiary (patient) or provider, through a touchtone telephone, to directly access information regarding current benefits or claim status. An average wholesale price is the average of all prices nationally for a particular drug/manufacturer. The information to determine the averages are provided by companies such as Medispan, Redbook and other pharmaceutical resources who publish reference books illustrating the national average wholesale prices based on information received from manufacturers, distributors and other suppliers. A person eligible to receive benefits under a healthcare plan (patient). The use of a single payment for a group of related procedures or services. Flat rate reimbursement paid to providers based on a per member/per month method regardless of the number or nature of services provided. The insurance company that writes and administers the health insurance policy. The second step in Medicare Part B appeals process. It is a formal procedure presided over by a Hearing Officer and offers the beneficiary (patient) or provider a chance to voice his/her dissatisfaction with a review decision. The amount in controversy must be at least $100.00. Monitoring and coordinating the delivery of health services for individual patients to enhance care and manage costs. Often used for patients with specific diagnoses or who require high-cost or extensive health care services. An employee or agent of an insurer, MCO, hospital, employer, or independent firm who coordinates and manages the care of seriously ill or high-risk patients to
3.36
Case Rate: Cash Indemnity Benefits: Certificate of Medical Necessity (CMN): CHAMPUS/Tricare
Claim: Claim Control Number (CCN): Claim Form: Claims Examiner: Coding: Coinsurance:
Complainant: Complementary: Coordination of Benefits (COB):
ensure that they receive high-quality, cost-effective treatment. A flat rate paid to providers, usually hospitals, that covers all services necessary for a single procedure, such as a gallbladder removal. Payments to subscribers for covered services that require submission of an insurance claim. Subscribers may assign such payments directly to providers. An essential tool in determining coverage. The CMN form is used to document the patients physiological need for specified DMEPOS services. Civilian Health And Medical Program of the Uniform Services now known as Tricare. A federally funded comprehensive health benefits program designed to provide eligible beneficiaries a supplement to medical care in military and Public Health Service facilities. A demand to the carrier, by the insured person, for payment of benefits under a policy. A number, usually 14 digits, assigned to each Medicare claim automatically at the time of imaging the claim for processing. A form used to present claim information in an organized manner to the carrier. See HCFA 1500. The carriers employee who is responsible for handling claims as they are received from patients and medical offices. The process of choosing codes which properly identify and define medical services and procedures and diagnoses. The portion of the balance of covered medical expenses which a beneficiary (patient) must pay after payment of the deductible. Under Medicare Part B, the beneficiary (patient) pays coinsurance of 20 percent of allowed charges. An individual alleging that fraud and/or abuse or other irregularity has or may have been perpetrated against the Medicare program. Supplemental insurers having voluntary written agreements with Medicare contractors for the routine transfer of Medicare claim information. A method to determine whether or not payment of benefits will be reduced because of group coverage with another insurance company (carrier). It is an attempt to
3.37
Cost Sharing: Coverage: CPI: Crossover:
Current Procedural (Procedure) Terminology (CPT):
Customary Charge: Days, Units, Times (DUTs): Deductible:
Denial: Department of Health and Human Services: Dependents: Diagnosis Code:
avoid double payment on a claim, yet assure full payment for benefits provided on either or both coverages. The portion of payment for health expenses that the beneficiary (patient) must pay, including the deductible, co-payments, coinsurance, and balance bill. The extent of benefits provided. Consumer Price Index. Occurs when Medicare claim information is transferred to state Medicaid agencies, Medigap insurers and Complementary insurers; the supplier is notified of this crossover on the remittance notice. A system of procedure codes, descriptions, rules, and conventions used for medical procedures to classify and report services and procedures. This procedure coding system is accepted by commercial insurance carriers and is mandated by federal law for Medicare, Medicaid, and other government health programs. Aprias charge for a given service during a specified time. A unit of measurement. For example, days = number of days in hospital, units = number of services rendered, and time = anesthesia time. A stipulated amount, generally on an annual basis, which the covered person must pay toward the cost of medical treatment before the benefits of the program go into effect. Medicare Part B has an annual deductible of $l00. Determination that certain care or services cannot be reimbursed. The Department of the U.S. Government that is responsible for setting and administering policy on health programs. The spouse and children of the insured as defined in the insurance contract. A numerical classification descriptive of diseases, injuries, and causes of death. Medicare requires suppliers to include a complete diagnosis code or codes on each claim submitted for payment. HCFA has adopted the International Classification of Diseases, Ninth Revision,
3.38
Clinical Modification (ICD-9-CM) coding system for this purpose. Diagnosis-Related: A statistical system of classifying any inpatient stay. Down Coding: A process used by insurance carriers to reduce the value of billed procedures by changing the codes submitted to ones of lower value. Procedure code and procedure description mismatch, and diagnosis code not supporting the level of care are the two most common opportunities for insurance carrier down coding. Durable Medical Durable Medical Equipment can withstand repeated Equipment (DME): use and is used primarily to serve a medical purpose in the home. Durable Medical Medicare regional payors for DME. Medicare Equipment Regional contractor for regionalized processing of Durable Carrier (DMERC): Medical Equipment. Eligibility: A determination that a beneficiary (patient) is qualified for Medicare benefits. Employer Group Health A health insurance or benefit plan that is offered Plan (EGHP): through an employer of 20 or more employees. Employer Identification Also referred to as a tax identification number. A Number (EIN): unique number assigned to a business entity by the government for tax purposes. Enrollment: The means by which a beneficiary (patient) establishes eligibility. Exclusions: Specific services or conditions which the policy will not cover or which are covered at a limited rate. Exclusive Provider A provider network wherein a patient must pay the Organization (EPO): entire cost of any care obtained outside the EPO network of providers. Expenditure Limit: A maximum level of spending for the health sector as a whole or for particular categories of services; usually set by the government to be achieved through rate setting or premium limits. Explanation of A form included with a check from the insurance Benefits (EOB): carrier that explains the benefits that were paid and/ or charges that were rejected.
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Explanation of Medicare Benefits (EOMB): Fair Hearing:
A form sent to a Medicare beneficiary/patient after a claim has been processed that explains the action taken on the claim. A level in the Medicare Part B appeals process after a review has been requested and performed. A Fair Hearing is a formal procedure presided over by a Hearing Officer, which offers the beneficiary (patient) or provider an opportunity to present the reasons for their dissatisfaction with the payment which Medicare has made on their claim, or denial of payment. See Review and Administrative Law Judge hearing. Federal Register (FR): The publication which makes available to the public regulations and legal notices issued by federal agencies. Federally Qualified An HMO that has satisfied certain federal HMO: qualifications pertaining to organizational structure, provider contracts, health service delivery information, utilization review/quality assurance, grievance procedures, financial status and marketing information. Fee-For-Service: Refers to paying medical providers for individual services rendered. UCR, CPR, and Fee Schedules are examples of fee-for-service systems. Fee Schedule: A list of predetermined payments for medical services. Fiscal Year (FY): A 12-month period; Medicares fiscal year is from October 1 through September 30. Food and Drug The governmental body responsible for testing, Administration (FDA): approval, and regulation of food and pharmaceutical products. Fraud: Intentional misrepresentation by either providers or beneficiaries/patients to obtain services or payment of services. Fraud may include deliberate misrepresentation of need or eligibility; providing false information concerning costs or conditions to obtain reimbursement or certification; or claiming payment for services which were never delivered or received. Fraud is illegal and carries a penalty when proven. See Abuse. Freedom of Established in 1967 as an amendment to the Public Information Act Information section of the Administrative Procedure (FOIA): Act. The purpose of the act was to reach a workable balance between the publics right to know and the need of the government to keep information in confidence to the extent necessary without permitting indiscriminate secrecy.
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Grandfathering: Group Model HMO:
Health Care Financing Administration (HCFA):
Health Care Financing Administration 1500 Form (HCFA 1500): Health Care Financing Administration (HCFA) Common Procedure Coding System (HCPC): Health Insurance Claim The social security number shown on the Medicare Number (HIC): card which identifies the beneficiary is eligible for Medicare benefits. It is required on all Medicare submitted claims. Health Insurance The CWF data that shows entitlement, utilization, Medical Records and claims payment. It contains the beneficiarys (HIMR): (patients) name, sex, birth date, status, HIC number, deductible status claims history, Medicare Secondary Payor (MSP), Health Maintenance Organization (HMO) and hospice enrollment status. Health Maintenance An organization that provides comprehensive health Organization (HMO): services to its members in return for a fixed prepaid fee. Health Plan Employer A report card that measures an HMOs quality, service, Data and Information and use. Set (HEDIS): Hearing: A step in the Medicare appeals process used when a provider is dissatisfied with a decision or determination made on a claim by Medicare. There are two types of hearings in the appeals process, Carrier Fair Hearing and Administrative Law Judge (ALJ) Hearing.
Refers to the Phase-ln of the new DMERC Region-Wide Medical Review policies. An HMO that pays a medical group a negotiated, per capita rate, which specifies rates, performance, relationships, schedule of benefits, and other conditions, usually for a 12 month period. Agency within the Department of Health and Human Services that administers the Medicare program. HCFA is responsible for developing Medicare payment regulations, implementing Medicare law, and overseeing Medicare carrier operations (now known as CMS - Centers for Medicare & Medicaid Services). A universal insurance claim form mandated for Medicare billing and generally accepted by all insurance carriers. Coding system based on CPT, but supplemented with additional codes for nonphysician services; required for coding by Medicare carriers.
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Home Health Agency (HHA): Hospice:
Independent Practice Association (IPA): Inquiry:
A health care agency engaged in providing skilled nursing services to patients in their homes. A program which provides health and supportive services to help terminal patients and their families live their lives as fully as possible during the final months of life. An HMO that contracts with individual physicians to provide services to HMO members in a negotiated per capita or fee-for-service rate. Requests for information or assistance made by or on behalf of a beneficiary (patient), provider or the government. Written inquiries may be made in any format (letter, memorandum, note attached to a claim, etc.) Allowable charge complaints and appeals are excluded from this definition. The person who represents the family unit in relation to the insurance program. Usually the employee whose employment makes this coverage possible. An insurance carrier or data processing company, designed to receive and process Medicare or Medicaid claims on behalf of the government. An institution licensed under state law to provide health related care and services to individuals because their mental or physical condition requires care above the level of room and board. A standard system of describing diagnoses by code numbers developed and maintained by the World Health Organization.
Insured: Intermediary: Intermediate Care Facility (ICF):
International Classification of Diseases (ICD-9-CM): Joint Commission An independent self-governing commission to ensure on Accreditation of quality of health care. Healthcare Organizations (JCAHO): Lowest Charge The charge at the 25th percentile, based on data Level (LCL): derived from claims processed during the preceding months of July through September prior to the annual Fee Screen Pricing update. Major Medical Health insurance to finance the expense of major
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Insurance:
Managed Care:
Managed Care Organization (MCO): Medicaid:
illnesses and injuries. Major medical policies usually include a substantial deductible clause. Above the initial deductible, major medical insurance is characterized by large benefit maximums. Any system of health service payment or delivery arrangements where the health plan attempts to control or coordinate use of health services by its enrolled members in order to contain health expenditures, improve quality, or both. Arrangements often involve a defined delivery system of providers with some form of contractual arrangement with the plan. Any insurer which provides members with financial incentives to use contracted providers and assumes at least partial responsibility for directing their care. A program that provides federal matching grants to the states to provide health insurance for the poor and medically indigent. States share in financing the program and determine eligibility and benefits consistent with federal standards. Determination that the level of services and supplies is adequate for the diagnosis and treatment of an illness or injury. The federal governments hospital and medical insurance program for the aged, totally disabled, and those with End-Stage Renal Disease (ESRD) as defined by Title XVII of the Social Security Act. Publication which provides the practical operating instructions needed by Medicare contractors responsible for administration of Medicare Part B. The Hospital Insurance program which covers the cost of medically necessary inpatient hospital care; skilled nursing facility services; care in the home by health agencies; and hospital care. As an entitlement program, it is available without payment of a premium. Beneficiaries (patients) are responsible for an initial deductible per incidence of illness and coinsurance payment for most covered services. The Supplementary Medical Insurance program (SMI) that covers the cost of medically necessary physician services, ambulance, outpatient physical therapy, speech pathology, and other health services, including patients with End Stage Renal Disease (ESRD), orthotic and prosthetic devices, and durable
Medically Necessary:
Medicare:
Medicare Carriers Manual (MCM): Medicare Part A:
Medicare Part B:
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Medicare Risk Contract:
medical equipment. As a voluntary program, Part B requires payment of a monthly premium. Beneficiaries (patients) are responsible for a deductible and coinsurance payment for most covered services. A contract between Medicare and an HMO or competitive medical plan under which the plan provides Medicare-covered services for enrollees and receives monthly capitated payments from Medicare, thereby assuming insurance risk for enrollees. A plan is eligible for a risk contract if it is a federally qualified HMO or a competitive medical plan. Private health insurance policies designed to supplement Medicare coverage. Benefits may include payment of Medicare deductibles, coinsurance, and balance bills, and payment for services not covered by Medicare. Two digit numeric or alpha code used with a CPT or HCPC code to indicate that a service or procedure has been altered. For example, RR indicates the item is being rented; NU indicates the item is being purchased. A national organization that accredits prepaid MCOs (HMOs, POSs) if they have organized, comprehensive quality assurance programs. Format developed to facilitate the electronic submission of claims and reduce the incidence of paperwork. The NSF can capture data required to establish medical necessity for DME and PEN claims. It includes the electronic version of the paper CMN and is accepted as full documentation. A claim for which the supplier does not agree to accept Medicares allowed charges. Apria can bill the beneficiary (patient) at a retail rate for all charges. Providers who can choose to accept Medicare assignment on a claim by claim basis. (Apria is a non-participating provider.) The governmental office that investigates suspected fraud and abuse. Legislation mandating physician payment reform, as
Medigap insurance:
Modifier:
National Committee on Quality Assurance (NCQA): National Standard Format (NSF):
Non-assignment: Non-participating: Office of Inspector General (OIG): Omnibus Budget
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Reconciliation Act (OBRA): Out-of-pocket: Participating Provider: Pending: Per Diem:
well as mandating other health care reform. Maximum amount that the patient must pay prior to a change in the level of benefit (family or individual out-of-pocket). A provider who enters into a written agreement with Medicare to accept assignment on all claims. Indication that a claim is on history or on file but has not completed processing or is waiting for additional information. An amount paid to a provider on a daily basis for patients receiving certain types of services. Per diems are commonly used for hospital days, infusion services, hospice care, and certain high value rental products. A separate legal entity owned by a hospital and participating physicians which can contract with insurance companies, HMOs, or self-insured employers for the provision of medical services. The PHO may also undertake utilization review, credentialing, and quality assurance. Physicians retain ownership of their own practices, maintain significant business outside the PHO, and typically continue in their traditional practice style. The location where provided services/items are to be used by the patient. An indemnity plan that operates under a contract with a group of providers to provide coverage under special financial arrangements. A written order from a physician for medication or a DMEPOS item. An authorization that permits a medical necessity decision before certain DME is delivered to the beneficiary/patient. A code used by a physician, provider, or supplier to describe the service rendered or provided to the beneficiary (patient). The area in Medicare that reviews complaints from any source concerning services billed to Medicare for any potential fraud or abuse.
Physician-Hospital Organization (PHO):
Place of Service: Preferred Provider Organization (PPO): Prescription: Prior Authorization (PA): Procedure Code:
Program Integrity:
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Proof of Eligibility: Provider: Query: Railroad Retired Board (RRB): Reasonable and Necessary:
Evidence of eligibility provided by a patient or MCO. A person, company, hospital, home health agency, DME dealer, or PEN company that renders/provides medical services or supplies to a beneficiary (patient). Communications with another Plan or with the Social Security Administration in Baltimore to verify eligibility and status for Medicare claims. A governmental agency which is responsible for the administration of benefits for beneficiaries/patients of the Railroad Retirement System. Refers to the medical necessity of an item or service in determining if the item or service billed is reasonable and/or necessary for a patients condition under Medicare guidelines based on available medical information. The method used to make payment for fragmented codes, by allowing the value of the major procedure which includes any separately identified services of the fragmented procedure code(s). A certificate that attests continuing medical necessity for a service or level of service. A notification from the payor explaining the benefits that were paid and/or charges that were denied. A consideration of medical records or information as it relates to a service rendered and billed by a provider or beneficiary (patient) for payment. This is the first level of the appeals process. The insurance carrier which is second in responsibility under Coordination of Benefits. Employer-provided health insurance in which the employer, not an insurer, is at risk for its employees medical expenses. An institution which provides continuous and comprehensive skilled nursing care on an inpatient basis at a lesser level than a hospital, but a greater level than a nursing home. The largest subdivision of the Department of Health and Human Services (DHHS) established by the Social Security law which provides retirement, survivor, disability, and Medicare benefits. The DMERC that is responsible for the statistical analysis and distribution of data related to procedure codes/modifiers, pricing files, and DMEPOS claims history. The current state of a claim.
Rebundling:
Recertification: Remittance Advice (RA): Review:
Secondary Carrier: Self-insured Health Plan: Skilled Nursing Facility (SNF): Social Security Administration (SSA): Statistical Analysis DMERC (SADMERC): Status:
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Supplier Action Codes: Third Party Administrator (TPA): Tricare:
Unique Physician Identification Number (UPIN): Utilization Review
Explains the action taken when processing a claim or claim line. The codes used on this remittance are explained on the last page of the supplier remittance. An administrative organization other than the insurance company or healthcare provider that collects insurance premiums, pays claims and provides administrative services. Formerly knows as CHAMPUS. A federally funded comprehensive health benefits program designed to provide eligible beneficiaries a supplement to medical care in military and Public Health Service facilities. Identification number assigned to the referring or ordering physician by Medicare. UPINs consist of an alpha character and five numerics, equaling a total of six characters. The process of reviewing services provided to
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(UR): Veterans Administration (VA): Workers Compensation: Working Aged:
determine if those services are medically necessary and appropriate. May be performed on a concurrent or retrospective basis. The governmental agency which establishes rules/ policies and administers programs for veterans. Deals with coverage or compensation for injuries or illnesses that arise out of or are related to an individuals work environment. Patients 65 years or older who have Employer Group Health Plan (EGHP) coverage through their own employment or employment of a spouse. An EGHP is a health insurance or benefit plan that is offered through an employer of 20 or more employees.
Dictionary of Diagnoses Disease may be defined as an impairment or other change from the normal state that prevents tissues and organs from carrying on their required functions. Causes are many and varied. Among them are congenital disorders or birth defects; disorders resulting from accidents, injuries or environmental factors; and infection, or invasion of the body by disease producing microorganisms including bacteria and viruses. Abscess: Acute Cor Pulmonale: Addisons Disease: AIDS/HIV: A localized collection of pus in any body part that results from invasion of a pyogenic (pus-forming) bacterium. Hypertrophy or failure of the right ventricle resulting from disorders of the lungs, pulmonary vessels, or chest wall. A disease caused by the under-functioning of the adrenal glands. AIDS (Acquired Immune Deficiency Syndrome) is an immune deficiency syndrome caused by the human immunodeficiency virus, or HIV. This virus permits opportunistic infections and malignancies, and can injure the cells of the nervous system. In the very early period following infection, there may or may not be signs of acute, brief, nonspecific viral infection with fever, malaise, rash, and joint pain. Following this, evidence of AIDS in the blood appears. After the infection, the patient may have no symptoms but be a carrier of the disease. The time from infection to diagnosis varies from several years to more than five.
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Alpha-1 Antitrypsin Deficiency: Alzheimers Disease: Amyotrophic Lateral Sclerosis (Lou Gehrigs Disease): Anemia:
Anorexia: Anorexia Nervosa:
Apnea: Arthritis:
AIDS is considered a fatal disease. The Food and Drug Administration has approved drugs such as AZT to treat HIV infection in certain AIDS patients, but this medicine does not cure AIDS. For this reason, it is important to educate the public about the ways HIV can be spread so that they can practice methods of prevention. HIV is transmitted by: unprotected sex with an infected partner; sharing needles; receiving a contaminated blood product; or birth or breast feeding from an infected mother. Alpha-1 Antitrypsin is an enzyme, a deficiency of which is associated with early-onset emphysema in some patients and liver disease in others. A chronic, progressive disorder that accounts for more than 50% of all memory impairment. A syndrome marked by muscular weakness and atrophy with spasticity and hyperreflexia due to degeneration of the motor neurons of the spinal cord, medulla, and cortex. A reduction in the number of circulating red blood cells per cubic millimeter, the amount of hemoglobin per 100 ml, or the volume of packed red cells per 100 ml of blood. Loss of appetite. An eating disorder marked by excessive fasting. A patient with anorexia nervosa has an intense fear of becoming obese, and claims to feel fat even when emaciated. Temporary cessation of breathing. An inflammation of a joint. The term covers more than 100 different types of joint diseases. The most common and chronic types are Osteoarthritis and Rheumatoid Arthritis. Arthritis may be a result of various causes, i.e., bacteria or infection. Osteoarthritis is a degenerative disease associated with the aging process as a result of wear and tear on joint surfaces. Osteoarthritis commonly involves the joints subjected to the most stress, such as hips, knees, shoulders and spinal column (large and weight bearing joints). Rheumatoid Arthritis is a crippling, inflammatory disease of the joints. Onset of the disease is most common in persons 20 to 40 years old and more than two-thirds are women. This progressive disease destroys the structure of joints and surrounding tissue. The entire
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Asbestosis: Asthma:
Auto-Immune Disease: Bacterial Prostatitis: Black Lung: Bowel Obstruction: Bronchiectasis: Bronchitis: Bronchopulmonary Infection: Bronchopulmonary Dysplasia: Bulimia Nervosa:
joint becomes red, warm, painful, swollen, and eventually deformed. Septic Arthritis is caused by the invasion of a joint space by an infectious agent. The onset is usually sudden; the joint becomes acutely painful, hot, and swollen. Chills and fever are often present. A lung disease resulting from inhalation of asbestos particles for an extended period of time. Asthma can best be described as an allergic reaction. As in chronic bronchitis, the bronchial tubes are affected. These tubes become reddened and swollen, making the air passages almost too small for air to move in and out of the lungs. A disease due to a reaction against an individuals own tissues. An inflammation of the prostate caused by a long-standing bacterial infection. A lay term for the chronic lung disease caused by inhaling particles of industrial substances such as coal and retaining them in the lungs. Blockage in the intestine. Chronic dilatation of a bronchus or bronchi, with a secondary infection that usually involves the lower portion of the lung. (See Chronic Obstructive Pulmonary Disease [COPD].) Infection in the bronchi and lungs. A chronic lung disease that develops in premature infants after a period of intensive respiratory therapy. A disorder marked by recurrent episodes of binge eating; self-induced vomiting and diarrhea; excessive exercise; strict dieting or fasting; and an exaggerated concern about body shape and weight. A tissue injury resulting from excessive exposure to thermal, chemical, electrical, or radioactive agents. A state of ill health, malnutrition, and wasting. (See Malignant Neoplasms.) Cellulitis is the process that occurs when an infection in or close to the skin spreads through the tissue. The resulting abnormal accumulation of fluid in the body tissues produces swelling, which is accompanied by heat, redness, and tenderness. Cellulitis is treated with IV antibiotics.
Burn: Cachexia: Cancer: Cellulitis:
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Cerebral Palsy:
Cerebrovascular Accident (CVA) (Stroke):
Chronic Obstructive Pulmonary Disease (COPD):
An umbrella term for a group of nonprogressive, but often changing, motor impairment syndromes secondary to lesions or anomalies of the brain arising in the early stages of development. A Cerebrovascular Accident, or stroke, results when there is damage to brain tissue caused by a sudden interruption of the blood supply, a tumor, or trauma. This results in loss of consciousness, paralysis, or other symptoms depending on the site and extent of brain damage. Pulmonary emphysema, chronic bronchitis, and severe asthma are three diseases that are becoming more and more common in the United States. Typically, they produce a long-term illness that is frequently accompanied by physical disability. They are commonly referred to as Chronic Obstructive Pulmonary Disease (COPD) or Chronic Obstructive Lung Disease (COLD), simply because each of the three diseases causes an obstruction to the air as it tries to leave the chest, making breathing difficult. Bronchitis is a disease that affects the bronchial tubes. The tubes become inflamed and produce a great amount of mucus. The combination of the swelling and the excess mucus interferes with the air flowing in and out of the lungs. Emphysema is a disease that results from the destruction of the alveoli, the air cells of the lungs. The alveoli lose their shape and eventually rupture. When this happens, the exchange of oxygen and carbon dioxide is compromised. A chronic recurring productive cough (moist and wheezing) is the first symptom of emphysema, but it is often ignored. Emphysema usually develops gradually over a long period of time. Often, the patient cannot recall the time of onset. Factors such as cigarette smoking, air pollution, chronic infection, allergies, dusty environments, and inherited factors may contribute. As the disease progresses and irreversible changes occur within the lungs alveoli, symptoms become severe and debilitating. Symptoms of emphysema include difficulty in breathing; anxious and strained facial expression; puffing out of cheeks during exhalation; barrel-shaped
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Chronic Respiratory Failure/Insufficiency: Cirrhosis: Colitis: Congenital Hydrocephalus: Congestive Heart Failure (CHF):
chest; and bluing or dusty color to skin (lips, fingers, and toes are most notable). Daily routine tasks such as dressing oneself or walking from bedroom to kitchen may prove extremely difficult and overwhelming physically for a patient with COPD. COPD also affects a persons arterial blood gases (ABGs). A healthy persons blood gases stay balanced at a ph value of between 7.35 and 7.45. If the blood has too much acid, the ph value decreases. The lungs are the organ primarily responsible for maintaining the proper amount of acid in the blood, and for eliminating the carbon dioxide (CO2), which is an acid waste product. Also, the alveoli in the lungs of a person with COPD are not able to efficiently transport oxygen and carbon dioxide. A person with COPD breathes more slowly or shallowly. Because of this, the amount of CO2 in a COPD patient increases, since he or she is not blowing off the CO2. A blood test to determine ABGs indicates the level of oxygen and CO2 in the blood. ABGs are important in the diagnosis and treatment of disturbances of acid-base balance. In COPD cases, ABGs can indicate the need for oxygen therapy. A chronic inability of the respiratory system to maintain the function of oxygenating blood and remove carbon dioxide from the lungs. An inflammation of an organ, particularly the liver. Cirrhosis is marked by degeneration of the liver cells and thickening of the surrounding tissue. An inflammation of the colon. Ulcerative Colitis is the ulceration of the mucosa of the colon. An accumulation of cerebrospinal fluid within the ventricles of the brain that is present at birth. Congestive Heart Failure is a condition in which the heart is so weakened that it is not strong enough to pump blood to maintain normal circulation. The lungs may become congested, and the blood may push back into the veins supplying blood to the heart. Fluid may escape from the blood into the tissues, causing the ankles to become puffy and swollen. Causes of CHF include high blood pressure, coronary heart disease, and congenital birth defects to the heart.
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Coronary Atherosclerosis: Cretinism: Crohns Disease: Cystic Fibrosis:
Cystitis: Dehydration:
Diabetes Mellitus:
A narrowing of the coronary arteries sufficient to prevent adequate blood supply to the heart. A congenital condition caused by a lack of thyroid secretion. A chronic inflammatory disease of the small intestine causing fever, weight loss, and disturbed bowel functions. Also known as Regional Enteritis. Cystic Fibrosis is a hereditary disease of the exocrine glands affecting the pancreas and respiratory system. The sweat glands and the mucus-secreting glands do not function properly. This disease usually begins in infancy. In most children, the mucus prevents the enzymes of the pancreas from reaching the intestine and aiding in the digestion and absorption of food. The result is a malnourished and underweight child. Another pronounced symptom is the excessive amounts of salt in body sweat. As a result, in hot weather or in episodes of fever, children with Cystic Fibrosis are dangerously subject to heat exhaustion. The salt loss, which may be three times as great as that of healthy children, provides the principal diagnostic indication of the disease. There is no cure for Cystic Fibrosis. Patients may be treated with a high protein diet, extra salt, chest physical therapy, and antibiotics to treat respiratory disease. An inflammation of the bladder usually occurring secondary to ascending urinary tract infections. The abnormal loss of fluid from the body. Water makes up the greater part of the blood and protoplasm, the fundamental material of which the body is composed. Refer to the Anatomy Section for more information. Dehydration occurs when less fluid is taken in than is being lost in urine, exhaled breath, perspiration, and stool. Dehydration often accompanies excessive urination, vomiting, diarrhea, or loss of blood. Fever also causes water loss. Dehydration is sometimes a symptom of diabetes and other diseases. In severe dehydration, saline solutions may be infused. The diarrhea, vomiting, or other condition producing dehydration must also be treated. Diabetes Mellitus results when the body is unable to metabolize sugar due to inadequate production of insulin. As a result, sugar is found in the blood and in the urine. Primarily the disease is controlled by a diet high in nutritive value and low in concentrated sweets,
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Dysphagia:
Emphysema: Empyema: Encephalitis: Endocarditis: Endometritis: Enteritis: Failure to Thrive: Fracture: Fungal Infection: Gastroenteritis, infectious: Gastroenteritis, noninfectious: Gastroesophageal Reflux/Chalazia: Gastrointestinal Disorder: Gauchers Disease: Guillain-Barre Syndrome: Heart Attack:
exercise, and administration of insulin or hypoglycemic agents. Side effects such as low resistance to infections, especially those involving the extremities, may result in tissue damage. Another side effect may be blindness. The inability to swallow or difficulty in swallowing. It may occur due to paralysis of the esophageal muscles or a narrowing of the pharynx or esophagus. Normally, involuntary contractions of the pharynx and esophagus force food or liquid to move downward to the stomach. Patients with dysphagia may have to be treated with enteral therapy. (See Chronic Obstructive Pulmonary Disease [COPD].) Usually a result of a primary infection in the lungs, empyema is pus in the body cavity, especially in the pleural cavity (pyothorax). An inflammation of the brain. An inflammation of the lining membrane of the heart. An inflammation of the mucus membrane that lines the uterus. An inflammation of the intestines, particularly of the mucosa and submucosa of the small intestine. A condition in which infants and children not only fail to gain weight but also may lose it. A broken bone. An infection caused by a group of organisms that includes yeasts, molds, and mushrooms. An inflammation of the stomach and intestinal tract which is capable of being transmitted with or without contact. An inflammation of the stomach and intestinal tract which is not capable of being transmitted by contact. The reflux of acidic gastric contents into the lower esophagus. A disorder pertaining to the stomach and intestine. A chronic congenital disorder of lipid metabolism caused by a deficiency of the enzyme beta-glucocerebrosidase. Acute autoimmune inflammatory destruction of the myelin sheath covering peripheral nerves, causing rapid progressive symmetrical loss of motor function; the sensory nerves remain intact. (See Myocardial Infarction.)
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Hemiplegia: Hemochromatosis: Hemophilia:
Hepatitis: Herpes Simplex:
Hirschsprungs Disease (Megacolon): Hodgkins Disease:
Hyperbilirubinemia: Hyperemesis:
Hypopituitarism (Dwarfism):
Inflammatory Bowel Disease: Infection: Insomnia: Irritable Bowel Syndrome: Jaundice:
Leukemia:
Paralysis of only one side of the body. A genetic disease marked by excessive absorption and accumulation of iron in the body. A hereditary blood disease marked by greatly prolonged coagulation time, with consequent failure of the blood to clot and abnormal bleeding, sometimes accompanied by swelling of the joints. An inflammation of the liver. A variety of infections caused by herpes virus type 1 and type 2. Type 1 infections are marked by the eruption of vesicles around the lips or nose; type 2 by such lesions on the genitalia. An extremely dilated colon, which is usually congenital but may occur in infancy or childhood. A malignant neoplasm of the lymphoid cells of uncertain origin, marked by chronic enlargement of the lymph nodes. It is often local at the onset and later generalized, together with enlargement of the spleen and often of the liver. An excessive amount of bilirubin in the blood. Excessive vomiting. Hyperemesis Gravidarum is nausea and vomiting during pregnancy that is severe enough to cause systemic effects such as acidosis, dehydration, and weight loss. A condition resulting from diminished secretion of pituitary hormones, especially those of the anterior lobe. The condition of being abnormally small. It may be hereditary or a result of endocrine dysfunction, deficiency diseases, renal insufficiency, diseases of the skeleton, or other causes. The term for a number of chronic inflammatory diseases of the gastrointestinal tract. The presence and growth of a microorganism that produces tissue damage. A prolonged or abnormal inability to sleep. A syndrome that is probably a group of disorders that manifest themselves in various ways so that some symptoms present in some patients but not in others. A condition characterized by yellowness of the skin, whites of eyes, mucous membranes, and body fluids owing to deposition of bile pigment resulting from excess bilirubin in the blood. A malignancy of the blood-forming cells in the bone marrow.
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Lupus (Systemic Lupus Erythematosus): Lyme Disease:
Lymphoma: Malabsorption: Malignant Neoplasms (Cancer):
Malnutrition: Megacolon: Meningitis: Multiple Sclerosis (MS):
A chronic autoimmune inflammatory disease involving multiple organ systems and marked by periods of exacerbation and remission. A multisystem disorder caused by the tick-transmitted spirochete Borrelia burgdorferi. After an incubation period of 3-32 days, usually in the summer when ticks are most active, stage 1 begins with a characteristic expanding skin lesion, called erythema migrans, at the site of the tick bite. Stage 2 begins within the next few days to weeks. The spirochete may spread to other skin sites and to the heart, joints, and nervous system. Stage 3 begins months after the onset of the infection. In patients who have not received an antibiotic 60% will develop arthritis. An unusual malignant lymphoid neoplasm. A disorder or inadequate absorption of nutrients from the intestinal tract, especially the small intestines. Cancer is a disease in which there is new growth of abnormal cells (neoplastic cells). In cancer, cell growth is unregulated and cells continue to reproduce until they form a mass of tissue known as a tumor. Malignant tumors grow in a disorganized fashion interrupting body functions and robbing normal cells of their food and blood supply. Chemotherapy refers to chemical reagents used to treat cancer that have either a specific toxic effect upon the cancer cells, or that prevent the cells from reproducing. Any disorder of nutrition causing a lack of necessary or proper food substances in the body or improper absorption and distribution of them. (See Hirschsprungs Disease.) An inflammation of the membranes of the spinal cord or brain. Multiple Sclerosis is a progressive inflammatory disease of the central nervous system that destroys nerve tissue throughout the brain and spinal cord in a patchy, irregular fashion. The disease generally occurs in young adults. Symptoms vary due to the diseases irregular course, but include: vision difficulties, loss of sensation, slurred speech, loss of memory, mood swings, and difficulty concentrating. As the disease progresses, motor function deteriorates, resulting in: poor muscle coordination; an unsteady slow gait; and involuntary muscle movements. MS becomes more severe and debilitating with time. There is evidence of remissions that may last for a year or more, which accounts for the slow progression of this disease.
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Muscular Dystrophy: Myasthenia Gravis:
A progressive wasting and weakening of the muscles. An autoimmune disease marked by skeletal muscle fatigability due to an abnormality in the synaptic junction between nerve and muscle fiber. Myocardial Infarction A severe condition caused by partial or complete (Heart Attack): occlusion of one or more of the coronary arteries. Nephritis: An inflammation of the kidney due to bacteria or their toxins, streptococcal infections, diphtheria, septicemia, or toxic substances. Obstructive Sleep Apnea: (See Sleep Apnea.) Osteomyelitis: The infection of the bone or bone marrow by pus-forming bacteria. The bacteria usually comes from a primary infection elsewhere in the body. Children are affected more often than adults. Any bone may be involved. An injury to a healthy bone may make it susceptible to infection. The onset of osteomyelitis is usually sudden, with high fever and severe pain in the area of the affected bone. Osteomyelitis is usually treated with antibiotics. Osteoarthritis: (See Arthritis.) Osteoporosis: A general term describing any disease process that results in reduction in the mass of bone per unit of volume. The reduction is sufficient to interfere with the mechanical support function of bone. Otitis Media: An inflammation of the ear. Pancreatitis: An inflammation of the pancreas. Paralysis: A temporary suspension or permanent loss of function, especially loss of sensation or voluntary motion. Paraplegia: A paralysis of the lower portion of the body and of both legs. Parkinsons Disease: A chronic nervous disease characterized by a fine, slowly spreading tremor, muscular weakness and rigidity, and a peculiar gait. Pelvic Inflammatory An infection of the uterus, fallopian tubes, and Disease (PID): adjacent pelvic structures that is not associated with surgery or pregnancy. Pericarditis: An inflammation of the pericardium. Peritonsillar Abscess: An abscess of the tissue around the tonsillar capsule. Peritonitis: An inflammation of the peritoneum, the serous membrane lining the abdominal cavity and covering the viscera. Pneumonia: An inflammation of the lungs resulting primarily from bacteria, viruses, and chemical irritants. Pneumonia caused by bacteria often begins suddenly with fever, chills, pain in the chest, and cough. Typically, pneumonia is treated with antibiotic therapy.
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Poliomyelitis: Post-Bone Marrow Transplant: Post-Op Infection:
An inflammation of the gray matter of the spinal cord. After the transplantation of bone marrow from one individual to another. An infection that occurs following a surgical operation. Post-Op Pain: Pain that occurs following a surgical operation. Prostatitis: An inflammation of the prostate gland. Puerperal Sepsis: Any infection of the genital tract occurring during the period after childbirth or as a complication of abortion. Pulmonary Fibrosis: A formation of scar tissue in the connective tissue framework of the lungs following inflammation or pulmonary disease. Pulmonary Heart Disease: A disease affecting the artery leading from the right ventricle of the heart to the lungs. Pyelonephritis: An inflammation of the kidney and renal pelvis. Pyloric Stenosis: A narrowing of the pyloric orifice, which may be due to excessive thickening of the pyloric sphincter or hypertrophy and hyperplasia of mucosa and submucosa. Quadriplegia: A paralysis of all four extremities and usually the trunk caused by injury to the spinal cord in the cervical spine. Rheumatoid Arthritis: (See Arthritis.) Septicemia (Sepsis): Septicemia, or blood poisoning, is the presence of bacteria in the blood. Once in the bloodstream, bacteria can produce abscesses throughout the body and in vital organs such as the lungs and heart. This condition is very serious and, if not treated, can result in death. Symptoms may include weakness accompanied by high fever and chills. Septicemia is usually treated with antibiotics. Sexually Transmitted A disease acquired as a result of sexual intercourse Disease (STD): with an infected individual. Short Bowel Syndrome: An inadequate absorption of ingested nutrients resulting from a surgical procedure in which a considerable length of the intestinal tract has been removed or bypassed. Sickle Cell Anemia: A genetically determined defect of hemoglobin synthesis. Sinusitis: An inflammation of a sinus, especially a paranasal sinus, that often occurs during an upper respiratory infection when an infection in the nose spreads to the sinuses.
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Sleep Apnea:
Soft Tissue Infection: Spina Bifida: Stricture: Stroke: Subacute Bacterial Endocarditis (SBE): Sudden Infant Death Syndrome (SIDS):
Tendonitis: Testitis: Thrombophlebitis: Tonsillitis: Tracheostomy: Transplant: Trauma:
The cessation of breathing during sleep. Obstructive Sleep Apnea is a sleep disorder that occurs when the airway is obstructed or blocked. As a result, no air moves into or out of the lungs. The obstruction may be due to a variety of factors including loss of muscle control over the tongue, which may cause the tongue to fall back against the airway and/or the collapse of the soft palate over the airway. (See Cellulitis.) A congenital defect of the vertebral column due to an imperfect union of the paired vertebral arches at the midline. A narrowing or constriction of the lumen of a tube, duct, or hollow organ such as the esophagus, ureter, or urethra. (See Cerebrovascular Accident [CVA].) A condition usually caused by colonization of Streptococcus viridans group in an abnormal heart or in valves damaged previously by rheumatic fever. The completely unexpected and unexplained death of an apparently well infant. SIDS is the most common cause of death between the second week and first year of life. This syndrome occurs more frequently in the third and fourth months of life, in premature infants, in males, and in infants living in poverty. These deaths usually occur during sleep and are more likely to happen in winter than in summer. An inflammation of a tendon. An inflammation of the testis. An inflammation of a vein in conjunction with the formation of a blood clot that obstructs a blood vessel or a cavity of the heart. An inflammation and enlargement of a tonsil. The operation of incising the skin over the trachea and making a surgical wound in the trachea to permit an airway during tracheal obstruction. The transfer of tissue or an organ from one part to another as in grafting or plastic surgery. A physical injury or wound caused by external force or violence.
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Tumor:
Ulcer:
A spontaneous new growth of tissue forming an abnormal mass (neoplasm). It is, with few exceptions, of unknown cause, noninflammatory, and develops independent of, and unrestrained by, normal laws of growth and morphogenesis. An open sore or lesion of the skin or mucous membrane accompanied by sloughing of inflamed necrotic tissue. If the sore becomes infected, pus is formed. Simple ulcers may result from trauma, caustics, intense heat or cold, or arterial or venous stasis. They may occur as a complication of various veins due to stasis of blood leading to inflammation, necrosis, and sloughing of tissue. Ulcers of the mucous membrane of the stomach or duodenum are usually caused by gastric acid and pepsin. (See Colitis.) A long lasting or recurring infection of the urinary tract caused by microorganisms. An inflammation of a valve, especially a cardiac valve. Enlarged veins with many twists or turns. An infection of a break in the continuity of soft parts of body structures caused by violence or trauma to tissue.
Ulcerative Colitis: Urinary Tract Infection (UTI): Valvulitis: Varices: Wound Infection:
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DIAGNOSES
Disease may be defined as impairment or other change from the normal state that prevents some of the tissues and organs from carrying on their required functions. The causes are many and varied. Among them are congenital disorders or birth defects; disorders resulting from accidents, injuries or environmental factors; and infection, or invasion of the body by disease producing microorganisms including bacteria and viruses. In this section, you will learn about signs and symptoms of the most common diseases you will encounter, and the diagnostic codes used to ensure Apria Healthcare is reimbursed for the products and services we provide. COMMON DIAGNOSES The information in this section will help you: Understand the effect of the disease process on the human body. Recognize the most common diagnoses requiring the products and services Apria Healthcare provides. Become familiar with the ICD-9 codes for these common diagnoses. ABOUT ICD-9 CODES If the code is the only code applicable to a disease and it requires no further modification, it will be listed as a single code. However, if there are multiple codes or the code requires more digits to further identify it (to ensure payment), the code will be listed with a blank (or underscore) after it, indicating that more digits (further classification) are needed. 042 HIV/AIDS AIDS (acquired immune deficiency syndrome) is an immune deficiency syndrome caused by the human immunodeficiency virus or HIV. This virus permits opportunistic infections and malignancies, and can injure the cells of the nervous system. In the very early period following infection, there may or may not be signs of acute, brief, nonspecific viral infection with fever, malaise, rash, and joint pain. Following this, evidence of AIDS in the blood appears. After the infection, the patient may have no symptoms but be a carrier of the disease. The time from infection to diagnosis varies from several years to more than five. AIDS is a fatal disease. The FDA has approved drugs to treat HIV infection in certain AIDS patients, but this medicine does not cure AIDS. HIV is transmitted by:
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unprotected sex with an infected partner sharing needles receiving a contaminated blood product birth or breast feeding from an infected mother Arthritis Arthritis is an inflammation of a joint. The term covers more than 100 different types of joint diseases. The most common and chronic types are Osteoarthritis and Rheumatoid Arthritis. 715._ or 721._ Osteoarthritis Osteoarthritis is a degenerative disease associated with the aging process because of wear and tear on joint surfaces. Osteoarthritis commonly involves the joints subjected to the most stress, such as hips, knees, shoulders and spinal column (large and weight bearing joints). 714.0 Rheumatoid Arthritis Rheumatoid arthritis is a crippling, inflammatory disease of the joints. Onset of the disease is most common in persons 20-40 years old and more than twothirds are women. This progressive disease destroys the structure of joints and surrounding tissue. The entire joint becomes red, warm, painful, swollen, and eventually deformed. 681._ or 682._ Cellulitis Cellulitis is the process that occurs when an infection in or close to the skin spreads through the tissue. The resulting abnormal accumulation of fluid in the body tissues produces swelling, which is accompanied by heat, redness, and tenderness. Cellulitis is treated with IV antibiotics. 436._ Cerebrovascular Accident (CVA) A Cerebrovascular Accident, or stroke, results when there is damage to brain tissue caused by a sudden interruption of the blood supply, a tumor, or trauma. There are three main causes: 1. Cerebral thrombosisa blood clot that forms within a vessel. 2. Cerebral embolisma detached portion of a blood clot that enters the bloodstream. 3. Cerebral hemorrhagerupture of a blood vessel.
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Results depend upon location and extent of tissue damage, but commonly include: Hemiplegialoss of muscle function on one side of the body, typically the opposite side from the brain damaged area Diminished sensation on the injured side Swelling of involved hand and foot Fatigability Lack of comprehension. Confusion and emotional instability Impaired judgement or inconsistent performance Impaired language Inability to swallow (dysphagia) Recovery depends on the severity and location of the stroke and general physical health of the patient. Some improvement may occur within the first two years. There is likelihood of repeated strokes, depending on the cause of the first episode. Rehabilitation may include physical therapy, occupational therapy, and speech therapy. Emotional support and encouragement are key factors in the recovery of a stroke victim. Chronic Obstructive Pulmonary Disease (COPD) 496 Chronic Obstructive Pulmonary Disease (COPD) Pulmonary emphysema, chronic bronchitis, and chronic asthma are three diseases that are becoming more and more common in the United States. Typically, they produce a long-term illness that is frequently accompanied by physical disability. They are commonly referred to as Chronic Obstructive Pulmonary Disease (COPD) or Chronic Obstructive Lung Disease (COLD), simply because each of the three diseases causes an obstruction to the air as it tries to leave the chest, making breathing difficult. 491._ Chronic Bronchitis Chronic Bronchitis is a disease that affects the bronchial tubes. The tubes become inflamed and produce a great amount of mucus. The combination of the swelling and the excess mucus interferes with the air flowing in and out of the lungs. 493. _ Asthma Asthma can best be described as an allergic reaction. As in chronic bronchitis the bronchial tubes are affected. These tubes become reddened and swollen, making the air passages almost too small for air to move in and out of the lungs.
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492. _ Emphysema Emphysema is a disease that results from the destruction of the alveoli, the tiny air sacs of the lungs that are responsible for the exchange of oxygen and carbon dioxide. The alveoli lose their shape and eventually rupture. When this happens, the exchange of oxygen and carbon dioxide is compromised. A chronic recurring productive cough (moist and wheezing) is the first symptom, but it is often ignored. The condition usually develops gradually over a long period. Often, the patient cannot recall the time of onset. Factors such as cigarette smoking, air pollution, chronic infection, allergies, dusty environments, and inherited factors may contribute. As the disease progresses and irreversible changes occur within the lungs alveoli, symptoms become severe and debilitating. Symptoms include: Difficulty in breathing Anxious and strained facial expression Puffing out of cheeks during exhalation Barrel-shaped chest Bluing or dusty color to skin (lips, fingers, and toes are most notable) Routine tasks such as dressing oneself or short walks from bedroom to kitchen can become extremely difficult and physically overwhelming for patients with emphysema. 428.0 Congestive Heart Failure (CHF) Congestive Heart Failure is a condition in which the heart is so weakened that it is not strong enough to pump blood to maintain normal circulation. The lungs may become congested, and the blood may push back into the veins that supply blood to the heart. Fluid may escape from the blood into the tissues, causing the ankles to become puffy and swollen. Causes of CHF include high blood pressure, coronary heart disease, and congenital birth defects of the heart. Treatment may include: Diet restrictions to limit sodium Medications to regulate heart beat and control fluid accumulation Adequate rest, as fatigue is a common symptom Elevation of the head of the bed for adequate ventilation
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277.0_ Cystic Fibrosis Cystic Fibrosis is a hereditary disease of the exocrine glands affecting the pancreas and respiratory system. The sweat glands and the mucus-secreting glands do not function properly. Cystic Fibrosis usually begins in infancy. In most children, the mucus prevents the enzymes of the pancreas from reaching the intestine and aiding in the digestion and absorption of food. The result is a malnourished and underweight child. Another pronounced symptom is the excessive amounts of salt in body sweat. Consequently, in hot weather or in episodes of fever, children with Cystic Fibrosis are dangerously subject to heat exhaustion. The salt loss, which may be three times as great as that of healthy children, provides the principal diagnostic indication of the disease. There is no cure for Cystic Fibrosis. Patients may be treated with a high protein diet, extra salt, chest physical therapy, and antibiotics. 707.0 Decubitus Ulcers Decubitus Ulcers result when there is prolonged pressure on the affected area of the skin. Under prolonged pressure, the soft tissue and skin begin to break down. The most common sites are the bony areas of the body. If untreated, an ulcer finally develops. If neglected, an ulcer may damage the deep layers of the skin and eventually cause further damage to the underlying muscle and bone tissue, which could result in the need for amputation. The goal is to try to prevent the decubitus ulcer with good skin care, turning and positioning the patient every two hours, lambs wool, and the use of egg crate mattresses, or alternating pressure or water mattresses. These mattresses relieve continued pressure from the bed by providing little cushions or pads under the skin. 276.5 Dehydration Dehydration is the abnormal loss of fluid from the body. Water makes up the greater part of the blood and protoplasm (refer to the Anatomy Section), the fundamental material of which the body is composed. If a persons fluid intake is less than what is lost in urine, exhaled breath, perspiration, and stool, dehydration occurs. Dehydration often accompanies excessive urination, vomiting, diarrhea, or loss of blood. Fever also causes water loss. Dehydration is sometimes a symptom of diabetes and other diseases. In severe dehydration, saline solutions may be infused. The diarrhea, vomiting, or other condition producing dehydration must also be treated.
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250. _ Diabetes Mellitus Diabetes Mellitus results when the body is unable to metabolize sugar due to inadequate production of insulin. Consequently, excessive sugar is found in the blood and in the urine. Symptoms of diabetes include excessive urine production, excessive thirst, and an increase in food intake. There is no known cure for diabetes. Treatment depends on the severity of the disease, the age of the patient, and the symptoms exhibited. Primarily the disease is controlled by diet (food high in nutritive value and low in concentrated sweets), exercise and administration of insulin or hypoglycemic agents. Proper management and specific instruction are essential to avoid the longterm side effects of the disease. Side effects such as low resistance to infections, especially those involving the extremities, may result in tissue damage. Another side effect may be blindness. 787.2 Dysphagia Dysphagia is the inability to swallow or difficulty in swallowing. It may occur due to paralysis of the esophageal muscles or a narrowing of the pharynx or esophagus. Normally, involuntary contractions of the pharynx and esophagus force food or liquid to move downward to the stomach. Patients with dysphagia may have to be treated with enteral therapy. 800-829 Fractures A fracture is a broken bone. In certain diseases and conditions such as osteomyelitis, bones break spontaneously without trauma. At other times, the bone is broken by some type of violence, either direct (being run over by a car), or indirect (falling down on an outstretched hand and breaking the collarbone). Signs of a fracture include loss of movement, pain with acute tenderness to the site, swelling and bruising, deformity and possible shortening, and grating that is heard when the ends of bone are rubbed together. 780.9 Generalized Pain Pain is not a diagnosis in and of itself, but a secondary condition to other diseases such as cancer. When the disease can not be treated, the goal is to manage the pain. 140-239 Malignant Neoplasm (Cancer) Cancer is a disease in which there is new growth of abnormal cells (neoplastic cells). In cancer, cell growth is unregulated and cells continue to reproduce until they form a mass of tissue known as a tumor. Malignant tumors grow in a disorganized fashion interrupting body functions and robbing normal cells of their
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food and blood supply. Chemotherapy refers to chemical reagents used to treat cancer that have either a specific toxic effect upon the cancer cells, or that prevent the cells from reproducing. 340 Multiple Sclerosis (MS) Multiple Sclerosis is a progressive inflammatory disease of the central nervous system that destroys nerve tissue throughout the brain and spinal cord in a patchy, irregular fashion. The disease is rare in children, and in about two thirds of cases, it begins between ages 20 and 40. Symptoms vary due to the diseases irregular course, but include: Double vision Spots before the eyes Blindness Loss of sensation (numbness, tremor, or weakness of extremities) Slurred speech Loss of memory, mood swings, difficulty concentrating As the disease progresses, motor function deteriorates resulting in: Deficient muscle coordination Unsteady, or slow gait Involuntary muscle movements Multiple Sclerosis becomes more severe and debilitating with time. There is evidence of remissions that may last for a year or more, which accounts for the slow progression on MS. 730. _ Osteomyelitis Osteomyelitis is the infection of the bone or bone marrow by pus-forming bacteria. The bacteria usually come from a primary infection elsewhere in the body. Children are affected more often than adults are. Any bone may be involved. An injury to a healthy bone may make it susceptible to infection. The onset of osteomyelitis is usually sudden, with high fever and severe pain in the area of the affected bone. Osteomyelitis is usually treated with antibiotics. 480-486 Pneumonia Pneumonia is an inflammation of the lungs resulting primarily from bacteria, viruses, and chemical irritants. Pneumonia caused by bacteria often begins suddenly with fever, chills, pain in the chest, and cough. Typically, pneumonia is treated with antibiotic therapy.
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038. _ Septicemia (Sepsis) Septicemia, or blood poisoning, is the presence of bacteria in the blood. Once in the bloodstream, bacteria can produce abscesses throughout the body and in vital organs such as the lung and heart. This condition is very serious and if not treated, can result in death. Symptoms may include weakness accompanied by fever and chills. Septicemia is usually treated with antibiotics. Sleep Disturbances 780.5_ Obstructive Sleep Apnea Obstructive Sleep Apnea is a sleep disorder that occurs when the airway is obstructed or blocked. Consequently, no air moves into or out of the lungs. The obstruction may be due to a variety of factors including loss of muscle control over the tongue, which may cause the tongue to fall back against the airway and/or the collapse of the soft palate over the airway. 798.0 SIDS (Sudden Infant Death Syndrome) SIDS is the completely unexpected and unexplained death of an apparently well infant. It is the most common cause of death between the second week and first year of life. This syndrome occurs more frequently in the third and fourth months of life, in premature infants, in males, and in infants living in poverty. These deaths usually occur during sleep and are more likely to happen in winter than in summer.
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CHAPTER 3: ANATOMY, TERMINOLOGY AND DIAGNOSES

CHAPTER 3: ANATOMY, TERMINOLOGY AND DIAGNOSES

Femur Pelvis Fibula Patella Tibia

CHAPTER 3: ANATOMY, TERMINOLOGY AND DIAGNOSES

CHAPTER 3: ANATOMY, TERMINOLOGY AND DIAGNOSES

Pons Midbrain Medulla Oblongata

Peripheral Nervous System

CHAPTER 3: ANATOMY, TERMINOLOGY AND DIAGNOSES

CHAPTER 3: ANATOMY, TERMINOLOGY AND DIAGNOSES

CHAPTER 3: ANATOMY, TERMINOLOGY AND DIAGNOSES

R. Pulmonary Artery L. Pulmonary Artery L. Pulmonary Veins

Aorta Superior Vena Cava R. Pulmonary Veins Inferior Vena Cava

CHAPTER 3: ANATOMY, TERMINOLOGY AND DIAGNOSES

Gall Bladder (under liver) Small Intestines Large Intestines

CHAPTER 3: ANATOMY, TERMINOLOGY AND DIAGNOSES

CHAPTER 3: ANATOMY, TERMINOLOGY AND DIAGNOSES

CHAPTER 3: ANATOMY, TERMINOLOGY AND DIAGNOSES

CHAPTER 3: ANATOMY, TERMINOLOGY AND DIAGNOSES

CHAPTER 3: ANATOMY, TERMINOLOGY AND DIAGNOSES

Common Word Roots

CHAPTER 3: ANATOMY, TERMINOLOGY AND DIAGNOSES

CHAPTER 3: ANATOMY, TERMINOLOGY AND DIAGNOSES

CHAPTER 3: ANATOMY, TERMINOLOGY AND DIAGNOSES

Antiseptic: Arterial Blood Gas:

Aseptic: Ataxia: Atresia: Atrophy: Bacteremia: Bacteria: Bilirubinemia: BK: Bolus:

CHAPTER 3: ANATOMY, TERMINOLOGY AND DIAGNOSES

Chronic Obstructive Pulmonary Disease (COPD): Colostomy:

CHAPTER 3: ANATOMY, TERMINOLOGY AND DIAGNOSES

CHAPTER 3: ANATOMY, TERMINOLOGY AND DIAGNOSES

CHAPTER 3: ANATOMY, TERMINOLOGY AND DIAGNOSES

CHAPTER 3: ANATOMY, TERMINOLOGY AND DIAGNOSES

CHAPTER 3: ANATOMY, TERMINOLOGY AND DIAGNOSES

CHAPTER 3: ANATOMY, TERMINOLOGY AND DIAGNOSES

CHAPTER 3: ANATOMY, TERMINOLOGY AND DIAGNOSES

ACIS* AHA AIDS/HIV

CHAPTER 3: ANATOMY, TERMINOLOGY AND DIAGNOSES

AP APN/RespiMed* APP AR ARU

ASC* AUTHS* AWP

CHAPTER 3: ANATOMY, TERMINOLOGY AND DIAGNOSES

COD CON COPD

CHAPTER 3: ANATOMY, TERMINOLOGY AND DIAGNOSES

CPAP CPI CPT

CS CSR* CST* CVA

CHAPTER 3: ANATOMY, TERMINOLOGY AND DIAGNOSES

DA/BCC DEA DHHS DL DME DMEPOS DMERC

DOB DOD DOT DSO DUTs:

DX ECS EDI EFT EGHP EIN EMC

ENF* EOB EOMB

CHAPTER 3: ANATOMY, TERMINOLOGY AND DIAGNOSES

FDA FFS FOIA

FOS-IV/ IV-400 FR FY H,E,D,C HCFA

HCFA 1500 HCPC

CHAPTER 3: ANATOMY, TERMINOLOGY AND DIAGNOSES

HHA HIDA HIPAA

HME HMO HIMR

IM INS IS ISR* IST* IV IVFOS*/IV 400 JCAHO JDE

CHAPTER 3: ANATOMY, TERMINOLOGY AND DIAGNOSES

LIB LMN LOPICS LPM LPN/LVN LOX MAPS* MCM

MSP NAPS* NCQA

CHAPTER 3: ANATOMY, TERMINOLOGY AND DIAGNOSES

O2 OBRA OIG OOP OSHA PA PCP PEN PHO

PICC PID PMG PMPM PO POS POT PPO

CHAPTER 3: ANATOMY, TERMINOLOGY AND DIAGNOSES