Anesthesia & Pain Management Compliance Auditors


Glossary of Terms and Abbreviations

A/R – Accounts Receivable
AA – Anesthesia Assistant
AAPCC – Adjusted Average Per Capita Cost
AAR – Approval, Adjustment or Reject Response
ABN – Advanced Beneficiary Notice
Accept Status – The encounter data has passed the “front-end” edit process. M+CO does not need to resubmit
ACR – Adjusted Community Rate
ACRP – Adjusted Community Rate Proposal
Acupuncture – Chinese practice of inserting needles into the skin at specific points of the body to relieve pain
Acute Pain – Often short-lived with a specific cause and purpose; generally produces no persistent psychological reactions. Acute pain can occur during soft tissue injury, and with infection and inflammation. It can be modulated and removed by treating its cause and through combined strategies using analgesics to treat the pain and antibiotics to treat the infection
Addiction – Psychological or emotional dependence on the effects of a drug
ADG-HOSDOM – Ambulatory Diagnostic Group C Hospital Dominant (type of comprehensive risk adjustment model)
AHIMA – American Health Information Management Association
Anesthesia Provider – An anesthesiologist who performs the anesthesia service alone, anesthesiologist who provides medical direction, a CRNA who is not medically directed, or a CRNA, AA, resident, SRNA who are medically directed
Anesthesia time – Refers to the time recorded in the anesthesia record
ASA – American Society Anesthesiologists
BBA – Balanced Budget Act (1997)
BBRA – Balanced Budget Refinement Act (1999)
BHI – Bureau of Health Insurance
BIF – Beneficiary Information Form
BMAD – Part B Medicare Annual Data Files
C/R – Collection Rate
–  Consumer Assessments of Health Plans Study
Carrier – Company through whom Medicare Part B Claims are submitted to HCFA
CASR – Contractor Auditing and Settlement Report
Causalgia – A persistent, severe burning sensation of the skin, usually following injury to a peripheral nerve.
CCI – Correct Coding Initiative (type of edit to detect unbundling of claims or claims that should not appear together)  CDPS – Chronic Illness and Disability Payment System (type of comprehensive risk adjustment model)
CD-RISC – Clinically Detailed Risk Information System for Costs (type of comprehensive risk adjustment model)
Central Pain – Pain associated with a lesion of the central nervous system.
CEO – Chief Executive Officer
CF – Conversion Factor
CFO – Chief Financial Officer
CFR – Code of Federal Regulations
CMS – Centers for Medicare and Medicaid Services
CoP – Condition of Participation
CPT – Current Procedural Terminology
CRNA – Certified Registered Nurse Anesthetist
CVC – Central Venous Catheter
DAP – DMERC Advisory Process
DCG – Diagnostic Cost Group
DCN – Document Control Number (See also ICN – Internal Control Number)
DDE – Direct Data Entry
Deafferentation Pain – Pain due to loss of sensory input into the central nervous system.
Denied Status – Encounter data that fails the CWF reported in the 070 Report (Final Host Response Report)
Dermatome – A delineated area of skin innervated by a spinal cord segment. Each cord segment has a representative skin area.
DHHS – Department of Health and Human Services
Distraction – A pain relief method that takes a person’s attention away from the pain.
DME – Durable Medical Equipment
DRO – Days Receivable Outstanding
E/M – Evaluation and Management
EDB – Enrollment Database
EDC – Encounter Data Contact
EDFS – Encounter Data Front-End System
EDI – Electronic Data Interchange
Edit – Logic within the Standard Claims Processing System that selects certain claims, evaluates or compares information on the selected claims or other accessible source, and depending on the evaluation, takes action on the claims, such as pay in full, pay in part, or suspend for manual review.
EDP – Electronic Data Processing
EFT – Electronic Funds Transfer (Direct Deposit)
EIN -Employer Identification Number
EMC – Electronic Media Claim
EOB – Explanation of Benefits
EOMB – Explanation of Medicare Benefits
Failed Back Surgery Syndrome – A descriptive (not diagnostic) term for the condition of a patient who has had several back surgeries; the patient could have as many as six to eight different pain pathologies producing the pain state.
FAQ – Frequently Asked Questions
FFS -Fee-for-Service
FI – Fiscal Intermediary
Finalized Status – Encounter data that has reached the CWF system. This includes approved and denied status of the encounter data on the 70 – Final Host Response Report
FISS -Fiscal Intermediary Shared System
FMR -Focused Medical Review
Foramen – A natural opening or passage in bone.
FSS -Florida Shared System (Medicare Part A standard claims processing system)
FTP – File Transfer Protocol
GHP – Group Health Plan
GROUCH – GHP Report Output User Communication Help
HCC – Hierarchical Coexisting Condition (type of comprehensive risk adjustment
HCFA – Health Care Financing Administration
HCFA 1450 – (Also called UB-92) – Medicare Part A claim filing form/form used for
HCPCS – Healthcare Common Procedure Coding System
Headache – A pain in the head from any cause. Tension headaches and migraine headaches account for 90% of all headaches. A migraine is a complex of symptoms that presents clinically as discrete episodes of severe headache with associated features, such as phonophobia (abnormal sensitivity to sound), photophobia (abnormal sensitivity to light), nausea and emesis (vomiting).
Herniated Disk – The protrusion of a degenerated or fragmented intervertebral disk that compresses a nerve root.
HIPAA – Health Insurance Portability and Accountability Act
Hyperalgesia – Extreme sensitivity to pain.
Hyperesthesia – Increased sensitivity to stimulation, excluding special senses.
Hyperpathia – A painful syndrome, characterized by increased reaction to a stimulus, especially a repetitive stimulus, as well as an increased threshold.
Hypoalgesia – Diminished sensitivity to pain.
Hypoesthesia – Diminished sensitivity to stimulation, excluding special senses.
ICD-9-CM – International Classification of Disease 9th Revision – Clinical Modification
IGs – Interpretive Guidelines
Imagery – A method of pain relief that uses mental images produced by memory or imagination.
Infusion – A method of giving pain medication into a vein or under the skin. Unlike an injection, which is pushed in by a syringe, an infusion flows in by gravity. Some continuous infusions are given using a mechanical pump.
Interventional Pain Management – An effort to “intervene” in the body’s production and/or transmission of a pain signal to the brain. In most cases, this means identifying and treating the underlying cause of a particular pain or pain complex and, by virtue of encouraging the healing process, the pain is subsequently reduced or resolved. Interventional pain management may involve an invasive procedure to treat and management pain, typically provided through an injection of an anesthetic, nerve block, spinal cord stimulation, implantation of a drug delivery system or a neurological procedure.
Intramuscular (IM) – Into a muscle.
Intrathecal (IC) – Into the spinal cord.
Intravenous (IV) – Into a vein.
Kyphosis – Abnormally increased convexity in the curvature of the thoracic spine as viewed from the side (hunchback).
Lamina – The portion of the vertebra (there are two for each vertebra) that connects the pedicles to the spinous process as part of the neural arch.
Laminectomy – Removal of all of a lamina (both sides).
Laminotomy – Hemilaminectomy or removal of part of the lamina, usually on one side of the vertebra.
Local Anesthetic – A drug that blocks nerve conduction in the region where it is applied.
Lordosis – Anterior concavity in the curvature of the lumbar spine as viewed from the side (swayback).
MAC – Monitored Anesthesia Care
Magnetic Resonance Imaging (MRI) – An imaging technique based on a computer analysis of the response of atoms of hydrogen, phosphorus or other elements to a generated magnetic field and radio signal; used to produce electronic images of specific atoms and molecular structures in solids, especially human cells, tissues, and organs.
Metastasis – The spread of cancer from one part of the body to another.
MGMA – Medical Group Management Association
Morphine – A bitter crystalline alkaloid extracted from opium, the soluble salts of which are used in medicine as an analgesic, a light anesthetic, or a sedative.
MPFS – Medicare Physician Fee Schedule
MPFS – Medicare physician fee schedule
Musculoskeletal Pain – Pain originating within the musculoskeletal system, such as pain from arthritic conditions, painful muscle conditions, broken bones, torn ligaments and tendons and pain of spinal disc origin.
Narcotic – Pain relieving drug related in action and structure to the opiates.
NCCI – National Correct Coding Initiative
Nerve Block – Pain relief method in which an anesthetic is injected into a nerve.
Neuralgia – Pain in distribution of nerve or nerves.
Neuritis – Inflammation of a nerve or group of nerves that is characterized by pain, loss of reflexes and atrophy of the affected nerves.
Neuroablative Therapy – The use of various injectable substances such as alcohol and phenol or the use of controlled heat or cold to render the nervous system unable to transmit a pain signal.
Neurology – The branch of medical science that deals with the nervous system and disorders affecting it.
Neuromuscular System – The muscles of the body together with the nerves supplying them.
Neuropathic Pain – Any pain originating from the central nervous system, especially pain affecting the cranial or spinal nerves.
Neuropathy – A disturbance of function or pathologic change in a nerve; in one nerve, mononeuropathy; in several nerves, mononeuropathy multiplex; if symmetrical and bilateral, polyneuropathy.
Nociceptive – Caused by or responding to a painful stimulus.
NPI – National Provider Identifier
NPO – non per os (nothing by mouth)
OB – Obstetric
Onset of Action – Length of time it takes for a medicine to start to work.
Opiate – Pain-killing drug chemically related to opium; also called a narcotic.
Osteoarthritis – A form of arthritis, occurring mainly in older persons, that is characterized by chronic degeneration of the cartilage of the joints.
Pain – An unpleasant sensory or emotional experience which is primarily associated with tissue damage or described in terms of tissue damage, or both. Pain is a complex perception that takes place only a higher levels of the central nervous system.
Pain Control – In cases where the pain pathology has no ability to heal despite medical or surgical therapy, intervention pain management takes on the form of “pain control.” This can be done by using medications aimed at reducing the ability of the body to transmit the pain signal to the brain or, in more advanced cases, by utilizing an implantable device to alter the ability of the body’s nervous system to transmit the pain signal. Other methods rely on the physician’s ability to damage nervous tissue in a controlled manner to stop the pain signal.
Pain Threshold – The least experience of pain that a subject can recognize.
Pain Tolerance Level – The greatest level of pain that a subject is prepared to tolerate.
Parethesia – An abnormal sensation, whether spontaneous or evoked.
Physical Therapy – The health profession that treats pain in muscles, nerves, joints, and bones with exercise, electrical stimulation, hydrotherapy, and the use of massage, heat, and cold.
PQRI – Physician Quality Report Initiative
Psychiatry – The branch of medicine that deals with the diagnosis, treatment, and prevention of mental and emotional disorders.
Psychology – The science that deals with mental processes and behavior
Radiation Therapy – Treatment with high energy from x-rays or other sources to kill cancer cells.
Radiculalgia – Pain along the distribution of one or more sensory nerve roots.
Radiculitis – Inflammation of one or more nerve roots.
Radiculopathy – A disturbance of function or pathologic change in one or more nerve roots.
Radiofrequency Thermo-coagulation (RFTC) – A form of neuroablation, this technique utilizes a finely controlled thermal injury at the tip of a needle to render a painful joint, disc, or nerve incapable of sending a pain signal. It is most appropriate for chronic pain of intermediate duration such as terminal cancer pain or an injury capable of restoring within that time frame.
Referred Pain – Pain that is felt in a part of the body at a distance from its area of origin
Reflex Sympathetic Dystrophy – More recently know as CRPS or complex regional pain syndrome, this is a natural reflex of the body that is only present due to some other stimulus. It is frequently treated by blocking the sympathetic nervous system with a local anesthetic injection for temporary pain relief. The goal is to block the nerve repeatedly so that it reduces its intensity and stop reflexively returning to its hyperactive painful state. A more appropriate approach is to identify the underlying stimulus for the sympathetic hyperactivity so that both the underlying cause as well as the sympathetic reflex can be resolved and the body can be given the opportunity to heal.
Regional Anesthesia – The abolition of painful impulses from any region or regions of the body by temporarily interrupting the sensory nerve conductivity. Motor function may or may not be involved, but the patient does not lose consciousness.
Relaxation Techniques – Methods used to lessen tension, reduce anxiety, and manage pain.
Rheumatism – Any of several pathological conditions of the muscles, tendons, joints, bones, or nerves, characterized by discomfort and disability.
Scoliosis – An appreciable lateral deviation (of greater than 10 degrees) in the normally straight vertical line of the spine.
Side Effect – An unintended symptom that results from using a drug.
Skin Stimulation – The use of pressure, friction, temperature change, or chemical substances to excite the nerve endings in the skin.
Somatosensory – Sensory signals from all tissues of the body including skin, viscera, muscles, and joints.
Spinal Stenosis – An abnormal narrowing of the spinal cord that may be either congenital or acquired.
Spondylolisthesis – Forward displacement of one vertebra over another
Spondylosis – A stiffening of the articulating vertebra.
SRNA – Student Registered Nurse Anesthetist
Stage – The extent of disease.
Subcutaneous – Under the skin.
Suffering – A state of emotional distress associated with events that threaten the biological and/or psychosocial integrity of the individual.
TEE – Transesophageal Echocardiography
Tolerance – Decreasing effect of a drug with the same dose or the need to increase the dose to maintain the same effect.
Tranquilizer – A drug used to treat anxiety.
Trigger Point – A hypersensitive area or site in muscle or connective tissue at which touch or pressure will elicit pain.
YTD – Year To Date