1. Official policies published by the Centers for Medicare and Medicaid Services (CMS) that tell how procedure codes are to be assigned by providers when submitting insurance claims for patients who have received medical services. 2. Official rules for assigning ICD-9-CM diagnostic codes to patients’ conditions of illnesses, injuries, and diseases.

Official code conventions used when selecting diagnostic and procedural code numbers for a patient who has received medical services by a provider.

Expert in coding diagnoses and procedures using diagnostic and procedural code books.

One type of certification earned by meeting the requirements of the American College of Medical Coding Specialists (ACMCS).

1. Acronym for occurring in the “course of employment.” An injury must occur in the course of employment to be compensable in workers’ compensation. Thus the activity the employee was engaged in at the time of injury must grow out of, or be incidental to, the employment. 2. Abbreviation for center of excellence. See center of excellence (COE).

Relevant to the mental processes of comprehension, judgment, memory, perception, and reasoning as compared with emotional and volitional processes.

Deterioration or loss of intellectual capacity that requires continual supervision to protect the insured or others, as measured by clinical evidence and standardized tests that reliably measure impairment in the area of (1) short- or long-term memory; (2) orientation as to person, place, and time; or (3) deductive or abstract reasoning. Such loss in intellectual capacity can result from Alzheimer’s disease or similar forms of senility or irreversible dementia.

Population group that shares a common property, characteristic, or event such as a year of birth or year of marriage. The most common one is the birth cohort, a group of individuals born within a defined time period, usually a calendar year or a 5-year interval.
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UK: a body of claims, for example, claims grouped by accident year, report year or underwriting year.

Dollar amount that a patient must pay in coinsurance expenses each year before an insurance plan will pay 100% of eligible expenses for the rest of the year. Also known as out-of-pocket maximum.