An Expert System Is Not a Good Choice When a Lot

question 52

True/False

An expert system is not a good choice when a lot of human expertise is needed to tackle a problem.

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Definitions:

Pathology And Laboratory

The branch of medicine and healthcare dealing with the examination of organs, tissues, and bodily fluids to diagnose disease.

ICD-9-PCS

International Classification of Diseases, Ninth Revision, Procedure Coding System; a system used in the United States for classifying medical procedures for billing and documentation.

Diagnosis Code

Diagnosis Code refers to a code assigned to a diagnosis based on a standardized system, such as the International Classification of Diseases (ICD), used for healthcare billing and statistics.

Upcoding

Reporting a higher-level code than is appropriate for the service that was rendered, resulting in higher reimbursement; when a facility coder assigns a diagnosis code that does not match patient documentation, with the intention of increasing reimbursement to the facility through the DRG system, serious penalties and fines will be levied against the facility for submitting fraudulent claims.