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Valencia College *

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Feb 20, 2024

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Memo To : Eastern Memorial Hospital CEO From : Hajar Hannit CC: Coding and Reimbursement Related Terminology ICD-10 purpose and usage: International Classification of Diseases, Tenth Revision (ICD-10) ICD codes are used in the healthcare industry by providers, coders, IT specialists, insurance companies, government agencies, and others to accurately note diseases on medical records, monitor epidemiological trends, and help with medical reimbursement decisions. The purpose of ICD is to promote international comparability in the collection, processing, classification, and presentation of mortality statistics. Physicians and other healthcare professionals use the ICD-10-CM (International Classification of Diseases, Tenth Revision, Clinical Modification) system to label and categorize all diagnoses, symptoms, and treatments that are documented in connection with hospital care in the United States. ICD-10-PCS purpose and usage: The Centers for Medicare and Medicaid Services (CMS) and 3M Health Information Management developed ICD-10-PCS to collect global morbidity and mortality statistics in a comparable manner. The medical operations are specified by the system using three- to seven-digit alphanumeric codes. Health care providers, insurance companies, and organizations are the target users of ICD-10-PCS. Many clinical and healthcare applications employ ICD-10-PCS codes for billing, reporting, and morbidity statistics. Every year, ICD-10-PCS is revised. Because it offers a uniform language for reporting, tracking, and documenting illnesses, the ICD is significant. STREET ADDRESS, CITY, STATE ZIP CODE T: TELEPHONE W: WEBSITE
CPT purpose and usage: The most widely recognized medical nomenclature for reporting medical procedures and services for processing claims, doing research, assessing healthcare utilization, and creating medical guidelines and other types of healthcare documentation is provided by the CPT descriptive terminology and related code numbers. In order to improve efficiency, accuracy, and reporting, physicians and other healthcare workers can categorize medical services and procedures more uniformly by using the Current Procedural Terminology (CPT®) codes. Although CPT and ICD-10 numbers are similar, CPT codes are used to identify services provided, whilst ICD-10 codes are used to indicate patient diagnoses. Please refer to the ICD-10: Understanding the Basics document for further details on ICD-10 codes. HCPCS purpose and usage: The Centers for Medicare and Medicaid Services (CMS) creates the Healthcare Common Procedure Coding System (HCPCS). A set of uniform codes known as HCPCS is used to identify medical supplies, services, procedures, and goods. Healthcare facilities and insurers benefit from more accurate and efficient billing because to this common coding language. Patients can also read an itemized list of codes used for operations, services, and materials that are being invoiced, which helps to make medical bills easier to understand for them. Drugs, supplies, and a few other services not covered by CPT are coded using HCPCS, a different set of codes. Similar to CPT codes, HCPCS codes consist of five characters, with the exception of the first letter which is a number. The AMA does not administrate the HCPCS codes; instead, the CMS does. Medical dictonory purpose and usage: The foundation of healthcare communication, medical terminology fosters patient care efficiency, safety, and accuracy while promoting international collaboration and the advancement of medical knowledge. Better patient outcomes are the ultimate result of healthcare practitioners being able to 2
interact with their care team and assess a patient's requirements more quickly and accurately thanks to this uniform language. The universal language that enables precise and efficient communication between healthcare workers is medical dictionary. Official terminology and acronyms that explain anatomy, physiological processes, diseases, diagnoses, treatments, procedures, and more are used in this language. terminology is widely used in the healthcare sector and in a variety of contexts. It is essential not just in the emergency department and surgical ward but also for medical receptionists, health insurance agents, health information technologists, and other related fields. Ms-DRGs purpose and usage: Comorbidities, major complications or comorbidities (MCCs/CCs) that may affect the patient's care and treatment are considered in MS-DRGs. Medicare uses the MS-DRG system, which is revised yearly to account for advancements in medical technology and practice. By taking into account a patient's severity of disease and the resources needed for their treatment, the MS-DRG system was designed to increase the accuracy and equity of Medicare reimbursements to hospitals. CCI purpose and usage: The National Correct Coding Initiative (CCI) was created by the Centers for Medicare & Medicaid treatments as a mechanism to stop overpaying for treatments that are duplicated or overlap in fee schedules. The Correct Coding Initiative (CCI) and the Medically Unlikely modifications (MUE) are the two main categories of code modifications. When wrong code combinations are reported, improper payment is prevented by the CCI modifications. The standards of practice serve as the foundation for many CCI modifications. There are two tables of edits in the CCI. 3
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RBRVS purpose and usage: Resource Based Relative Value Scale, or RBRVS Medicare uses the Discounted Fee for Service (FFS) payment method, which was introduced in 1992 and categorizes health services according to the labor, overhead, and malpractice insurance costs associated with providing physician services. In the US, the method used to calculate reimbursement rates for medical services is called the Resource-Based Relative Value Scale (RBRVS). It assigns a relative value to each service based on characteristics including physician work, practice expenses, and malpractice expenses. The RBRVS was developed to offer a uniform method of physician service pricing that assigned a weight to the resources utilized in providing the service. Resources: https://www.cdc.gov/nchs/icd/icd10.htm#:~:text=International%20Classification%20of%20Diseases%2CTenth %20Revision%20(ICD%2D10)&text=The%20International%20Classification%20of%20Diseases,and %20presentation%20of%20mortality%20statistics . https://www.ama-assn.org/practice-management/cpt/cpt-overview-and-code-approval#:~:text=The%20Current %20Procedural%20Terminology%20(CPT,reporting%2C%20increase%20accuracy%20and%20efficiency. 4