a) hospitals (ICD codes)
ICD codes are used in health care to correctly state diseases on patients’ health files. Currently, the codes ICD-10-CM and ICD-10-PCS are used in hospitals. The code ICD-10-PCS is used for inpatient procedures and consists of seven characters. The second and third components are characters that contain both letters and numerals; with each character able to hold up to 34 values. The components from the fourth through the seventh can be either alpha or numeric. ICD-10-PCS can contain the following characters: numbers from 0-9, 24 characters of the alphabet, except letter O and I because of similarity to numbers 0 and 1. Example: 0DQ10ZZ- Repair upper esophagus, open approach.
The code ICD-10-CM is used to code inpatient and outpatient diagnoses. The components of ICD-10-CM are the following: the first character of the code is a letter (u is excluded). The second and third components of the code should be numbers. The first three components of the code classify the type of the injury. Characters four through six are a mix of letters and numbers and define the reason, the place and difficulty of an injury or disease. The seventh character can be either be a letter or number and categorize care encounter. Example: R50.9 – Fever, unspecified. b) medical practices (CPT & HCPCS codes). Codes HCPCS are used to characterize the procedures to Medicaid, Medicare and third-party payers. HCPCS codes are split into to two levels: Level II and I. …show more content…
Level I includes CPT codes. HCPCS Level II consists of five characters, both numbers and letters and used to present services outside of a health provider’s office, ambulance, supplies and other non-physician services. CPT codes are used for the description of surgical, laboratory and other services of health care providers. It consists of five number or letter components. CPT codes are divided into 3 categories: Category I, Category II and Category III. Category I: codes for evaluation and management, anesthesia, surgery, radiology, pathology and laboratory, medicine. Category II: composite measures, patient measures, patient history, physical examination and diagnostic results. Category III: codes for emerging service. B) Describe, define and explain in detail how both Medicare and Medicaid each pay for of the following services: a) hospital in-patient services Medicare and Medicaid reimburse hospital in-patient services through the Inpatient prospective payment system. Each case is sorted into a diagnosis-related group, where each group has a fee appointed to it. Payment is calculated for variances in region wage prices and hospital status and characteristics. The IPPS reimburses a hospital using a flat rate …show more content…
ICD-9-CM also allows the third payer to know the reason of performing a particular medical service. ICD-9-CM codes consist of three up to five components and are mainly numbers. The code combinations are differed by the chapter. Each chapter presents a certain kind of disease or injury. The first three numbers of the code are the category and it presents the type of injury or illness that is explained in the code. The decimal in the code divides it into a category, before decimal and subcategory, after the decimal. The subcategory holds extra information about the disease that the code is assigned to. E-codes and V-codes are alphanumeric codes that are used in ICD-9-CM. E-codes are used to define external situations that result in injury or disease and V-codes are used for injury or illnesses that are not
ICD codes are used in health care to correctly state diseases on patients’ health files. Currently, the codes ICD-10-CM and ICD-10-PCS are used in hospitals. The code ICD-10-PCS is used for inpatient procedures and consists of seven characters. The second and third components are characters that contain both letters and numerals; with each character able to hold up to 34 values. The components from the fourth through the seventh can be either alpha or numeric. ICD-10-PCS can contain the following characters: numbers from 0-9, 24 characters of the alphabet, except letter O and I because of similarity to numbers 0 and 1. Example: 0DQ10ZZ- Repair upper esophagus, open approach.
The code ICD-10-CM is used to code inpatient and outpatient diagnoses. The components of ICD-10-CM are the following: the first character of the code is a letter (u is excluded). The second and third components of the code should be numbers. The first three components of the code classify the type of the injury. Characters four through six are a mix of letters and numbers and define the reason, the place and difficulty of an injury or disease. The seventh character can be either be a letter or number and categorize care encounter. Example: R50.9 – Fever, unspecified. b) medical practices (CPT & HCPCS codes). Codes HCPCS are used to characterize the procedures to Medicaid, Medicare and third-party payers. HCPCS codes are split into to two levels: Level II and I. …show more content…
Level I includes CPT codes. HCPCS Level II consists of five characters, both numbers and letters and used to present services outside of a health provider’s office, ambulance, supplies and other non-physician services. CPT codes are used for the description of surgical, laboratory and other services of health care providers. It consists of five number or letter components. CPT codes are divided into 3 categories: Category I, Category II and Category III. Category I: codes for evaluation and management, anesthesia, surgery, radiology, pathology and laboratory, medicine. Category II: composite measures, patient measures, patient history, physical examination and diagnostic results. Category III: codes for emerging service. B) Describe, define and explain in detail how both Medicare and Medicaid each pay for of the following services: a) hospital in-patient services Medicare and Medicaid reimburse hospital in-patient services through the Inpatient prospective payment system. Each case is sorted into a diagnosis-related group, where each group has a fee appointed to it. Payment is calculated for variances in region wage prices and hospital status and characteristics. The IPPS reimburses a hospital using a flat rate …show more content…
ICD-9-CM also allows the third payer to know the reason of performing a particular medical service. ICD-9-CM codes consist of three up to five components and are mainly numbers. The code combinations are differed by the chapter. Each chapter presents a certain kind of disease or injury. The first three numbers of the code are the category and it presents the type of injury or illness that is explained in the code. The decimal in the code divides it into a category, before decimal and subcategory, after the decimal. The subcategory holds extra information about the disease that the code is assigned to. E-codes and V-codes are alphanumeric codes that are used in ICD-9-CM. E-codes are used to define external situations that result in injury or disease and V-codes are used for injury or illnesses that are not