Question

A) Describe, define and explain the components of the medical coding systems used at:

1) hospitals (ICD codes), and

2) medical practices (CPT & HCPCS codes).

B) Describe, define and explain the methodologies used by both Medicare and Medicaid to pay providers for the following services:

1) hospital in-patient services,

2) physician professional services.

3) out-patient medical services and tests (lab, x-ray, etc.).

C) Describe, define and explain in detail what are DRG's and RVU's and how they are used.

Answer 1

A) Medical coding is now the functional occupation in the healthcare management. The medical cracker experts interpret the paper work into globally acquired standards. In the health care industry the medical coding should be accurate. In actual sense the medical coding is used for filing the claims related to health but along with it, it is further used for absolute diagnosis.

There is three type of coding that is used by the medical experts.

1) ICD: International Classification of Disease. This type of coding proffer consistent lexicon for explaining the reason of wound, sickness and death. In 1940, these codes were founded by WHO (World Health Organization). They were updated number of times within the years. The number following “ICD” present the revised version of the code like the code is ICD-10-CM represent that it is the 10^th revised version of ICD code and the CM represent the “Clinical Modification”. ICD codes basically highlight the doctor’s identification and the patient situation. These codes help in identifying the urgent medicine during the billing.

The ICD codes are allocated if and only if a conclusive diagnosis is found. In the ambulance or in emergency theatre the suspected situation is translated to identify the facility that should be provided. The same is used for patient setting while performing the number of experiments in case of final conclusion is not reached. ICD codes are governed differently for the different situations like in case of outpatient setting the patient situation are not coded however its symptoms are coded.

2) CPT: Current Procedure Terminology. These codes are basically used for the purpose of documenting the experiments performed in the Medical Practitioner’s office. These codes were founded by AMA (American Medical Association). These are numeric codes with 5 digits with division into three categories.

The most widely used category is first with division into 6 ranges. These 6 ranges are: Evaluation and Management, Surgery, Anesthesia, Pathology and Laboratory, Radiology, and Medicine.

The second category represents the operation computation and laboratory results. These are alphanumeric codes with 5 digits. These codes are placed after the first category codes with a hyphen. These codes are optional. These are just used to reduce the pressure of the administrative in the Medical Practitioner’s office by proffering more and more absolute information with respect to working of professionals.

The third category is related to emerging medical technology.

HCPCS: Healthcare Common Procedure Coding System. These codes are based on CPT. These codes were founded and maintained by the same organization that founded the CPT that is the AMA. These codes cover the procedures and the services that were not included by the CPT. These codes basically covers the flexible medical equipment, ambulance rides, prosthetics,and some medicines and drugs. These codes are set for outpatient hospital setting, chemotherapy drugs, Medicaid. These are one of the important codes to be use because of it inclusion in Medicaid and Medicare.

These codes are having 2 levels. The first level is same as that of CPT. The secod level is having 17 section of alphanumeric codes based on the field like Medical and Laboratory or Rehabilitative Services.