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Glossary
Average Length of Stay
The average number of days a patient stays at the hospital.
(Calculation: Total # of patient days divided by the # of
discharges for a given period.)
Complications or
Comorbidities
A complication is a secondary disease or a negative reaction
occurring during the course of an illness and usually
aggravating the illness.
While a comorbidity is the
effect of another disease a patient may have along with the
primary disease of interest. (For example, diabetes may be the
primary disease but high blood pressure may also be a factor.
That would make high blood pressure the comorbidity.)
CPT Code
CPT stands for Current Procedural Terminology. CPT codes are
universal five digit codes that are recognized by all insurance
companies, hospitals and physicians. Theses codes are used by
the insurance companies and providers to identify the type of
care you receive.
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Insurance companies use
this code, along with a diagnosis, to determine payment and
reimbursement for your individual claims.
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The hospital and
physicians use the CPT code to indicate the type of care or
procedure(s) used to treat you.
Diagnosis
The determination of the nature of a disease, injury, or
condition.
Discharges
The number of patients that leave a hospital setting.
DRG Code
DRG stands for Diagnosis Related Group. A DRG is only
assigned to an inpatient hospital service. DRGs are universal
groupings that are used by Medicare and most insurance companies
to further clarify the type of inpatient care you receive.
Insurance companies use the DRG code, along with a diagnosis
code and the length of the inpatient stay, to determine payment
and reimbursement for your individual claims.
Inpatient Procedure
A procedure that requires a patient to be admitted to a
hospital for treatment and to stay at least one night.
International
Classification of Disease - 9th Revision - Clinical Modification
(ICD-9-CM)
The International Classification of Diseases, Ninth
Revision, Clinical Modification (ICD-9-CM) is based on the World
Health Organization's Ninth Revision, International
Classification of Diseases (ICD-9). ICD-9-CM is the official
system of assigning codes to diagnoses and procedures associated
with hospital utilization in the United States.
Medicaid
Medicaid provides health coverage for people of any age who
meet certain low-income guidelines. You can ask your hospital or
doctor to help you apply for Medicaid. Medicaid may pay for all
your health care services, but sometimes a particular service is
not covered. Some services are covered for children but not
adults. You can also ask your hospital or doctor to help you
find out whether Medicaid will cover a particular service.
Medicare
Medicare is a federal health insurance program for all
people 65 years or older, or for some disabled persons and those
with end-state renal disease. Eligibility is not based on the
person's income or assets. Medicare requires patients to pay for
some of their health care through premiums, deductibles and
other expenses. Medicare is a federal program and is the same in
all states. It is administered by the federal Department of
Health and Human Services, Centers for Medicare and Medicaid
Services.
Outpatient Procedure
A procedure that allows the patient to go home the same day
he or she was treated.
Procedure
A surgical operation performed on a person during a visit,
as classified according to the ICD-9-CM or CPT-4 coding schemes.
A person may undergo more than one procedure during a single
surgical operation.
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