- Insurance companies use this code, along with a diagnosis, to determine payment and reimbursement for your individual claims.
- The hospital and physicians use the CPT code to indicate the type of care or procedure(s) used to treat you.
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Diagnosis - The determination of
the nature of a disease, injury, or
condition. |
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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.
|
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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. |
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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-stage 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. |
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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. |
