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Chap 3 Basic Coding

Basic ICD-9-CM Coding 2011 CHAP 3 Author: Lou Ann Schraffenberger. AHIMA

Declared by the U.S. Department of Health, Education, and Welfare as a minimum, common core of data on individual acute care short-term hospital discharges in Medicare and Medicaid programs. It has been expanded to include all in patient settings. Uniform Hospital Discharge Data Set (UHDDS)
Give some examples of specific items pertaining to patients and their episodes of care found in the UHDDS. Personal identifications, DOB, Sex, Race, Ethnicity, Residence, Hospital identification, Expected payer for most of the bill.
This is reported to keep with the UHDDS standards. It is defined as a 'preexisting' condition that, because of its presence with a specific principal diagnosis, will likely cause an increase in the patient's length of stay in the hospital. Comorbidity
Diagnoses, complications, comorbidity, procedures and date, significant procedures and principal procedures are all items that should be reported to keep in standards with who? Uniform Hospital Discharge Data Set (UHDDS)
All institutional paper claims are submitted with this. It provides better alignment with the electronic HIPPA 837 transaction standard or the electronic billing format. Uniform Bill-04
The UB-04 data elements also include this indicator. Its purpose is to differentiate between conditions present on admissions and conditions that develop during an inpatient admission. Present on admission (POA)
UHDDS definition: The condition established 'after study' to be chiefly responsible for occasioning the admission of the patient to the hospital for care. Principal diagnosis
Complications from what code # though what code # that lack the necessary specificity in describing the complication may require the use of an additional more specific code. 996-999
Found in the discharge summary or the face sheet. These codes may be used as secondary codes if the historical condition or family history has an impact on current care or influences treatment. Status post procedures/operations are not coded. history codes (V10-V19)
These types of findings such as those found in a pathological report are not coded unless the provider indicates their clinical significance. Abnormal findings.
This is a method of payment undertaken by CMS to control the cost of inpatient acute care hospital service to Medicare recipients. Inpatient Prospective Payment System (IPPS)
This title was established by PPS to provide payment to hospitals for each Medicare case at a set reimbursement rate, rather than on a fee-for-service or per-day basis. Title V1 of the Social Security Amendments of 1983
With the PPS the Medicare payment rates to hospitals are established before services are rendered and are based on what? Diagnosis-related groups (DRG's)
In 2008 Medicare adopted this group, it is projected to increase payments to hospitals for services provided to the sicker patients and decrease payments for treating less severely ill patients. Medicare-Severity DRG's
What is the formula used by the MS-DRG to compute hospital payments? DRG relative weight X Hospital Base rate= hospital payment
In addition to the basic payment rate Medicare provides additional payment for other factors such as what? Disproportionate share hospital (DSH)- for low income pts hospitals; approved teaching hospitals; and new technologies
This organizations is the basis for Medicare's quality improvement efforts such as conducting case reviews, educate and respond to beneficiaries and assist Dr.s offices in the adoption of electronic health record technology. CMS Health Care Quality Improvement Program
Congress directed the department of HHS to implement this to detect and correct improper payments in the Medicare traditional fee-for-service program. Recovery Audit Contractors (RAC's)
Medical fiscal intermediaries and carriers that process Part A and Part B Medicare claims may develop this to ensure that claims submitted for certain services have been deemed reasonable and necessary for the patient's condition. Local coverage decisions (LCDs)
ICD-10-CM includes chapter-specific guidelines for external-cause coding known as this. In ICD-9 they are are known as V codes and are used for factors influencing health status and contact with health services. Y codes
Created by: 100000223367771
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