Coding and Reimbursement Chapter 10 Coding and Reimbursement

Nomenclatures and Classification Systems Medical nomenclature Coding/classification system

Nomenclatures Basle Nomina Anatomica Standardized Nomenclature of Disease (SND) Standardized Nomenclature of Diseases and Operations (SNDO) Systematized Nomenclature of Pathology (SNOP)

Nomenclatures (Continued) Systematized Nomenclature of Medicine (SNOMED) Current Medical Information and Terminology (CMIT) Unified Medical Language System (UMLS)

Medical Classification and Coding Systems London Bills of Mortality Nosologia Methodica Bertillon International Statistical Classification of Causes of Diseases Manual of the International Statistical Classification of Diseases, Injuries, and Cause of Death (ICD-6)

Medical Classification and Coding Systems (Continued) International Classification of Diseases (ICDA) Diagnostic and Statistical Manual of Mental Disorders (DSM) Current Procedural Terminology (CPT) International Classification of Injuries, Disabilities, and Handicaps (ICIDH)

Medical Classification and Coding Systems (Continued) HCPCS Level II (national codes) Current Dental Terminology (CDT) National Drug Codes (NDC) Alternative Billing Codes (ABCcodes™)

Third-Party Payers Blue Cross and Blue Shield (BCBS) Commercial payers Employer self-insurance plans Government-sponsored programs Managed care Workers’ compensation

Health Care Reimbursement Systems Medicare Severity DRGs (MS-DRGs) Resource Utilization Groups (RUG) Home Health Resource Groups (HHRG) Ambulatory Payment Classifications (APC) Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS)

Health Care Reimbursement Systems (Continued) Long-Term Care Diagnosis-Related Groups (LTC DRG) End-Stage Renal Disease Composite Payment Rate System

Case Mix Analysis and Severity of Illness Systems Chargemaster and encounter form CMS-1450 (or UB-04) and CMS-1500 Electronic data interchange (EDI) Fraud and abuse