1. Coding and Reimbursement
Chapter 10
Coding and Reimbursement

2. Nomenclatures and Classification Systems
Medical nomenclature
Coding/classification system

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

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

5. 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)

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)

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

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

9. 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)

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

11. 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