1. MEDICAL TERMS & CODES HEALTH INFORMATICS

2. CODING In hospitals, the payment allowed by Medicare for services to inpts is based mainly on pt’s diagnoses CMS CMS=Centers for Medicaid and Medicare Services

3. CODING LOS LOS=length of stay or how long a pt stays in the hospital CMS analyzes pts with the same diagnosis & decides what services & LOS each group usually needs

4. CODING diagnosis-related groups (DRGs) CMS assigns a payment amount for the average hospital stays of pts in these diagnosis-related groups (DRGs) Most insurance carriers base their payment of Medicare payments diagnostic codes procedural codes There are diagnostic codes & procedural codes

5. DIAGNOSTIC CODING Diagnoses are assigned codes from a standard coding system Codes determine how much a facility is paid for its services to pts Codes are grouped by disease or by area of body that is involved

6. DIAGNOSTIC CODING Principal diagnosis Principal diagnosis=condition that is the main reason for the pt’s hospital visit Principal diagnosis is the most important diagnosis that is coded Admitting diagnosis Admitting diagnosis=condition identified by MD at admission to the hospital; may also be coded

7. DIAGNOSTIC CODING Other conditions that have an effect on the pt’s LOS are also coded International Classification of Diseases Codes assigned to pt’s diagnoses are taken from a reference that is revised every year=International Classification of Diseases Also identified by the revision #

8. DIAGNOSTIC CODING ICD-9-CM ICD-9-CM=International Classification of Diseases, Ninth Revision, Clinical Modification It has 3 digit categories for diseases, injuries, & symptoms These categories are divided into 4 digit code groups They are further divided into 5 digit code groups to be as specific as possible

9. DIAGNOSTIC CODING ICD-9-CM used in hospitals has 3 sections: 1.Volume 1-Diseases: Tabular List 2.Volume 2-Diseases: Alphabetic Index 3.Volume 3-Procedures: Tabular list & Alphabetic Index

10. DIAGNOSTIC CODING ICD-9-CM diagnoses codes are listed in the alphabetic index & tabular list Alphabetic index Alphabetic index lists diagnoses in alphabetic order & gives their codes Tabular list Tabular list provides the codes in numerical order & gives additional instructions

11. DIAGNOSTIC CODING Never use only the alphabetic index because it doesn’t contain all the information After a code is located in the alphabetic index, verify it with the tabular list

12. PROCEDURAL CODING Procedures are also assigned codes CPT Procedure codes come from the CPT CPT CPT=Current Procedural Terminology, Fourth Edition HCPCS Hospitals use codes from the HCPCS HCPCS HCPCS=Health Care Procedural Coding System, Level III

13. PROCEDURAL CODING CPT codes are 5 digit numbers They are organized into 6 sections Modifiers Modifiers=2 digit # assigned to the 5 digit code to show special circumstances (like 2 surgeons worked together)

14. HEALTH CARE SYSTEMS HEALTH INFORMATICS

15. JCAHO Joint Commission on the Accreditation of Healthcare Organizations a private, nonprofit organization whose mission is to continuously improve the safety and quality of care provided to the public

16. JCAHO Joint Commission accreditation can be earned by many types of health care organizations: hospitals, doctor’s offices, nursing homes, office-based surgery centers, behavioral health treatment facilities, and providers of home care services

17. RISK MANAGEMENT The health care risk manager performs a variety of duties related to managing potential risks and liabilities They identify and evaluate risks as a means to reduce injury to patients, staff members, and visitors within an organization.

18. RISK MANAGEMENT They work proactively and reactively to either prevent incident or to minimize the damages following an event