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Overview of Health Care Data
Published in Chengliang Yang, Chris Delcher, Elizabeth Shenkman, Sanjay Ranka, Data-Driven Approaches for Health care, 2019
Chengliang Yang, Chris Delcher, Elizabeth Shenkman, Sanjay Ranka
A well-organized and comprehensive set of procedure codes can classify the medical interventions in a standardized way, make it easier for doctors and patients to track and understand a patient’s medical history, and bill appropriately. The ICD has a subsystem for procedural coding that mostly covers inpatient procedures. In this system, each ICD procedure code consists of seven characters, with the leading character encoding the procedure type and the following characters encoding detailed information of the procedure and the corresponding body system [9]. Notably, procedure coding systems vary by country. For example, in the United States, Current Procedural Terminology (CPT) [7] is a set of codes for medical procedures and services that health care organizations use to unify the information among patients, physicians, and payers. Similarly, the Office of Populations Censuses and Surveys (OPCS) Classification of Interventions and Procedures is the procedure coding system used by National Health Services in the United Kingdom, and The Canadian Classification of Health Interventions, Classification des Actes Mdicaux (CCAM), Classificatie van verrichtingen, and Gebhrenordnung fr rzte are coding systems used in Canada, France, Netherlands, and Germany, respectively.
Healthcare Delivery Systems
Published in A. Ravi Ravindran , Paul M. Griffin , Vittaldas V. Prabhu , Service Systems Engineering and Management, 2018
A. Ravi Ravindran , Paul M. Griffin , Vittaldas V. Prabhu
In the United States, the AMA developed the Current Procedural Terminology (CPT) coding as a standard for coding medical procedures. CPT codes identify the services that were provided to the patient, including diagnostic, radiology, surgical, and laboratory procedures. The CPT costs bridges the patient, physician, and payer. It is used by insurance companies to decide the fee that the physician receives for the service. CPT codes are more complex than ICD codes. Details for CPT codes may be found at the AMA website (https://www.ama-assn.org/practice-management/cpt-current-procedural-terminology).
Bringing Regenerative Medicine to Patients: The Coverage, Coding, and Reimbursement Processes
Published in Karen J.L. Burg, Didier Dréau, Timothy Burg, Engineering 3D Tissue Test Systems, 2017
Khin-Kyemon Aung, Scott Levy, Sujata K. Bhatia
Medical coding systems vary by the place of service and type of provider billing for the service, though some coding systems are used in multiple settings. Physicians and other medical professionals use five-digit numbers known as Current Procedural Terminology codes (CPT codes or simply CPTs*) to bill for the services they provide.† Each CPT corresponds to a defined medical treatment. For example, a physician applying a high cost skin substitute to a wounded arm would record CPT code 15271 on the medical bill. CPT codes do not, however, identify a specific company's device that must be used. Nevertheless, providers may only perform some procedures using certain types of devices. For example, in 2015, physicians could bill for code 15271 when using 1 of over 20 different skin substitute models. Irrespective of the skin substitute used, each physician would still bill Medicare using 15271 code.
Accelerating the adoption of bundled payment reimbursement systems: A data-driven approach utilizing claims data
Published in IISE Transactions on Healthcare Systems Engineering, 2018
Wenchang Zhang, Margrét V. Bjarnadóttir, Rubén A. Proaño, David Anderson, Renata Konrad
Services rendered by medical facilities are coded using various coding systems: Current Procedural Terminology codes (CPT), which are maintained and copyrighted by the American Medical Association (AMA); Healthcare Common Procedure Coding System (HCPCS) codes, which are administrated by CMS; Primary Procedure Codes, which are maintained by the National Center for Health Statistics of the U.S. Public Health Service; and Revenue Codes, which are maintained by the National Uniform Billing Committee. We only utilize the PPC, CPT, HCPCS and revenue codes in our clustering algorithm, as together these codes summarize a patient's treatment and are the elements that drive the fee-for-service reimbursements.