Definition and Purpose of Various Codes (Research Paper Sample)

Definition and Purpose of Various Codes
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Today health care providers in different places have to understand the meaning of several standard codes in order to deliver the appropriate care to their patients. The following is a discussion on some of such codes with respect to their definition and purpose.
An example of such codes is the Current Procedure Terminology (CPT) codes, which are numbers given to every service and task, which a health practitioner may offer to their patient, including the medical, diagnostic and surgical services (Torrey, 2014). In their application, CPT codes help insurers in determining the total reimbursement calculation for every practitioner for performing the services. The utilization of the codes for the same meaning helps in ensuring uniformity. American Medical Association has the mandate of developing, maintaining, revising as well as copyrighting CPT codes for new and old services.
From another perspective, there is the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes, which refer to the system of giving codes to various diagnoses, as well as procedures linked with hospital use in the U.S. The codes normally comprise a harmonized tabulated numerical list of various disease codes. Moreover, they contain some alphabetical index for different disease entries (CDC, 2013). Finally, they consist of a standardized system of classification for diagnostic, surgical and treatment procedures. In order to keep the codes updated, Centers for Medicare and Medicaid Services (CMS) work together with the National Center for Health Statistics (NCHS) to revise and add the codes. However, the revision and any amendment have to be in tandem with the International Classification of Diseases (ICD-9).
Accordingly, there is the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes, which is the standardized morbidity classification as per the U.S. publication (CDC, 2014). The codes help in classifying diagnoses, as well as reasons for health visits in every healthcare setting. Markedly, they borrow their content from ICD-10, which is a World Health Organization statistical ranking of diseases.
When properly implemented, the ICD-10-CM codes are to replace the aforementioned ICD-9-CM. However, ICD-10-CM codes are currently undergoing amendment and improvement (AACE, 2014). Notably, in ICD-9-CM, as well as ICD-10-CM, there are unspecified codes and signs/symptoms with acceptable uses (HHS, 2014). However, it is appropriate to code each care encounter with specific codes.
Finally yet importantly, there are the Diagnostic Related Group (DRG) codes, which refer to some patient ranking schemes that offer a means of associating the kind of patients or clients a hospital manages to every cost that the hospital incurs (Averill et al. 2003). Currently, there are three DRGs versions in use, including All Patient DRGs (AP-DRGs), basic DRGs, as well as All Patient Refined DRGs (APR-DRGs). Normally, basic DRGs aid CMS in the hospital payment processing for the Medicare beneficiaries.
By contrast, AP-DRGs serve as an expansion to the aforementioned basic DRGs in the efforts to represent the non-Medicare populations more, including the pediatric patients. Conversely, APR-DRGs comprise the improved version of AP-DRGs since they incorporate illness severity subclasses into AP-DRGs (Averill et al. 2003). Considering the fact that APR-DRGs cover the first two aforementioned DRGs, there have been ongoing reviews to harmonize the codes.
Notably, DRGs were initially to create a successful framework for assessing and monitoring care quality and services utilization in the hospital (Averill et al. 2003). Indeed, DRGs evolution to becoming a payment unit in Medicare’s reimbursement system shows the essential role that hospitals play in deciding their costs.
References
American Association of Clinical Endocrinologists [AACE]. (2014). International Classifi...