Biomedical Engineering and Design

Information specific to BME and BME/CBID design teams.

Codes and Classifications

CPT -- Current Procedural Terminology
 
  • The American Medical Association produces this annual list to classify and report medical services and procedures.
     
  • Public and private health insurance programs depend on CPT codes to describe medical, surgical, and diagnostic services, to manage reimbursements, and to facilitate reliable nationwide communication among physicians, other healthcare providers, patients, and third parties

How to find them:  The AMA no longer has a free site, but you can look on Google (please check more than one source, just to raise the chance that you have the correct code)

HCPCS -- Healthcare Common Procedure Coding System

The HCPCS has two levels:

  1. the CPT (whose information is on the previous tab)
     
  2. the system that identifies "products, supplies, and services not included in the CPT codes, such as ambulance services and durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) when used outside a physician's office."
  • --- This system was created to identify services, supplies, and equipment that are not included in the CPT but which *are* covered by Medicare and other insurers.

Here is the DMEPOS fee schedule that you can search.

  • Unlike the CPT and ICD, you *cannot* search this with keywords, but only with the DMEPOS code itself
  • The easiest way to find those is by searching the open web, but look at more than one source to make sure you've found the correct code
HCUP -- Healthcare Costs and Utilization Project

Agency for Healthcare Research and Quality (AHRQ) -- This agency works to improve the quality, safety, and cost-effectiveness of health care throughout the U.S. It has data on healthcare expenditures; reports about specific populations such as children, women, and minorities; and much more. Here is the Research Tools and Data page.

  • The Healthcare Cost and Utilization Project (HCUP) collects the data from "State data organizations, hospital associations, private data organizations, and the Federal government," and "includes the largest collection of longitudinal hospital care data in the United States," beginning in 1988
  • The databases within HCUPnet (middle column) help research on health policy issues such as "cost and quality of health services, medical practice patterns, access to health care programs, and outcomes of treatments at the national, State, and local market levels"
  • The national statistics are updated annually, and state statistics are updated as new state data are processed
  • There is at least an 18-month lag between the end of the calendar year and the availability of the National (Nationwide) Inpatient Sample (NIS)
HCUPnet -- Note: You must use ICD-9 codes to search, and *not* ICD-10 (which didn't start until October 1, 2015).
  1. ----> Before you go to HCUPnet, get an ICD-9 code
  2. On the HCUPnet page, choose "Create a new analysis"
  3. "Inpatient" will get you the most information. Note that if you choose "Ambulatory," the number of patients generated only represents about 2/3 of the U.S. total, since only 26 states provided info for this database. Therefore, multiply the numbers you get by 3/2. 
  4. "Descriptive Statistics"
  5. "Yes"
  6. Chose Classification “procedures—ICD-9” etc.
  7. Type in each code, then select the link that dropped down, type in the next code, etc.
  8. "Combine all codes"
  9. Create analysis

On the left side of the results page, click on the blue tab “For Diagnosis/Procedure” to see more choices.

Note that “All-Listed” procedures is selected.  When a patient comes to the hospital or other health care facility, the billing is set up with one “principal” diagnosis and one “principal” procedure.  Additional diagnoses and procedures can be added as secondaries. 

When “all listed” is selected, the database will find all incidences of the procedure code, whether it was the primary procedure, or an incidental procedure done during the stay (in which a different procedure was primary).

If you do select “principal” instead of “all-listed,” the number will of course be lower; but it also allows you to click on the blue tab labeled “Outcomes & Measures” on the left, where you’ll be able to get mean cost and charges per patient and aggregate.  The charges is simply what was billed (not necessarily what was paid), and the cost is an algorithmic estimate of the actual cost to the facility.

(Thanks to my colleague Alan Zuckerman for most of this information.)

ICD - International Classification of Disease 
 

ICD-10 became the official version on October 1, 2015. (Here is a version that is all on one page.)

  • The ICD is used to code signs, symptoms, injuries, diseases, and conditions
     
  • It standardizes reporting of illness, death, and medical procedures; and the classification of diseases and other health problems recorded on many types of health and vital records, such as death certificates
     
  • This allows the compilation of national mortality and morbidity statistics by WHO Member States, which is also essential for compiling of statistical info about diseases in a format that allows international comparison of those data
     
  • The ICD was originally created by the World Health Organization (WHO), and is now maintained by the Centers for Medicare & Medicaid Services (CMS) and the National Center for Health Statistics (NCHS)

 

ICF -- International Classification of Functioning, Disability, and Health
 

This classification was created by the World Health Organization (WHO) and approved in 2001.

Its purpose is to provide a "framework for measuring health and disability at both individual and population levels."

The WHO page about the ICF includes:

(Remember that this framework is only one piece of a complicated landscape!)

 

For more codes and information, see the Reimbursement Toolkit page of the Health Care Reimbursement guide.

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