Biomedical Engineering and Design
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- Codes and Classifications (incl. HCUP and ICD)
Codes and Classifications
Health care reimbursement is complex.
- ICD (International Classification of Diseases) is maintained by the CDC with the authorization of World Health Organization, and is international.
- CPT (Current Procedural Terminology) is maintained by the American Medical Association, and is United States only.
Please read the Health Care Reimbursement guide, especially the Reimbursement Toolkit page, which also has information about "Classification and Coding Systems":
CPT -- Current Procedural Terminology
- The American Medical Association produces this annual list to classify and report medical services and procedures.
--- Overview of what CPT codes are, and descriptions of CPT categories I, II, and III
--- There are free CPT codes on the CMS site -- after you click ACCEPT to the terms, they will download
--- You can also look around the web for CPT codes, but please add site:.gov to your search (so that you get U.S. government results), and/or get *several* results from the web, so that you can verify that the code you found is correct
- 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.
HCPCS -- Healthcare Common Procedure Coding System
The HCPCS has two levels:
- CPT (whose information is on the previous tab)
- DMEPOS -- For "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) and HCUPnet
These are not intuitive databases. Strongly recommended is their free, short, interactive tutorial, and here are more tutorials.
Here is the HCUP page.
---The HCUP FAQ page is OUT OF DATE, so contact User Support at hcup@ahrq.gov "for any HCUP database, tool, or product-related questions."
Background
- 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. HCUP is run by the Agency for Healthcare Research and Quality (AHRQ).
- HCUPnet has databases of inpatient, ER, and ambulatory surgery statistics. These are estimates based on a sampling of data provided by each state. All 50 states participate in the inpatient sample, but the outpatient statistics are only provided by states representing about 2/3 of the U.S. population.
- HCUP data come in two types: (1) The underlying datasets, which require some red tape and the use of statistical software such as SPSS; and (2) HCUPnet, which is an online search tool providing immediate results.
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UPDATE FREQUENCY:
National statistics -- updated annually
State statistics -- updated as new state data are processed
Note: There is at least an 18-month lag between the end of the calendar year and the availability of the Nationwide Inpatient Sample (NIS)
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NOTE: As of 2021, ICD-10 codes are no longer available *within* HCUPnet. Find ICD-10 codes from the WHO or the CDC.
ICD - International Classification of Disease
ICD-11 became the official version on January 1, 2022. However, it is not yet being used in the United States. Always check to see whether the tool you are using requires ICD-9 pr ICD-10 codes.
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ICD General Information
- 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.
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More about ICD-11
ICD-11 Overview: Key Facts, History, and References (September 2023; National Committee on Vital and Health Statistics [NCVHS])
ICD-11 codes for Mortality and Morbidity (on the WHO site)
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:
- an overview of the classification, written by the CDC
- an easy way to browse the sections online
(Remember that this framework is only one piece of a complicated landscape!)