Codes, Codes Everywhere

ICD10monitor August 5, 2024
Laurie M. Johnson, MS, RHIA, FAHIMA, AHIMA Approved ICD-10-CM/PCS Trainer

There are various reimbursement methodologies that involve medical codes. These medical codes include the Current Procedural Terminology (CPT)®, Healthcare Procedural Coding System (HCPCS), and International Classification of Diseases, 10^th Revision (ICD-10-CM and ICD-10-PCS) codes.

The Inpatient Prospective Payment System (IPPS) uses ICD-10-CM and ICD-10-PCS. These codes are placed into a computerized grouper that assigns Medicare Severity Diagnosis Related Groups (MS-DRGs). This reimbursement methodology is utilized by Medicare fee-for-service (FFS).

Commercial payers may use this methodology, but it is dependent on the contract with the facility. Other acute-care payers, such as Medicaid, may utilize All Patient Refined Diagnosis Related Groups (APR-DRGs). This proprietary methodology was developed by 3M. The inpatient methodologies run from October through September.

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