1 / 23

Unit 5 Ch 6: Nomenclatures and Classification Systems Tuesday, April 5 th at 8PM EST

Unit 5 Ch 6: Nomenclatures and Classification Systems Tuesday, April 5 th at 8PM EST. HS 410 - 01 Adrienne Palmer, BSPH, MHA, FACHE. Medical communications. Medical language Greek and Latin derivations Eponyms Modern words Overtime changes occur. Languages.

aminia
Download Presentation

Unit 5 Ch 6: Nomenclatures and Classification Systems Tuesday, April 5 th at 8PM EST

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Unit 5Ch 6: Nomenclatures and Classification SystemsTuesday, April 5th at 8PM EST HS 410 - 01Adrienne Palmer, BSPH, MHA, FACHE

  2. Medical communications • Medical language • Greek and Latin derivations • Eponyms • Modern words • Overtime changes occur

  3. Languages • Essential for accurate and consistent indications • Vocabulary • Clinical vocabulary • Nomenclature or terminology • Clinical terminology • Importance of standardization: • It is difficult to communicate electronically if variances in meaning exist.

  4. SNDO • Standard classified nomenclature of disease (SNDO) • Published by the American Medical Association in 1933 • Classifies diagnostic terminology in order of localization (site) and etiology (Cause) • Use through 1961, then deemed to simplistic

  5. SNOP • Systematized nomenclature pathology (SNOP) • Published by the American College of pathologists • classifies pathological specimens • Use since 1965, but its use gradually diminished as it did not cross fields of specialization

  6. SNOMED • Systematized nomenclature of medicine (SNONET) • Published at American College of pathologists in 1977 • Expansion of SNOP • Crosses fields of specialization • Classifieds in multiple ways • Can be used with computers

  7. CPT • Current procedural terminology (CPT) • Published by the American Medical Association • Conference of listing a medical terms and codes used to designate diagnostic and therapeutic procedures • Can be used with computers

  8. Electronic communication • Unified medical language system • MEDLINE • MEDLARS • MeSH • UMLS purpose: • Helps computers understand medical meaning; therefore providers can retrieve biomedical information from various sources, including EMRs

  9. Knowledge sources • UMLS Metathesauras – uniform, integrated distribution format • SPECIALIST lexicon – syntactic information for many terms, component words, and English words not in metathesaurus • UMLS semantic network – information about types or categories of meta-thesaurus concepts and relationships • Updated regularly • Available to the public at no cost

  10. Classification systems • Taxonomies • Coding • ICD ( international classification of diseases) • ICD-9-CM • ICD-10

  11. Updating the ICD • NCHS ( national Center for health statistics) • CMS ( centers for Medicare and Medicaid services) • American Hospital Association • American health information management Association

  12. Coders • Apply classification systems to data • Must possess extensive knowledge of the number of related areas • Biomedical sciences • Information technology • Healthcare data content, structure, and systems • Reimbursement methodologies

  13. ICD-9-CM • Volume 1 – tabular numerical listing of diagnosis codes • Volume 2 – alphabetic listing of diagnoses • Volume 3 – both tabular and alphabetic listings of procedures that are primarily used in a hospital setting • E-codes and V-codes

  14. CPT • When a practitioner does when providing a performing medical services • Evaluation and management • Anesthesia and surgewillry • Pathology, laboratory, and radiology • Medicine • Can be complex and requires coder skills

  15. DRGs • Diagnosis – related group (DRG) • In 1982, U.S. Congress passed TEFRA • In 1983, CMS introduce the PPS for inpatient hospital services • Medicare adopted the DRG model developed by Yale University to make PPS work

  16. Role of DRGs • 1. Evaluate quality of care: Classify hospital stays in terms of what was wrong with the patient (major diagnosis) and what was done for the patient (resources used) • MDC– Major Diagnostic category • 25 MDCs cover over 500 diagnoses • 2. Calculate reimbursement: Reimbursement on these DRGs is on a flat rate basis • Adjustments on an annual basis • Adjustments for cost outliers, patient transfers, capital costs, and medical education • 3. Evaluate utilization of services

  17. DRGs • Statistically consistent – patients grouped in a particular DRG consume similar amounts of resources as measured by length of stay and cost • Medically meaningful – patients grouped in a particular DRG possess similar clinical conditions or treatment

  18. DRGs • Medicare PPS has been expanded • SNF PPS • OPPS • APC • HH PPS • HHRG • IRF PPS • CMG

  19. HIM transformation • PPS and DRG have major impact • Becomes more complex, ties coded diagnosis and procedure to amount reimbursed and impacted focus on ethics and compliance. • Nosologists • Encoders • Groupers • Optimizing programs • Natural language processing encoding systems • Ethics and up-coding • Coding compliance program to prevent healthcare fraud and abuse

  20. Other classification systems • SNOMED • CPT • HCPCS • RBRVS (resource-based relative value scale) • DSM-IV

  21. Other classification systems • Classification systems for mental retardation or developmentally disabled • Nursing • Oncology • Injury, disabilities, and handicaps • Dental • Prescription drugs • Alternative billing codes (ABC) • Others address multiple specialties

  22. Emerging issues • Case mix – type and volume of patients a healthcare organization treats. • Case mix management and analysis • Automation and impact on coders – potential for off-site coding and reduced costs; more of a oversight and quality assurance role for coders • Clinical data representation • Data mapping

  23. Questions?

More Related