AElam_Module 09_reimbursement and change master_9.10.16
1. ICD -9 to ICD-10;
The standard code
set for reporting
and coding diseases,
injuries,
impairments, and
other health related
issues.
Angel Elam
2. Why make the change?
• Medical practice and advancements have
changed dramatically over the years. From new
discoveries involving diseases, conditions, and
medical treatment, to new types of medical
devices and services. With the medical field
continuously developing and growing, we needed
a more organized and expanded coding system.
3. Areas of improvement
• Has 68,069 codes, 3-7 alphanumeric diagnosis codes, and 2,033
code categories.
• There is more room for expansion and organization of code sets.
• Expanded from 5 positions to 7 positions.
• Terminology has been adjusted and made more precise and
understandable.
• Injuries are grouped anatomical vs. by type of injury.
• More combination codes are available to reduce the number of
codes needed to fully report a condition/situation
• Provides more specific information on diagnosis and inpatient
procedures
4. New codes impact in the following
areas;
• New coverage policies and accuracy
• New medical review edits
• New reimbursement schedules
• Increased rejections, denials, and pending while providers make the
drastic changeover
• HIM practices
• Additional documentation process requiring a 15% increase in
processing time
5. Revenue cycle impacts
Minor affects to the process
and training Huge affects to the process
and training
ITApplicationsClinicalBusinessProcess/
PatientAccess
Payment
Posting
Scheduling
Patient Access Services Charge/Coding Integrity Patient Financial Services
Pre-
Registration
Financial
Counseling
Charge Capture
Entry
Coding
Assignment
Account
Resolution
Claims
Processing
Test Order
“Optional”
Clinical
Doc.
Clinical
Intervention
Scheduling
Patient
Accounting
Registration
Performance
Measurement
Pricing
HIS
(including
CPOE)
HIM Claims
Clearinghouse
Patient
Accounting
Case
Management
Utilization
Management
6. Chargemaster
• Every hospital has a chargemaster system. A
chargemaster system is a huge list for every
procedure provided by the hospital to their
patients. Chargemaster systems help maintain a
smooth running billing cycle. They also include
set charges for supplies, medication, individual
procedure codes, services, and revenue codes.
7. Components of a chargemaster
• Each chargemaster system includes an item description, CPT/HCPCS code, revenue code, charge dollar
amount, general ledger number, charge description number, and activity date.
• CPT/HCPCS codes are codes that identify a specific service or procedure. Modifiers may also be included
for additional charges.
• Revenue codes are a four-digit numerical code that identifies a specific accommodation, ancillary service,
or billing calculation used for Medicare billing.
• Charge dollar amounts is the price charged for an item and the amount that will appear on a patients bill.
• General ledger numbers are usually two or three digits and they are used for accounting purposes to
distribute the revenue to the appropriate department of service rendered.
• Charge description numbers are a unique number used to identify each specific item listed on the
chargemaster. Another term used for this is “charge code”, “item code” or “CDM number”
• Activity date indicate the most recent activity for the said item listed. This area allows for the facility to
monitor whether the item was charged to the patients bill in a period of time.
8. Chargemaster Example
Item Description CPT/HCPC
code
Revenue
Code
Charge
amount
General ledger
number
Charge description
number
Activity
date
Echo Encephalogram 76506 320 1,500.00 15 232622 09/06/2016
Removal of kidney
stone
50080 272 390.00 11 810004 09/06/2016
Injection, cardiac
cath.
93540 481 220.00 11 791000 09/08/2016
Repair eyelid defect 67915 636 110.00 12 761003 09/08/2016
Ultrasound of breast 76645 845 421.00 15 689542 09/10/2016
CT Scan of Chest 71250 659 2,422.00 15 864571 09/10/2016
Nasal Bone x-ray 70160 321 150.00 15 2214111 09/12/2016
Blood Test, Clotting
Time
85610 402 125.00 14 586254 09/23/2016
Thyroid Encephalogram 76506 568 1,500.00 15 2326221 09/23/2016
