The idea of classifying medical conditions is a concept that has been around for thousands of years. It became more complicated and detailed, as knowledge of medicine evolved over time. Today, classifying medical information is an integral part of modern medicine. It is used to track illnesses at a local, regional, national and international level. It provides a common language that medical professionals around the world can understand. It can be used for medical billing and other administrative needs also.
Let's review a few of the medical classification systems used in the United States today.
International Statistical Classification of Diseases and Related Health Problems (ICD)
This is a health care classification system, maintained
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Its purpose is to provide a uniform method for reporting medical, surgical and diagnostic services among doctors, patients, accreditation organizations and payers.
Healthcare Common Procedure Coding System (HCPCS)
The HCPCS is a classification system required by the Centers for Medicare and Medicaid (CMS). The use of the codes ensure that claims are processed in a consistent manner. The code set has two active levels, as well as an obsolete third level. The first level consists entirely of the CPT code set developed by the American Medical Association. The second level is for non-physician services, such as ambulance services and prosthetic devices. A third level had been active prior to 2003 for use by non-CMS entities, but is no longer in use.
International Classification of Functioning, Disability and Health (ICF)
The ICF is a code set used to classify the functioning and disability of an individual as it occurs within a given context. It also includes environmental factors. This code set was developed by the World Health Organization to provide a common classification system for measuring health and disability in individuals as well as population
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There are over 500 groups within the system. Each group has a particular payment weight behind it, which allows the hospital to determine how much to charge for services. The exact weight used by each hospital depends on its geographic location, the percentage of low-income patients within the group, if it is a teaching hospital, and whether a particular case involved higher expenses than normal.
National Drug Codes (NDC)
Every drug sold within the United States must have a unique identifying number attached to it, known as a National Drug Code. The NDC set was first developed in 1972 to give the FDA a current list of all drugs manufactured, prepared, distributed, compounded or processed within the United States. This list is maintained by the FDA and updated as needed.
Each code consists of 10 digits, in three sections. The first section is the unique Labeler ID assigned by the FDA to a particular manufacturer. The second section is the code is the product code, which indicates the strength, dosage, and formulation. The third section is the package code, which indicates the form and size of the drug
• Provides a basic level of interoperability among electronic health records (EHRs) maintained by individual physicians and organizations
The federal government has taken a stance to standardized care by creating incentive programs that are mandated under the Health Information Technology for Economic and Clinical Health Act (HITECH) of 2009. This act encourages healthcare providers and healthcare institutions to adopt Meaningful use in order to receive incentives from Medicare and Medicaid. Meaningful use is the adoption of a certified health record system that acquires or obtains specified objectives about a patient. The objectives or measures are considered gold standard practices with the EHR system. Examples of the measures include data entry of vital signs, demographics, allergies, entering medical orders, providing patients with electronic copies of their records, and many more pertinent information regarding the patient (Friedman et al, 2013, p.1560).
ICD-10 CM is developed by Centers for Medicare and Medicaid Services (CMS) involved with the Department of health and human Services (HHS) known as inpatient procedural coding system.includes several new features and offers a greater specificity.Is classified by 5 to 7 characters.Carries laterality,and allows an additional code when there is a x which symbolizes an expansion to allow the code add a seventh character as many times, this includes injuries,external causes and obstetrics.
Another useful tip: understand that sometimes a code from another section must be used to fully describe the procedure. This is called, component or combination coding. For example, when the radiologist injects, or places material necessary to perform a procedure, a CPT code from the surgery section must be used.
and to issue recommendations for improvements. The committee was composed of 16 experts, including leaders in clinical medicinemedical research, economics, biostatistics, law, public policy, public health, and the allied health professions, as well as current and former executives from the pharmaceutical, hospital, and health insurance industries. The authors found major deficiencies in the current FDA system for ensuring the safety of drugs on the American market. Overall, the authors called for an increase in the regulatory powers, funding, and independence of the FDA. Some of the committee's recommendations have been incorporated into drafts of the PDUFA IV bill, which was signed into law in 2007.
U.S. Code, 21 U.S. Code § 812 - Schedules of controlled substances, 1970. Retrieved from: http://www.law.cornell.edu/uscode/text/21/812
(Charles R. McCornell, 2015, pg 514) This title is the one that has had the most affect on patients and healthcare systems. “The Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA, Title II) require the Department of Health and Human Services to establish national standards for electronic health care transactions and national identifiers for providers, health plans, and employers. It also addresses the security and privacy of health data.” (HIPAA Title Information, 2015, par 2) Switching over to electronic forms allows for administrative simplification, and the codes used for each location, individual, insurance helps reduce
The Centers for Medicare and Medicaid Services (CMS) is an agency within the federal government that administers Medicare, Medicaid, the Children’s Health Insurance Programs (CHIP), and the state and federal health insurance marketplace. The Joint Commission is one of several organizations approved by CMS to certify hospitals. It is a non-profit organization that accredits healthcare organizations and programs. The major goal of these organizations is to ensure quality care and patient safety in healthcare institutions. By complying with the standards set by the organizations, there is greater consistency of care, better processes for patient and staff safety, and thus higher quality of care.
A case referring to the beneficial use of the expert systems in the health sector was the attempt of the LDS Hospital in Salt Lake city,Utah to build “ the most complex artificial intelligence system ever created'; according to the words of DR David Classen.Its name was AIC or “Antibiotic Computer Consultant'; and it was part of HELP(Health Evaluation through Logical Processing), which was LDS’s hospital information system. The latter was existed, before the implementation of the Expert System.
“Current Procedural Terminology codes otherwise known as CPT codes are a classification of diagnostic and therapeutic procedures performed by physicians and other health care providers”. Each procedure is assigned a 5 digit code (Centers for Disease Control and Prevention, 2013). “CPT codes are numbers assigned to every procedure and service a medical professional may provide to a patient. These include medical, surgical and diagnostic services” ("5 thoroughly explain," 2014). They are then used by insurers to determine the amount of reimbursement a physician will receive from the insurer. Since everyone uses the same codes to mean the same thing, they ensure uniformity ("5 thoroughly explain," 2014).
Individual hospitals belong to a number of different buying groups and often switch from one group to the next.
a drug gets the CDER approval, the drug is on the market as soon as the firm gets its production
U.S. Food and Drug Administration. “CFR -- Code of Federal Regulations Title 21” (21CFR101.9). U.S. Food and Drug Administration. U.S. Department of Health & Human Services, 1 Apr. 2013. Web. 21 Mar. 2014.
...0. CMS-1500 is the basic form that has been set by Center for Medicare and Medicaid services and is used by most outpatient clinics. CMS-1450 is the form that is used hospitals to claim reimbursement for hospital visits. While CMS-1500 is used for patients who are under Medicare Part B, CMS-1450 is used for patients insured under Medicare Part A. Some of the charges that need to be claimed using CMS 1500 are ambulatory surgery performed in a certified Ambulatory Surgery Center, all hospital based clinics, and hospital based primary care office. Furthermore, some of the charges that need to be claimed in CMS-1450 are emergency department visits, ancillary department visits, outpatients services such as infusion therapy or observation, all services rendered during an inpatient visit, and any pathology service provided regardless of patients’ presence (Ferenc, 2013).
To the "Hospital medicine" in the past, it uses a cross-sectional nosographic technique to be classified different types of patients according to the internal lesion for example: they will distinguish the heart disease patient and high blood pressure disease patient and distinguish which cause it and prescribe the right medicine for an illness. This technique can let the doctor be more focus on their professional and more expert on those lesions. Also the "hospital medicine" will according to the symptom and disease to conflate an infinite chain of risk which found out the root cause of illness for example: A headache may be a risk for high blood pressure, but high blood pressure may also