Institute:Office of National Coordinator (ONC) Workforce Training Curriculum
Component:The Culture of Health Care
Unit:Health Care Processes and Decision Making
Lecture:Making a diagnosis
Choosing therapy
Communicating the plan
The impact of EHRs and technology on clinical decision-making
Slide content:Insurance Companies Documentation of the illness ICD10 Documentation of the procedure CPT Documentation of supplies, injections, services, etc., to Medicare beneficiaries HCPCS Documentation of the process Details to support diagnosis, treatment plan SNOMED CT 12
Slide notes:Another group that the clinician must inform about a patients diagnosis and management plan is the insurance companies. In most cases, before payment is authorized, insurance companies require a diagnosis expressed as an International Classification of Diseases, or ICD-10 [I-C-D ten] code, even if the diagnosis is not yet known. They also require a description of the services provided or procedures performed expressed as a Current Procedural Terminology, or CPT [C-P-T] code. Based on CPT, the Health Care Common Procedure Coding System, or HCPCS [hick picks], is a set of health care procedure codes used for Medicare billing for the Centers for Medicare and Medicaid Services (or CMS) as well as for Medicaid billing and some insurance companies. Beyond these codes, which may not always describe exactly what the clinician is thinking, theres frequently a need to provide certain details that support a given diagnosis or treatment in order to justify payment. Electronic clinical documentation may also use other classifications, such as SNOMED CT [snow med C T]. [quote] The Systematized [ sis - te -me- tized ] Nomenclature [ no -men- klay - cher ] of Medicine, is a systematic, computer- processable collection of medical terms, in human and veterinary medicine, to provide codes, terms, synonyms, and definitions which cover anatomy, diseases, findings, procedures, microorganisms, and substances. [end quote] 12