ADVANCE: Health Information Learning Resources Vol. 1, 2024

Coding, Classification, and Reimbursement

Table of Contents

About the Book

Healthcare Code Sets, Clinical Terminologies, and Classification Systems , Fourth Edition, features up-to-date content to familiarize readers with healthcare’s vast and complex structure of terminologies. With content that includes ICD-10-CM, ICD-10-PCS, CPT ® , HCPCS, CDT, SNOMED CT, LOINC, RxNorm, DSM-5, and ICD-11, this resource provides students and practitioners in health information management and informatics with an overview of each system. From code sets and classification systems commonly used for administrative reporting to more complex clinical terminologies for semantic interoperability, parts I and II of this book introduce readers to the content, principles, and guidelines while demystifying the terminologies through use cases and explanations of tools to access and use. Parts III and IV highlight the use of data standards and explore how terminology and classifications are applied in real-world settings.

Coding professionals and educators will discover a unique and valuable resource to assist them with under- standing the complexities of coding for inpatient reimbursement. Those training for positions in the coding field will find a useful guide to en - hance their inpatient coding knowl- edge base as they prepare for certifi - cation. This book includesinformation from the 2016 Inpatient Prospective Payment System Final Rule.

Part I: Healthcare Code Sets and Classifications Commonly Used for Administrative and Statistical Reporting 1 International Classification of Diseases (ICD) and the US Modifications 2 Current Procedural Terminology (CPT) 3 Healthcare Common Procedure Coding System (HCPCS) 4 National Drug Codes (NDCs) 5 Current Dental Terminology (CDT) Part II: Other Terminologies and Classification Systems 6 SNOMED Clinical Terms (SNOMED CT) 7 ICD-11 Overview 8 RxNorm 9 Diagnostic and Statistical Manual of Mental Disorders 10 Logical Observation Identifiers, Names, and Codes (LOINC) 11 International Classification of Functioning, Disability, and Health 12 Terminologies Used in Nursing Practice 13 Other Terminology and Classification Systems Part III: HIT Data Standards and Interoperability 14 Healthcare Data Governance and Data Set Standards 15 Data Interchange Standards Part IV: Application of Terminologies and Classification Systems in Healthcare 16 Centralized Locations and Tools for Multiple Terminologies: Servers, Services, Databases, and Registries 17 Data Mapping of Clinical Terminologies, Classifications, and Ontologies 18 Use of Terminologies, Classifications, and Value Sets Glossary

Part I: Reimbursement Systems for Inpatient Services 1 Introduction to Hospital Inpatient Services 2 Reimbursement Methodologies for Inpatient Services 3 Structure and Organization of the Medicare Inpatient Acute-Care Prospective Payment System 4 Structure and Organization of Other Medicare Inpatient Prospective Payment Systems Part II: Coding for Inpatient Services 5 Diagnostic and Procedural Coding for Inpatient Services 6 Coding and DRG Assignment Part III: Processes Related to Coding and Reimbursement for Inpatient Services 7 Data Quality Management 8 Coding Compliance 9 The Health Record Auditing Process Abbreviations Appendix A: Exercises Appendix B: Case Studies Appendix C: Guidelines for Achieving a Compliant Query Practice Appendix D: Sample Audit Worksheets, Forms, and Tools Abbreviations Glossary

Key Features

• Reimbursement and methodologies specific to inpatient practice settings, such as the inpatient prospective payment system (IPPS), the long-term care hospital prospective payment system (LTCH-PPS), the inpatient rehabilitation facilities prospective payment system (IRF-PPS), and inpatient psychiatric facility prospective payment system (IPF-PPS) • Structure and organization of Medicare inpatient acute-care prospective payment system • Relationship between coding and MS-DRG assignment • Data quality and coding compliance processes related to coding and reimbursement for inpatient services • Updated to include ICD‑10‑CM keys and content on how these systems will impact inpatient reimbursement • Case studies and exercises and ICD‑10‑PCS code sets in exercise and case answer About the Author Karen S. Scott , MEd, RHIA, CCS-P, CPC, FAHIMA, is the sole proprietor of her own consulting firm.

Healthcare Code Sets, Clinical Terminologies, and Classification Systems, Fourth Edition Kathy Giannangelo , MA, RHIA, CCS, CPHIMS, FAHIMA

Coding and Reimbursement for Hospital Inpatient Services, Fourth Edition Karen S. Scott , MEd, RHIA, CCS-P, CPC, FAHIMA

Product#: AC206214

Product#: AB201918

ISBN: 978-1-58426-500-9 Softcover 208 pages Premier Member: $71.95 Member: $75.95 List: $94.95

ISBN: 978-1-58426-673-0 Softcover 624 pages Premier Member: $74.95 Member: $79.95 List: $99.95

Key Features

• Content includes ICD-10, SNOMED CT, LOINC, data set, and interchange standards such as FHIR and data mapping • Material describing adoption and use cases provides an understanding of how the terminology is used in the real world • Explains the relationship between

ebook Available e-ISBN: 978-1-58426-535-1

ebook Available e-ISBN: 978-1-58426-755-3

Instructor Resources include the following: • Complete answer key for case studies and exercises in the book

Instructor Resources include the following: • Sample syllabi • Test bank • Full answer key • Presentation slides The test bank is also available in Respondus.

terminologies and acts as a resource for many facets of healthcare

About the Editor Kathy Giannangelo , MA, RHIA, CCS, CPHIMS, FAHIMA, has a comprehensive background in the field of clinical terminologies, classification, and data standards with more than 40 years of experience in HIM.

ORDER my.ahima.org/store SAMPLE ahima.org/reviewcopy

AHIMA I ADVANCE