Indlela Iikhowudi zeNkqubo zeMpilo ezichaphazela ngayo impilo yakho
Nanini na xa unenkqubo yezokwelapha eyenziwa okanye inkonzo yonyango enikezelweyo, ibhalwe kwirekhodi yakho yonyango yokulandelela kunye nokuhlawula. Iikhowudi ze-CPT kunye neikhowudi ze-HCPCS zinxulumene neendlela zokudibanisa ngezokwelapha ezifunekayo kubaboneleli kunye nabaqhankqalazi ukuthumela ulwazi ngekhompyutha. Jonga indlela esetyenziswa ngayo kunye noko bathethayo kunyango lwakho lwempilo.
Ziziphi iikhowudi ze-CPT?
I-CPT (i-Common Procedural Technology) iikhowudi zamanani anikezelwe kuyo yonke imisebenzi kunye nenkonzo ugqirha unokubonelela ngesigulane kubandakanya iinkonzo zonyango, zokucoca kunye nokuxilonga.
Zisetyenziswe ngabaqhorensi ukugqiba inani lokubuyiselwa kwenzelwe ukuba ugqirha uzakufumana ngumbhorensi waloo nkonzo. Ekubeni bonke abantu basebenzisa iikhowudi ezifanayo ukuthetha into efanayo, baqinisekisa ukulingana.
Ikhowudi ye-CPT ibonakala njengekhowudi yeenombolo ezihlanu ezinamagama angama-decimal, nangona ezinye zinenani eline kunye neleta enye. Ezinye zisetyenziswe ngokuphindaphindiweyo njenge-99213 okanye i-99214 (ukwenzela ukuba i-check-up jikelele).
Iikhowudi ze-CPT ziphuhlisiwe, zigcinwe kwaye zikhutshwe ngu-AMA (American Medical Association). Njengoko ukuguqulwa kwezempilo kuntshintsho, iikhowudi ezintsha zenzelwe iinkonzo ezintsha, iikhowudi zangoku zinokuhlaziywa, kwaye iikhowudi ezindala ezingasetyenziswayo zilahlwa. Amawaka amakhowudi asetyenziswa kwaye ahlaziywa ngonyaka.
Ukungafani ekuqondeni ukuba yintoni inkonzo kunye nemirhumo eyahlukeneyo ibuyiselwayo ayiyi kuba yinto efanayo. Oku kunqunywe ngezivumelwano phakathi kwababoneleli ngabanye kunye nabashuseli.
Ngokomzekelo, ugqirha A ungenza uphenyo lwengqondo (99396) kwaye ubuyisele imali eyi-100 yakho yinkampani yakho yomshuwalense. Ukuba uye waya kwiDokotela B, ukubuyiswa kwakhe kwenkampani yakho yomshuwalense ukuba uhlolwe ngokufanayo, I-Code 99396, ingaba ngu-90 kuphela.
Iikhowudi zeHCPCS zihambelana njani neekhowudi zeCPS?
I-HCPCS imele iNkqubo yeCoding System yeCandelo leMpilo.
Ziyiikhowudi ezisetyenziswayo kwaye zigcinwe ngamaziko e-Medicare & Medicaid Services kwaye zisetyenziselwa ukuhlawula i-Medicare, Medicaid, kunye nabanye abaninzi abahlawuli-ntlawulo. Ukuba usebenzisa i-Medicare, uza kubona iikhowudi ze-HCPCS kwimaphepha akho.
Kukho amacandelo amabini eikhowudi. Iikhowudi zamanqanaba zisekelwe kwiikhowudi ze-CPT (zifana ngokufanayo) kwaye zisetyenziselwa iinkonzo kunye neenkqubo eziqhelekileyo zinikezelwa ngamagqirha. Iikhowudi zeNqanaba II zifumana iinkonzo zonyango kunye neenkqubo ezingenakunikezwa ngamagqirha. Imizekelo yezinto ezihlawulwe ngeekhowudi ze-II zezixhobo zonyango, iimpahla kunye neenkonzo ze-ambulensi. Iikhowudi ze-HCPCS nqanaba II ziqala ngeleta kwaye zinamanani amane. Bayakwazi ukuguqula iincwadi okanye iileta kunye nenombolo.
Imizekelo yeekhowudi ze-CPT
- I-99214 ingasetyenziselwa ukutyelela iofisi
- I-99397 ingasetyenziselwa uvavanyo lokukhusela xa ungaphezu kwama-65
- 90658 ibonisa umkhuhlane wesifo
- I-90716 ingasetyenziselwa isitofu sokugonya inkukhu (varicella)
- I-12002 ingasetyenziselwa ukugaya isiski enye intshi kwisandla somguli
Ezinye iikhowudi ze-CPT zixutywa . Oko kukuthi, zisetyenziselwa ukudibanisana omnye nomnye ukuze zichaze ngokwenene iinkalo ezininzi zokunyamekela.
Ukulinganisa iikhowudi ze-CPT kwiiNkonzo ezizimelayo
Inzala yakho kule khowudi idla ngokumalunga noogqirha bakho kunye ne-inshorensi .
Iikhowudi ze-HCPCS ze-II zingatholakala kwi-intanethi, kodwa inqanaba lam iikhowudi kunye neikhowudi ze-CPT zigcinwe ngu-AMA. I-AMA ihlawulisa iintlawulo zelayisenisi zokusetyenziswa kweekhowudi ze-CPT kunye nokufikelela kuluhlu olupheleleyo, oko kuthetha ukuba awuyi kufumana uludwe olubanzi kwi-intanethi mahhala. Ukwenza ukuba kufinyeleleke ngakumbi kwizigulane, i-AMA inikezela iindlela zokujonga iikhowudi ze-CPT zodwa onokuzifumana kwiibhilikhwe okanye o-EOB (uqikelelo lweenzuzo).
Ukuba unemaphepha e-CPT okanye i-HCPCS ikhowudi kuyo, kwaye ufuna ukufumana ukuba ikhowudi imele ntoni, unokukwenza ngeendlela ezininzi:
- Yenza uphando lwekhowudi ye-CPT kwiwebhusayithi ye-American Medical Association. Uya kufuneka ubhalise (mahhala) kwaye unganqamle ukukhangela ezintlanu ngosuku. Oku kuvumela izigulane ukuba zifune ikhowudi ye-CPT okanye isebenzise igama elingundoqo ukuze ubone ukuba ikhowudi ye-CPT edibeneyo ingaba yintoni.
- Xhumana neofisi yakho yegqirha uze ubacele ukuba bancede ufanise amakhodi kunye neenkonzo ze-CPT.
- Qhagamshelana nabasebenzi bakho bentlawulo kwaye ubacele ukuba bancede.
- Khumbula ukuba ezinye iikhowudi zingaphokhwe kodwa zingakhangela ngendlela efanayo.
- Izintlu zekhowudi ze-HCPCS zenqanaba II zifumaneka kwiwebsite ye-CMS kwaye ngokwenza uphando lwewebhu kwiindawo ezininzi ezinobungane.
Kuphi ukufumana iikhowudi ze-CPT kwiiNgxelo zakho zezoNyango kunye nePhepha
Iikhowudi ze-CPT kunye ne-HCPCS zifunyenwe kwaye zisetyenziswe kumaphepha ahlukeneyo kunye namaxwebhu njengoko usuqulela kuyo nayiphi na amava enkonzo. Iikhowudi zingasetyenziselwa ukucacisa yonke into evela kwi-diagnosis yakho kwiindleko zempilo yakho.
- Njengoko ushiya isigqibo sokuba ugqirha okanye ukhululwe esibhedlele okanye nakwezinye izibonelelo zonyango, unikezelwa iphepha elibandakanya isishwankathelo sesevisi abanikezele zona. Iikhowudi ezinhlanu eziqhelekileyo zikhowudi zeCPT okanye iikhowudi ze-HCPCS (ukuba usebenzisa i-Medicare). Kukho ezinye iikhowudi kule maphepha, kwakhona. Ezinye zingaba yiikhowudi ze-ICD , ezinokuthi zinamanani okanye iileta kwaye zihlala zifumana amanqaku aphezulu.
- Xa ufumana ibhajethi evela kugqirha, ngaphambi okanye emva kokuba ithunyelwe kumhlawuli wakho (i-inshurensi okanye i-Medicare), iya kuba neluhlu lweenkonzo. Emva kwesevisi nganye iya kuba ikhowudi eyi-5. Leyo ikhowudi ye-CPT okanye ikhowudi ye-HCPCS.
- Xa ufumana i-EOB, Inkcazo yeeNzuzo, ukusuka kumhlawuli wakho (inshuwalense, i-Medicare okanye abanye), iya kubonisa ukuba zininzi iinkonzo zinikezelwa ngenxa yethu. Njengomthetho osayilwayo ugqirha, inkonzo nganye iya kuhambelana neCPT okanye ikhowudi ye-HCPCS.
Ababoneleli kunye nabashuseli basebenzisa iiCTT kunye neikhowudi ze-HCPCS
- Iikhowudi ze-CPT kunye ne-HCPCS zichaphazela ngqo ingeniso yomnikezeli. Ngaloo ndlela, bathile ngokukodwa malunga nendlela yokwenza ikhowudi yenziwe ngayo kwaye ngokuqhelekileyo isebenzise iikhowudi zezobugcisa okanye iinkonzo zokunikwa iinkcukacha ukuqinisekisa ukuba iinkqubo zibhalwe ngokuchanekileyo.
- I-ofisi yakho ugqirha iya kuqalisa inkqubo yokwenza ikhowudi. Ukuba basebenzisa iifom ze-paper encounter, baya kuphawula ukuba yiziphi iikhowudi ze-CPT ezisebenza kulo tyelelo lwakho. Ukuba basebenzisa irekhodi yezobugcisa ngexesha lokutyelela, kuya kuqatshelwa kule nkqubo.
- Emva kokuba ushiye iofisi yegqirha, iirekhodi zakho zihlolwe ngamakhowudi ezonyango kunye nabaqulunqi ukuba banike iikhowudi ezichanekileyo. Iirekhodi zakho ke ziya kuhlawula ukuthumela uluhlu lweenkonzo ezibonelelwe ngomshuwalense okanye umhlawuli. Oogqirha kunye namaziko ngokubanzi basebenzisa iindlela zecomputer ukugcina nokugqithisa le ngcaciso, nangona ezinye zisenziwa ngeposi okanye ngefeksi.
- Isicwangciso sakho sempilo okanye umhlawuli ofana ne-Medicare ke usebenzisa iikhowudi ekusebenzeni ibango kwaye unqume ukuba bunjani ukubuyisela ugqirha wakho.
- Abahlalutyi baseburhulumenteni karhulumente kunye nabasemagunyeni basebenzise idatha ekukhoneni iikhowudi ukulandelela ukunyuka kwonyango kunye nokuchonga ibhajethi yabo kwi-Medicare kunye neMedicaid.
- Iinkampani ze-inshorensi zezempilo kunye neenkcukacha zorhulumente zisebenzisa i-coding data ukuqikelela iindleko zonyango lwexesha elizayo kwizigulane kwiinkqubo zazo.
ILizwi
Ukuba nesigulane esinolwazi kuyingxenye yokuqinisekisa ukuba unyamekela unyango olungcono. Xa ubona into ongayiqondi kwirekhodi yakho yonyango okanye i-bill, xubusha ngayo nomboneleli wakho wezempilo okanye umshwalense. Unelungelo lokuthatha inxaxheba ekuqinisekiseni ukuba unyango lwakho lwempilo lulandelwa ngokuchanekileyo.
> Imithombo:
> Inkqubo yePCT®: Indlela iPhumo ibe yiKhowudi. AMA. https://www.ama-assn.org/practice-management/cpt%C2%AE-process-how-code-becomes-code.
> HCPCS_Coding_Iziphakamiso. Amacandelo eCMS.gov neeNkonzo zeMedare. https://www.cms.gov/Medicare/Coding/MedHCPCSGenInfo/HCPCS_Coding_Questions.html. Ipapashwe ngoJulayi 22, 2013.