1. CPT Codes:
Answer
The Current Procedural Terminology forms the basis for specific services performed in
relation to the diagnosis. It is the numeric code used to report medical procedures and
services under public and private health insurance programs. It is a five-digit number that
is used to indicate a level of service.The codes are developed by the American Medical
Association (AMA).
2. ICD-10-CM:
Answer
The ICD concept is an ancient one that has evolved into an international database to study
causes of mortality. The most current version isthe International Classification of Diseases,
10th Revision, Clinical Modification (ICD-10-CM). It is a tabular list of categories,
subcategories, and codes.
Codes may be 3-7 characters long. They may start with a letter to signify a disease, followed
by 6 numeric digits that specify etiology, anatomic site, and severity. There may be an extra
character that helps identify injuries, obstetrics, or external causes of injury.
3. Medicare Part A:
Answer
Includes inpatient care received in a hospital or skilled nursing facility. Covers critical
access hospitals, short-term care in nursing facilities, post institutional home health care.
Individuals eligible for Social Security are automatically enrolled in Part A.
Funded primarily through payroll taxes, although beneficiary cost sharing in the form of
deductibles coinsurance also fund the program.
Part A does not reimburse the APRN directly because those services are already paid for as
part of the hospital expense and to bill under Part A would be considered "double dipping".
4. Medicare Part B:
Answer
Includes coverage of physician services and outpatient care. Covers physician and
nonphysician providerservices;home health care not covered by Part A, such as physical
and occupational therapy; and other medical services, such as diagnostic testing, durable
medical equipment, and ambulance costs. Enrollment in Part B is voluntary to
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