Download Current Procedural Technology DRG

EHDI Terminology and Codes
Abbreviations
CCE – Commercial Claims and Encounters
CPT – Current Procedural Technology
DRG – Diagnosis-Related Group
ICD-9-CM –International Classification of Diseases, 9th Revision, Clinical Modification
Definitions
Bundled payment is a single payment to providers or health care facilities (or jointly to both) for all services to treat a
given condition or provide a given treatment.
Current Procedural Terminology (CPT) a system developed by the American Medical Association for standardizing the
terminology and coding used to describe medical services and procedures
A Diagnosis-Related Group (DRG) is a statistical system of classifying any inpatient stay into groups for the purposes of
payment. It is how Medicare and some health insurance companies categorize hospitalization costs and determine how
much to pay for a patient's hospital stay. DRG are based upon the patient's principal diagnosis, ICD diagnoses, gender, age,
sex, treatment procedure, discharge status, and the presence of complications or comorbidities.
Direct costs are the medical and non-medical monetary costs directly related to prevention, treatment and diagnosis of the
disease. It includes fees from services such as medical professionals, surgery, hospital stays, and diagnostic tests like x-rays,
ambulances, and medications.
Indirect costs are also monetary costs, however they are not directly related to treating the disease. Indirect costs can
include travel costs related to treatment, lost economic productivity due to death or disability, and informal care costs.
Intangible costs are social, emotional and human costs. They are not related to money and hard to measure.
The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) is based on the World
Health Organization's Ninth Revision, International Classification of Diseases (ICD-9). ICD-9-CM is the official system of
assigning codes to diagnoses and procedures associated with hospital utilization in the United States.
Payment includes the total eligible charges less any reasonable and customary amounts and discounts for PPO services,
but prior to reductions for deductibles, copayments, and other savings.
Net payment is the payment received by the provider excluding patient out-of-pocket and COB, i.e., employer or plan
liability.
Codes Used to Determine EHDI Costs
Newborn DRGs
DRG
Description
789
Neonates, died or transferred to another acute care facility
790
Extreme immaturity, neonate (no respiratory distress syndrome 769)
791
Prematurity w major problems
792
Prematurity w/o major problems
793
Full term neonate w major problems
794
Neonate
795
Normal newborn
Hearing Screening CPTs
CPT
Description
ICD-9
92586
Auditory evoked potentials for evoked response audiometry
and/or testing of the central nervous system, limited
92587
Distortion product evoked otoacoustic emissions, limited
evaluation (to confirm the presence or absence of hearing
disorder, 3-6 frequencies) or transient evoked otoacoustic
emissions, with interpretation and report
92551
Screening test, pure tone, air only
V20.2
92552
Pure tone audiometry (threshold); air only
V20.2
92567
Tympanometry (impedance testing)
V20.2
Code Description
Routine infant or child health
check
Routine infant or child health
check
Routine infant or child health
check
ICD-9 Diagnosis Codes for Delivery
Code Description
ICD-9 Code
V72.11
Post-term infant
V30.xx-V39.xx
Liveborn infants according to type of birth
ICD-9 Diagnosis Codes for Failed Hearing Screening
Code Description
ICD-9 Code
V72.11
Encounter for hearing examination following failed hearing screening
V72.19
Other examination of ears and hearing