Ukwenza ikhodi yezokwelapha kuyingxenye ebalulekile yokukhokha kwezokwelapha kanye nokuxhumana phakathi kwabahlinzeki bezempilo kanye nabashuwalense. Funda okuyisisekelo ukuthi kusho ukuthini nokuthi lezi zimakhodi zisetshenziswa kanjani.
Kuyini Ukwelashwa Kwezokwelapha?
Ukwenza ikhodi yezokwelapha kuyisimiso sezinombolo nezinhlamvu zamagama ezihlukile ekuxilongweni ngamunye, uphawu noma uphawu olubekwayo, futhi imbangela yokufa kubantu.
Ukwengeza, amakhodi asetshenziselwa ukuxhumana okujwayelekile kwempahla nezinqubo ezisetshenziselwa ukwelashwa kwezimo zabantu. Ukukhokhwa kwezokwelapha okulungile kubalulekile ekukhokhiseni nasekulandeleni izibalo zezifo nokuphathwa kwezokwelapha.
Ukwenza ikhodi yezokwelapha kuyisici esiyinhloko ekutholeni ukubuyiselwa kweminshuwalense kanye nokugcina amarekhodi eziguli. Ukukhokhwa kwe-coding ngokucacile kwenza umkhokheli womshuwalense wazi ukugula noma ukulimala kwesiguli kanye nendlela yokwelapha.
Ukwenza ikhodi yezokwelapha kungabandakanya eyodwa noma ngaphezulu yalezi zinhlobo zamakhodi: Amakhodi we-ICD, amakhodi we-CPT, amakhodi we-HCPCS, amakhodi we-DRG, namakhophi wokuguqula. Zonke lezi zinhla zokubhala zibalulekile ekukhulumisaneni nasezinjongo zokukhokha. Akukona nje ukuthi ukukopisha kubalulekile emthini wezokwelapha, kubalulekile ngoba abakhokhisi bezentengiselwano ezinjengezinkampani zomshuwalense, i-Medicare ne-Medicaid ngeke bakhokhe isimangalo uma kungeniswa kahle ngamakhodi amukelekile.
Amakhodi we-ICD
I-International Statistical Classification of Diseases noma ama- ICD amakhodi uhlelo olulodwa lwamakhodi. Lokhu kuqondile ekuhlukanisweni kwezinkinga zokuxilongwa, izimpawu, nezimbangela zokufa kubantu. I-World Health Organization idala, i-copyright, futhi iqondisa lezi zigaba futhi ziyizinga futhi ngaleyo ndlela zihlonishwa yizo zonke izikhungo zezokwelapha kanye nodokotela emhlabeni jikelele.
E-United States iNational Center for Health Statistics, okuyingxenye yamaCenter for Medicare neMediicaid Services ilawula noma yikuphi ukuchibiyela kuma-ICD amakhodi eduze ne-WHO.
Amakhodi we-HCPCS
I-HCPCS (I-Healthcare Common Procedure System Coding System) amazinga I no-II enye indlela yokubhala ikhodi. Izinga lami linamakhodi we-CPT, futhi i-Level II ihlanganisa amakhodi alphanumeric asetshenziselwa ukukhomba imikhiqizo, ukuhlinzekela, kanye nezinsizakalo ezingafakiwe kumakhodi we-CPT uma zisetshenziswe ngaphandle kwehhovisi likadokotela.
Amakhodi we-HCPCS achazwe emazingeni amathathu:
- Amakhodi I-CPT (Current Procedural Terminology) amakhodi ayizinombolo ezingu-5 futhi alawulwa yi-American Medical Association (AMA). Amakhodi we-CPT asetshenziselwa ukukhomba izinsizakalo zezokwelapha nezinqubo eziyalwe odokotela noma ezinye izichwepheshe ezilayisensiwe.
- I-Level II i-HCPCS yizinkomba ezihambisana ne-alfabhethi eyodwa elandelwa izinombolo ezine futhi ilawulwa yi-The Centers for Medicare neMedicaid Services (CMS). Lezi zimpawu zikhomba amasevisi angewona odokotela njengamasevisi we-ambulensi, imishini yokwelapha ehlala njalo, kanye nekhemisi.
- Amakhodi we-Level III amakhodi alphanumeric W, X, Y, noma Z alandelwe ikhodi yenombolo enezinombolo ezine. Ngaphandle kwalokho eyaziwa njengamakhodi wendawo, lawa manikhodi asetshenziswa njengikhodi ehlukile uma kungekho iveli ye-I noma yezinga le-II ukulikhomba.
Amashintshi: Amanye amakhodi we-HCPCS adinga ukusetshenziswa kwe-modifiers. Zinezinombolo ezimbili zamadijithi, izinhlamvu ezimbili noma izinhlamvu ze-alphanumeric. Ama-modifiers amakhodi we-HCPCS anikezela ngolwazi olwengeziwe mayelana nenkonzo noma inqubo eyenziwe. Amashintshi asetshenziselwa ukukhomba indawo yomzimba lapho kwenziwa khona inqubo, izinqubo eziningi esimisweni esifanayo, noma ukhombise inqubo eqalisiwe kodwa ishiyiwe.
Amakhodi we-CPT
Amakhodi we-CPT yiMikhodi Ejwayelekile Yomsebenzi futhi asethuthukiswa futhi agqanyiswa yi-American Medical Association ngo-1966. Lezi yizinhlelo zamakhodi ezinombolo eziyisihlanu ze-alphanumeric ezichaza ngendlela ejwayelekile yokwelashwa, yokuhlinzeka, nokuxilongwa.
Amakhodi we-DRG
Amakhodi we-DRG , amakhodi wokuqoqa ahlobene nokuxilongwa, asetshenziselwa ukukhokha izicelo zokwelashwa. Abaningi bomshuwalense bakhokhela ngokusho kwe-DRG, ngakho-ke, ukunemba kwazo zonke izingxenye kubalulekile ekubuyiseni isimangalo esifanele.
Indlela Ukwelashwa Kwezokwelapha Kusetshenziswa Ngayo
Lezi zinethi zokubhala zibalulekile ekukhulumisaneni nasezinjongo zokukhokha. Akukona nje kuphela ukuthi ikhodi ebalulekile emthini wezokwelapha, kubaluleke kakhulu kwezokwelapha kubahlinzeki bezokwelapha ngoba abakhokhisi bezentengiselwano ezinjengezinkampani zomshuwalense, Medicare kanye neMedicaid ngeke bakhokhe isimangalo uma kungeniswa kahle ngamakhodi amukelekile.
Ukwengeza, amakhodi okuxilongwa asetshenziselwa ukuhlaziya amaphethini wezifo emiphakathini kanye nezibalo zezempilo nezokufa zezwe nezesifundazwe. AmaLunga we-World Health Organisation angabe esezuza ezidingweni ezidingekayo zokulwa nezinkinga zezempilo ezandayo, ukufundisa abantu ngokuvimbela kanye nokwelapha, nokuqinisekisa impilo nezakhamuzi zesikhathi esizayo izakhamizi zabo.
Imfundo ku-Coding Medical
Amakholeji amaningi kanye nezikole zokuhweba zinikeza amakilasi, izitifiketi, ngisho nama-degrees ehambisana ne-Applied Science ekukhokhweni kwezokwelashwa nokukhokhwa. Lezi yizinhlelo ezijulile zezifundo noma iziqu ezifundisa abafundi ngesigama sezokwelapha, amakhodi afanelekile kanye namasu okukhokhisa, izinqubo ezifanele zehhovisi, kanye nenqwaba yezifundo ezihlobene. Ezinye zazo zivunyelwe kanti ezinye azikho, ngakho umfundi ngamunye ongase abe khona kufanele enze umsebenzi wesikole ngaphambi kokukhetha uhlelo lokufunda.
Ukubaluleka kwemfundo yokuqala kanye nokuqhubeka nemfundo emtholampilo noma ehhovisi likadokotela angeke kudlulele. Ukungahambisani nokushintshwa kwemikhuba yokukhokha kanye nokukhokha, kanye nemithetho yokuphatha ibalulekile kulolu hlelo lwedijithali olusheshayo lapho sonke sisebenza khona siphile.
Ukwenza ikhodi nokukhokha
Ukwenza ikhodi nokukhokha kuvame ukukhulunywa ndawonye ngoba lezi zingxenye ezimbili zehhovisi lezokwelapha ezihlobene kakhulu. Abasebenzi (abasebenza) abaqedela ikhodi yakho yokukhokha kanye nokukhokhisa kumele basebenze ndawonye ngokubambisana ukuqinisekisa ukukhokha okunembile futhi okusheshayo kuzo zonke izimangalo zezokwelapha futhi balungise futhi bagcwalise amarekhodi wezokwelapha.
Izinsiza ezifana nezincwadi zamakhodi ezesikhathini samanje zihlula amakhodi ahlukahlukene noma isofthiwe yamanje yamakhodi noma ukukhokhiswa kubalulekile kubasebenzi bokukhokha nokukhokha ukuze kuqinisekiswe ukufaka ngokucacile ezinkampanini zomshuwalense noma kwi- Medicare ne-Medicaid , bese ukhokha ukukhokha kusuka kulezi zinhlangano, futhi njenge-diagnosis enembile namarekhodi wezokwelapha. Ngaphezu kokufakwa kokuqala kwezicelo zesiguli, i-coder ne-biller ingaba nesibopho sokulandela izimangalo eziphikisiwe ngokucwaninga ishadi lesiguli, ukufaka kabusha isimangalo, ukufaka isimangalo, noma ukuthatha ezinye izinyathelo ukuqinisekisa ukuchithwa kwalo Faka isicelo.
Njengoba kunikezwa ukuthi abasebenzi bezokwelapha nezokukhokhisa banesibopho sokunemba kwamarekhodi wezokwelapha ngokuhambisana nemigomo kahulumeni kanye nesifundazwe, ukubaluleka kwababhalisi abanekhono kanye namakhodi akukwazi ukucindezeleka. Isikhungo sezokwelapha esiphumelelayo kumele sibe nama-billers aqeqeshiwe, ahlelekile, aqeqeshiwe kanye nama-coder yezokwelapha.