Indlela Amakhodi Okusebenza Kwezokwelapha Okuthinta Ngayo Ukunakekelwa Kwezempilo
Noma nini lapho unenqubo yokwelashwa eyenziwe noma insizakalo yokunakekelwa kwezempilo enikeziwe, ibhalwe ikhodi yakho yezokwelapha yokulandelela nokukhokha. Amakhodi we-CPT namakhodi we-HCPCS yizinhlelo ezihlobene zokukhokhwa kwezokwelapha ezidingekayo kubahlinzeki nabanimshuwalense ukuthumela ulwazi ngekhompyutha. Bona ukuthi zisetshenziswa kanjani nokuthi zisho ukuthini ukunakekelwa kwezempilo.
Yini Amakhodi we-CPT?
Amakhodi we-CPT (Common Procedural Technology) amanani anikezwe kuwo wonke umsebenzi kanye nensizakalo udokotela angase anikeze isiguli esibandakanya izinsiza zezokwelapha, zokuhlinza, nokuxilonga.
Zisetshenziswe ngabashuwalense ukucacisa inani lokubuyiselwa umhlinzeki ozothola ngumhlinzeki wesikhwama salowo msebenzi. Njengoba wonke umuntu esebenzisa amakhodi afanayo ukuze asho into efanayo, aqinisekisa ukufana.
Ikhodi ye-CPT ibheka ikhodi yezinombolo ezinamadijithi amahlanu ngaphandle kwamamaki edesimali, nakuba amanye anezinombolo ezine kanye nencwadi eyodwa. Ezinye zisetshenziswa kaningi njenge-99213 noma i-99214 (ngokuhlola jikelele).
Amakhodi we-CPT akhiwe, agcinwe futhi anelungelo lobunikazi yi-AMA (American Medical Association). Njengoba umkhuba wokunakekelwa kwezempilo ushintsho, amakhodi amasha akhiwa ngezinsizakalo ezintsha, amakhodi wamanje angabuyekezwa, futhi amakhodi amadala, angasetshenzisiwe alahlwe. Izinkulungwane zamakhodi zisetshenziswa futhi zibuyekezwa njalo ngonyaka.
Ukungafani kokuqonda ukuthi yini le nsizakalo kanye nezindleko ezahlukahlukene ezibuyiselwayo ngeke zifane. Lokhu kunqunywe yizinkontileka phakathi kwabahlinzeki ngabanye nabanomshwalense.
Isibonelo, uDokotela A angenza isheke-sangempela (99396) futhi abuyiselwe imali engu- $ 100 yinkampani yakho yomshuwalense. Uma uye kuDokotela B, ukubuyiselwa kwakhe yinkampani yakho yomshuwalense yokuhlola efanayo, Ikhodi ye-99396, kungenzeka ibe ngu-90 kuphela.
Amakhodi we-HCPCS ahlobene kanjani namakhodi we-CPS?
I-HCPCS imelela uhlelo lweCoding System Procedure Coding System.
Amakhodi asetshenziswa futhi agcinwe yiCenter for Medicare & Medicaid Services futhi asetshenziselwa ukukhokhela i-Medicare, i-Medicaid, nabanye abaningi abakhokhisayo. Uma usebenzisa i-Medicare, uzobona amakhodi we-HCPCS kumaphepha akho.
Kunamazinga amabili amakhodi. Ama-Level I amakhodi asekelwe kuma-CPT amakhodi (afana ngokufanayo) futhi asetshenziselwa izinsizakalo nezinqubo ngokuvamile ezihlinzekwa odokotela. Amakhodi e-Level II ahlanganisa nezinsizakalo zokunakekelwa kwezempilo kanye nezinqubo ezinganikezwa odokotela. Izibonelo zezinto ezikhokhwa ngamakhodi wezinga lama-2 ziyimishini yezokwelapha, izinto zokuhlinzeka, kanye nezinsiza ze-ambulensi. Amakhodi wezinga le-HCPCS liqala ngencwadi futhi unezinombolo ezine. Bangakwazi ukuba nama-modifiers angaba izinhlamvu ezimbili noma incwadi nenombolo.
Izibonelo zamakhodi we-CPT
- 99214 ingasetshenziselwa ukuvakasha kwehhovisi
- 99397 ingasetshenziselwa ukuhlolwa kokuvikela uma ungaphezu kuka-65
- I-90658 ikhombisa ukudubula komkhuhlane
- I-90716 ingasetshenziselwa umgomo wokugoma inkukhu (varicella)
- I-12002 ingasetshenziselwa ukugoqa ukusika okungamamitha-intshi engalweni yesiguli
Amanye amakhodi we-CPT ahlanganiswa . Okusho ukuthi zisetshenziselwa ukuhlanganiswa komunye nomunye ukuze zichaze izici eziningana zokunakekelwa.
Ukuqhathanisa Amakhodi we-CPT Amasevisi Awakumeleyo
Intshisekelo yakho kulezi zimakhodi ngokuvamile ihlotshaniswa nodokotela bakho kanye nemali yomshuwalense .
Amakhodi we-HCPCS wezinga II angatholakala ku-intanethi, kodwa izinga engilikhomayo namakhodi we-CPT anelungelo lobunikazi nge-AMA. Ama-AMA akhokhisa izimali zelayisense zokusebenzisa amakhodi we-CPT nokufinyelela kuhlu olugcwele, okusho ukuthi ngeke uthole uhlu olunzulu oluku-inthanethi mahhala. Ukwenza kube lula ukuthola iziguli, i-AMA inikeza izindlela zokubheka amakhodi we-CPT oyedwa ongayithola kumalimboli kadokotela noma ama-EOB (ukulinganisela kwezinzuzo).
Uma unemaphepha ephethe ikhodi ye-CPT noma ye-HCPCS, futhi ufuna ukuthola ukuthi leli khodi limelela, ungakwenza ngezindlela eziningi:
- Yenza usesho lwekhodi ye-CPT kwi-website ye-American Medical Association. Kuzodingeka ubhalise (mahhala) futhi ukhawulelwe ekusesheni amahlanu ngosuku. Lokhu kuvumela iziguli ukuba zifune ikhodi ye-CPT noma isebenzise igama elingukhiye ukuze ubone ukuthi iyiphi ikhodi ye-CPT ehambisanayo.
- Xhumana nehhovisi lakho nodokotela bese ubacela ukuba bakusize ufanise amakhodi we-CPT namasevisi.
- Xhumana nabasebenzi bakho bokukhokhisa futhi ucele ukuthi bakusize.
- Khumbula ukuthi amanye amakhodi angadliwa kodwa angabheka ngendlela efanayo.
- Izinhlu zekhodi zezinga le-HCPCS ezingeni lika-2 zingatholakala kwiwebsite ye-CMS nangokuwenza usesho lwewebhu ukuthola amasayithi amaningi anobungane.
Ukutholaphi Amakhodi we-CPT kumarekhodi akho wezokwelapha kanye nephepha
Amakhodi we-CPT ne-HCPCS atholakale futhi asetshenziswe emaphepheni ahlukahlukene kanye nemibhalo njengoba ushintsha ngokusebenzisa noma yiluphi ulwazi lwezempilo. Amakhodi angasetshenziselwa ukunquma yonke into kusuka ekuxilongweni kwakho kuze kube yindleko yokunakekelwa kwezempilo.
- Njengoba ushiya ukuqokwa kukadokotela noma ukhululwa esibhedlela noma kwenye indawo yezokwelapha, unikezwa amaphepha afaka isifinyezo sezinombolo zezinsizakalo abanikezwe zona. Amakhodi amahlanu ajwayelekile amakhodi we-CPT noma amakhodi we-HCPCS (uma usebenzisa i-Medicare). Kunamanye amakhodi kulawo maphepha, futhi. Amanye angase abe amakhodi e-ICD , okungenzeka abe nezinamba noma izinhlamvu futhi ngokuvamile abe namaphoyinti asezingeni eliphezulu.
- Uma uthola umthethosivivinywa ovela kudokotela, ngaphambi noma ngemuva kokuthi uthunyelwe kumkhokheli wakho (umshuwalense noma uMedare), uzoba nohlu lwamasevisi. Okulandelayo kwesevisi ngayinye kuyoba ikhodi yamadijithi angu-5. Leyo ikhodi ye-CPT noma ikhodi ye-HCPCS.
- Uma uthola i-EOB, Incazelo Yemihlomulo, kusuka kumkhokheli wakho (umshuwalense, Medicare noma abanye), izobonisa ukuthi insizakalo ngayinye ikhokhwa ngenxa yethu. Njengomthethosivivinywa kadokotela, isevisi ngayinye izohambisana nekhodi yayo ye-CPT noma ye-HCPCS.
Indlela Abahlinzeki Nezinkampani Zomshwalense Zisebenzisa Amakhodi we-CPT ne-HCPCS
- Amakhodi we-CPT ne-HCPCS ayithinta ngokuqondile imali yomhlinzeki. Njengalokhu, bathile kakhulu mayelana nendlela yokubhala ikhodi eyenziwa ngayo futhi ngokuvamile basebenzisa amakhodi wezokwelapha ochwepheshe noma izinsiza zokubhalisa ukuqinisekisa ukuthi izinqubo zikhokhwa ngendlela efanele.
- Ihhovisi likadokotela wakho ngokuvamile lizoqala inqubo yokwenza ikhodi. Uma basebenzisa amafomu we-paper encounter, bazokwazi ukuthi yiziphi amakhodi we-CPT asebenzayo ekuvakasheni kwakho. Uma basebenzisa irekhodi lezokwelapha nge-elekthronikhi ngesikhathi sokuvakashelwa kwakho, kuzoqaphela kuleso simiso.
- Ngemuva kokuphuma ehhovisi likadokotela, amarekhodi akho ahlolwe ngamakhodi wezokwelapha kanye nezikhwama zezimali ukuze abanike amakhodi afanele. Amarekhodi akho ke aya ekukhokhiseni ukuhambisa uhlu lwezinsizakalo ozinikezwe kumshwalense wakho noma umkhokheli wakho. Odokotela nezindawo ngokuvamile zisebenzisa izindlela zokugcina ukugcina nokudlulisela lolu lwazi, nakuba amanye angase ayenze ngeposi noma ngefeksi.
- Uhlelo lwakho lwezempilo noma umkhokheli njengoMedare bese usebenzisa amakhodi ukucubungula isimangalo futhi unqume ukuthi kungakanani ukubuyisela udokotela wakho.
- Abahlaziyi bombuso bakahulumeni nabasezingeni likahulumeni basebenzisa idatha ekukhokheni ikhodi ukulandelela izitayela zokunakekelwa kwezokwelapha futhi banqume ibhajethi yabo ye-Medicare ne-Medicaid.
- Izinkampani zomshuwalense wezempilo kanye nezibalo zikahulumeni zisebenzisa idatha yokubhala ikhodi ukubikezela izindleko zokunakekelwa kwempilo esikhathini esizayo iziguli ezisezinhlelo zabo.
Izwi elivela
Ukuba nesiguli esinolwazi kuyingxenye yokuqinisekisa ukuthi uthola ukunakekelwa okungcono kakhulu kwezokwelapha. Uma ubona okuthile ongaqondi kumarekhodi wakho wezokwelapha noma imali ekhokhwayo, xoxisana nomhlinzeki wakho wezempilo noma umshuwalense. Unelungelo lokuthatha indima ekuqinisekiseni ukuthi ukunakekelwa kwezempilo kwakho kulandelwa ngokunembile.
> Imithombo:
> Inqubo ye-CPT®: Indlela Ikhodi Eba Ngayo Ikhodi. AMA. https://www.ama-assn.org/practice-management/cpt%C2%AE-process-how-code-becomes-khodi.
> HCPCS_Coding_Iziphakamiso. Izikhungo ze-CMS.gov ze-Medicare & Services Medicaid. https://www.cms.gov/Medicare/Coding/MedHCPCSGenInfo/HCPCS_Coding_Questions.html. Ishicilelwe ngoJulayi 22, 2013.