Medical Classification In Healthcare

The idea of classifying medical conditions is a concept that has been around for thousands of years. It became more complicated and detailed, as knowledge of medicine evolved over time. Today, classifying medical information is an integral part of modern medicine. It is used to track illnesses at a local, regional, national and international level. It provides a common language that medical professionals around the world can understand. It can be used for medical billing and other administrative needs also.

Let's review a few of the medical classification systems used in the United States today.

International Statistical Classification of Diseases and Related Health Problems (ICD)

This is a health care classification system, maintained

by the World Health Organization, that allows for the systematic classification of diseases, symptoms, abnormal findings, patient social circumstances, and external causes of injury and disease. It is a standard used around the world. Currently, revision 10 (ICD-10) is the standard used in most parts of the world.

Many countries have developed a special version of the code for use within their own internal medical systems. In the US, for example, there are two versions in use: ICD-10-CM and the ICD-10-PCS. These codes are used for medical condition tracking as well as billing.

Current Procedural Terminology (CPT)

The CPT is a medical code set developed and maintained by the American Medical Association.

Its purpose is to provide a uniform method for reporting medical, surgical and diagnostic services among doctors, patients, accreditation organizations and payers.

Healthcare Common Procedure Coding System (HCPCS)

The HCPCS is a classification system required by the Centers for Medicare and Medicaid (CMS). The use of the codes ensure that claims are processed in a consistent manner. The code set has two active levels, as well as an obsolete third level. The first level consists entirely of the CPT code set developed by the American Medical Association. The second level is for non-physician services, such as ambulance services and prosthetic devices. A third level had been active prior to 2003 for use by non-CMS entities, but is no longer in use.

International Classification of Functioning, Disability and Health (ICF)

The ICF is a code set used to classify the functioning and disability of an individual as it occurs within a given context. It also includes environmental factors. This code set was developed by the World Health Organization to provide a common classification system for measuring health and disability in individuals as well as population

groups.

Diagnosis Related Groups (DRG or MS-DRG)

The Diagnosis Related Groups is a system used by hospital administrators to classify inpatient care.

There are over 500 groups within the system. Each group has a particular payment weight behind it, which allows the hospital to determine how much to charge for services. The exact weight used by each hospital depends on its geographic location, the percentage of low-income patients within the group, if it is a teaching hospital, and whether a particular case involved higher expenses than normal.

National Drug Codes (NDC)

Every drug sold within the United States must have a unique identifying number attached to it, known as a National Drug Code. The NDC set was first developed in 1972 to give the FDA a current list of all drugs manufactured, prepared, distributed, compounded or processed within the United States. This list is maintained by the FDA and updated as needed.

Each code consists of 10 digits, in three sections. The first section is the unique Labeler ID assigned by the FDA to a particular manufacturer. The second section is the code is the product code, which indicates the strength, dosage, and formulation. The third section is the package code, which indicates the form and size of the drug

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Code on Dental Procedures and Nomenclature (CDT)

This set is also known as Current Dental Terminology. Dental procedures have almost always been treated separately from other medical procedures. However, with insurance being involved with dental claims, the need for standardization in dental records arose. This evolved into the CDT developed by the American Dental Association and in use since 2000.

Diagnostic and Statistical Manual of Mental Disorders (DSM or DSM-5)

This classification system, developed by the American Psychiatric Association, provides a common set of codes for classifying mental disorders. It is used by clinicians, researchers, insurance companies, drug manufacturers, and the legal system along side the ICD. The first version of the code came about in the early 1950s, developed from attempts by the armed forces to classify and treat soldiers experiencing mental issues after World War II. In 2013, the 5th revision, commonly referred to as DSM-5, was released.

As you can see medical classification and coding is highly complex. If you need help with your medical coding, call us at [phone] with any questions you might have.