Dorman Todd, Loeb Laura, Sample George
The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Crit Care Med. 2006 Mar;34(3 Suppl):S71-7. doi: 10.1097/01.CCM.0000200037.30800.E3.
Physicians should have a working knowledge of the process by which patient care codes are created and subsequently assigned values. The Society of Critical Care Medicine has representatives on the national committees that focus on code creation and definition and on assignment of relative value units. In addition, a better understanding of documentation requirements and the audit process will facilitate improved compliance and minimize liability.
The authors discuss the current procedural terminology (CPT) process for defining care codes and the relative update commission (RUC) process for assigning values to those codes, with each code assigned a separate value in three separate categories. Steps for managing any concern or dispute about billing, denials, or an audit are subsequently addressed. Tenets of proper documentation are discussed, and some future developments are identified that are likely to affect critical care.
Knowledge of the procedures by which care codes are defined and valued is necessary for using these codes properly, as well as for addressing needs unmet by existing codes. Preventing audits is the best approach to proper coding and billing, and documentation is key.
医生应掌握患者护理编码的创建过程以及随后赋值的实用知识。危重病医学会在专注于编码创建、定义及相对价值单位赋值的国家委员会中有代表。此外，更好地理解文档要求和审核流程将有助于提高合规性并将责任降至最低。
作者讨论了用于定义护理编码的当前程序术语（CPT）流程以及为这些编码赋值的相对更新委员会（RUC）流程，每个编码在三个不同类别中被赋予一个单独的值。随后阐述了处理有关计费、拒付或审核的任何问题或争议的步骤。讨论了正确文档记录的原则，并指出了一些可能影响重症监护的未来发展情况。
了解护理编码的定义和赋值程序对于正确使用这些编码以及满足现有编码未满足的需求是必要的。预防审核是正确编码和计费的最佳方法，而文档记录是关键。
