TY  - CHAP
M1  - Book, Section
TI  - Coding and Billing
A1  - Reed II, R. Lawrence
A2  - Feliciano, David V.
A2  - Mattox, Kenneth L.
A2  - Moore, Ernest E.
PY  - 2020
T2  - Trauma, 9e
AB  - KEY  POINTSMedicare  (established  in  1965)  provides  health  care  benefits  to  Social  Security  beneficiaries  (ie,  previously  employed  individuals  over  age  65).Medicare  hospital  payments  are  payments  based  on  the  patient’s  admitting  diagnosis  in  diagnosis-related  groups  that  may  be  affected  by  documented  comorbidities  and  quality  metrics.Medicare  physician  payments:  For  each  Current  Procedural  Terminology  (CPT)  code,  a  previously  determined  assessment  is  made  of  the  amount  of  physician  work  (~50%),  practice  expense  (~40%),  and  malpractice  costs  (~10%)  associated  with  that  service  or  procedure.  The  amount  of  work  is  assessed  in  comparison  to  the  work  already  assigned  to  other  similar  procedures.The  Relative  Value  Scale  Update  Committee  (RUC)  is  a  committee  of  the  American  Medical  Association  that  assesses  physician  work  for  procedures  and  services  and  provides  recommended  relative  value  unit  (RVU)  valuations  to  the  Centers  for  Medicare  and  Medicaid  Services  (CMS).  Although  the  RUC  provides  recommendations,  CMS  makes  all  final  decisions  about  what  the  Medicare  payments  will  be.Conversion  factor  =  Dollars  paid/RVU.Billing  Concept  1:  Identify  why  physician  does  something  for  a  patient  by  using  codes  for  diagnoses  from  the  International  Classification  of  Diseases,  10th  edition,  Clinical  Modification.Billing  Concept  2:  Identify  what  the  physician  does  for  the  patient  by  using  codes  for  services  or  procedures  from  CPT  (updated  annually).The  provision  of  critical  care  services  is  specifically  excluded  from  a  global  surgical  package  in  the  setting  of  trauma  and  burns.  
SN  - 
PB  - McGraw Hill
CY  - New York, NY
Y2  - 2024/04/18
UR  - accesssurgery.mhmedical.com/content.aspx?aid=1175130482
ER  -