Ta yaya dokokin ICD-10 zasu shafi lafiyarka da kuma takalminka
Yana daukan shekaru ilimi da horo don koyar da likitoci da basira da ake buƙata don gwada marasa lafiya, yin ganewar asali, da kuma bi da wannan mutumin bisa ka'idar kulawa. A shekara ta 2015, an kara sababbin sabon ma'auni wanda ke shafar ko shirin inshora naka zai biya don kulawarka - canje-canje a cikin lambobin ganewar asali.
Ta yaya Dokar Lissafin Kiwon lafiya ke aiki
Zaka iya ɗaukar hanya don fahimtar matsalolin lissafi na likita , amma abin da kake bukatar sanin shi ne nauyin lissafin kuɗin da zai shafi ka a matakin sirri.
A cikin sauƙi, likitanku ya gwada ku, ya zaɓi lambar ganewar asali don dace da yanayinku, kuma ya zaɓi lambar lissafin kuɗin da ya danganci muhimmancin ziyarar ku. Duk wani gwaje-gwaje da aka ba da umarnin dole ne a haɗa shi da lambar ganewar asali. Bayan haka an ba da wannan bayani ga kamfanin kamfanin inshora, Medicare ya haɗa, don haka likitanku ya biya bashin aikinsa.
Idan likitanku bai karbi lambar ƙididdigar ganewa daidai ba, yana yiwuwa shirin ku na inshora zai biya bashin kula da kuka samu. Wannan ya sa ku biya ba kawai a kocin ko dai ba don gwaji ko ziyarci cikakken adadi.
Canjin daga ICD-9 zuwa ICD-10 Codes
Kwayar Kayan Ƙasa ta Duniya shine akwatin kayan aiki na ganewar asali. A cikin 10th edition (ICD-10) tun shekara ta 1990, ana amfani da wannan jerin samfurori a dukan duniya don biyan cututtukan cututtuka da mutuwa. Ka'idojin ganewar asali sun inganta ikon yin nazarin hanyoyin kiwon lafiya, duba hanyoyin kiwon lafiyar, da kuma magance barazanar lafiya.
{Asar Amirka, duk da haka, ya yi jinkirin yin amfani da lambobin da suka wuce, kuma ba su canja daga ICD-9 zuwa ICD-10 har zuwa Oktoba 2015.
Akwai ƙarin lambobin ganewar asali fiye da yadda zaka iya tunanin. Lambar yiwuwar lambobin ku na kiwon lafiya dole ne ku zaɓi daga karuwa a cikin watan Oktobar 2015. Akwai lambobin 155,000 a cikin sabuwar shekara ta ICD-10 idan aka kwatanta da lambobin 17,000 a ICD-9.
Domin 2018, akwai sabon lambobi 363, lambobin da ba a umarce su bane 142, da kuma 226 lambobin da aka sabunta.
Wannan ƙarar da aka ƙayyade ya sa ya fi ƙarfin likita su sami lambobin da suke buƙatar samun inshora don biya. Nazarin gwajin gwajin da Hukumar Kula da Lafiya ta Ƙungiyar Kula da Lafiya ta bayar da shawarar cewa kawai kashi 63 cikin dari na coding na ICD-10 na iya zama daidai. Ƙarin ƙwaƙwalwar biyan kuɗi zai iya haifar da ku biya fiye da yadda kuke da kyau.
Zaɓi Lambar Dama
Don samun ra'ayi game da mahimmanci na ICD-10, dubi yawan ƙwayoyin numfashi na numfashi. Rhinitis na bala'i (hanci mai haɗari daga allergies) yana da akalla lambobi daban-daban guda shida daga abin da za a zaba, lambobin ƙwayar ƙwayar ƙwayar ƙwayar cuta , lambobin ƙwayar asthma 15, lambobin mura 5, sinusitis 21 lambobin, da ciwon mako bakwai. Wadannan sune masu sauki.
Yanayin rikitarwa kamar hauhawar jini na da nau'i-nau'i da yawa zuwa ganewar asali da ke nuna yadda yanayin ya shafi cututtukan zuciya, cututtukan koda, ciki, da sauransu. Ciwon sukari yana da lambobi mafi yawa. Har ila yau, akwai lambobin uku don abin da wani abu ya fadi a kan wani jirgin ruwa mai hawa! Zaka iya yin amfani da kanka da kuma bincika lambobin akan Cibiyoyin Kula da Medicare da Medicaid (CMS).
Alal misali: Medicare kawai yana biya bashin kashi kashi don osteoporosis idan ana amfani da wasu lambobin ICD-10. Medicare zai ƙaryata ɗaukar hoto na ICD-10 na M85.80, "wasu ƙayyadaddun ƙwayoyin ƙananan kashi da tsarin, shafin da ba a bayyana ba", amma zai amince da sake biyawa ga M85.81x-M85.89x, lambobin da ke saka wurin (idon, ƙafa, kullun, hannu, ƙananan kafa, kafada, cinya, babba babba, ko shafuka masu yawa) da kuma lalacewa (hagu ko dama) na ɓarna, watau M85.822, "sauran cututtukan da aka ƙayyade na ƙananan kashi da tsarin, hagu na hagu" .
Wannan ƙari ne kamar yadda akwai sauran lambobin da za su rufe don nunawa mai yawa. Duk da haka, yana da sauƙi a ga yadda takarda ɗaya zai iya yanke shawara wanda ya biya ku kula, ku ko mai insurer ku.
Kirar Kalmominku
Bayan miƙa mulki zuwa ICD-10 a shekara ta 2015, Cibiyoyin Medicare da Medicaid Services (CMS) sun ba da izini don tsawon lokacin shekara daya don dalilan lissafin kuɗi. An sanya shi kawai, CMS ya bawa likita horo don watanni 12. Muddin likitocin da aka sanya su a cikin kundin tsari don cutar, koda kuwa ba lambobin da aka fi so ba, CMS ba za su sami kuskure ba kuma ana kula da kulawa. Wannan ba haka ba ne.
Idan kowane lokaci ka karbi lissafin da baka tsammanin za'a buƙaci ka biya, tuntuɓi ofishin likitanka. Yana yiwuwa sun yi amfani da lambar ICD-10 mara daidai. Kwararka zai iya canza lambar asirin ganewa zuwa wanda ya ba ku asusun inshora wanda kuke bukata.
Kalma daga
Doctors ne mafi alhẽri sanin a cikin kiwon lafiya fiye da lissafin kudi likita. Tare da fiye da 155,000 ICD-10 lambobin samuwa, yana yiwuwa likita zai iya zaɓar abin da ba daidai ba. Idan Medicare ya musanya biyan bashin sabis saboda kuskuren coding, an bar ku don ku biya daga aljihu. Sanin hakkinku. Komawa ga ofishin cajin kuɗin kiwon lafiyar ku idan kun sami wani rikitarwa a cikin lissafin kuɗin ku.
> Sources:
> 2018 ICD-10 CM da GEMs. Cibiyoyin Cibiyar Magunguna da Magungunan Medicaid. https://www.cms.gov/Medicare/Coding/ICD10/2018-ICD-10-CM-and-GEMs.html. Updated 8/11/2017.
> Bone Mass Measure ICD-10 Abubuwan Ɗaukaka Ayyuka. Cibiyar Nazarin Harkokin Labaran {asar Amirka. https://www.acr.org/Advocacy/Economics-Hoya-Policy/Billing-Coding/Coding-Source-List/2016/March-April-2016/Bone-Mass-Measurement-ICD-10-Covered-Serve- An sabunta.
> Herman, B. Sai kawai 63% na ICD-10 Documentation Daidai Coded. Becker's Hospital CFO Report website. http://www.beckershospitalreview.com/finance/report-only-63-of- > icd > -10-takardun-daidai-coded.html. An buga Oktoba 24, 2013.
> Cikin lambobi na ICD-10. Cibiyoyin Cibiyar Magunguna da Magungunan Medicaid. https://www.cms.gov/medicare-coverage-database/staticpages/icd-10-code-lookup.aspx.
> Kwayoyin Kasa na Duniya (ICD). Ƙungiyar Lafiya ta Duniya ta yanar gizo. http://www.who.int/classifications/icd/en/.