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Insurance reimbursement for embolization varies based upon the patient's
diagnosis, insurance coverage, and location of the hospital. However, current
information is available via the links below which will provide proper ICD-9
and CPT codes for reimbursement of the products and procedure used during embolization.
GLOSSARY OF REIMBURSEMENT TERMS
ICD-9: International Classification of Disease
- Describes an inpatient procedure
- Describes a patient's medical condition
DRG: Diagnostic Related Group
- Hospital Inpatient Claims
- Derived from ICD-9 codes
- Assigned as a result of extracting information from the patient's
chart
Revenue Codes
- Used to track a cost or charge of an item to a revenue center
- Product may be billed with revenue code 278
- Relevant for cost accounting and the Medicare Cost Report
Device Codes
- HCPCS - Health Care Financing Administration Common Procedure Coding
System
- HCPCS codes start with a letter
- C-code is a special type of code
- HCFA assigns C-codes to drugs, biologicals and devices or pass through
payments
Embolic Agents
- C-Code has an H STATUS
- New Technology - Pass Through Items
- May be used on those procedures classified as outpatient by HCFA
- Hospital Outpatient Supplies
- Providers must provide same level of care regardless of payor
- Those drugs and devices not used in 1996
- Use revenue codes and HCPCS codes
- Charge per item
- Not subject to patient deductible or co-pay
Related links to assist with additional information:
SIR.org
American Hospital Directory
SIR Reimbursement Centers for Medicare & Medicaid Services
Centers for Medicare & Medicaid Services
American Hospital Association
Food & Drug Administration
Medicare Learning Network
RSNA
National Archives and Records Administration
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