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Glossary

Average Length of Stay
The average number of days a patient stays at the hospital. (Calculation: Total # of patient days divided by the # of discharges for a given period.)

Complications or Comorbidities
A complication is a secondary disease or a negative reaction occurring during the course of an illness and usually aggravating the illness.

While a comorbidity is the effect of another disease a patient may have along with the primary disease of interest. (For example, diabetes may be the primary disease but high blood pressure may also be a factor. That would make high blood pressure the comorbidity.)

CPT Code
CPT stands for Current Procedural Terminology. CPT codes are universal five digit codes that are recognized by all insurance companies, hospitals and physicians. Theses codes are used by the insurance companies and providers to identify the type of care you receive.

  • Insurance companies use this code, along with a diagnosis, to determine payment and reimbursement for your individual claims.
  • The hospital and physicians use the CPT code to indicate the type of care or procedure(s) used to treat you.

Diagnosis
The determination of the nature of a disease, injury, or condition.

Discharges
The number of patients that leave a hospital setting.

DRG Code
DRG stands for Diagnosis Related Group. A DRG is only assigned to an inpatient hospital service. DRGs are universal groupings that are used by Medicare and most insurance companies to further clarify the type of inpatient care you receive. Insurance companies use the DRG code, along with a diagnosis code and the length of the inpatient stay, to determine payment and reimbursement for your individual claims.

Inpatient Procedure
A procedure that requires a patient to be admitted to a hospital for treatment and to stay at least one night.

International Classification of Disease - 9th Revision - Clinical Modification (ICD-9-CM)
The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) is based on the World Health Organization's Ninth Revision, International Classification of Diseases (ICD-9). ICD-9-CM is the official system of assigning codes to diagnoses and procedures associated with hospital utilization in the United States.

Medicaid
Medicaid provides health coverage for people of any age who meet certain low-income guidelines. You can ask your hospital or doctor to help you apply for Medicaid. Medicaid may pay for all your health care services, but sometimes a particular service is not covered. Some services are covered for children but not adults. You can also ask your hospital or doctor to help you find out whether Medicaid will cover a particular service.

Medicare
Medicare is a federal health insurance program for all people 65 years or older, or for some disabled persons and those with end-state renal disease. Eligibility is not based on the person's income or assets. Medicare requires patients to pay for some of their health care through premiums, deductibles and other expenses. Medicare is a federal program and is the same in all states. It is administered by the federal Department of Health and Human Services, Centers for Medicare and Medicaid Services.

Outpatient Procedure
A procedure that allows the patient to go home the same day he or she was treated.

Procedure
A surgical operation performed on a person during a visit, as classified according to the ICD-9-CM or CPT-4 coding schemes. A person may undergo more than one procedure during a single surgical operation.

 

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