Hospital Inpatient Coding and Reimbursement Process
Hospitals
assign ICD-9-CM codes for both diagnoses and procedures for inpatient
admissions. For Medicare, inpatient hospital reimbursement is under the
Diagnosis Related Group (DRG) system.
For
each admission, the ICD-9-CM diagnosis and procedure codes are grouped into one
of more than 800 DRGs. Regardless of the number of codes, only one DRG is assigned
per admission. Each DRG has a unique relative weight, which is then converted
into the payment amount.
Medicare
has used DRGs for hospital inpatient reimbursement since 1983.
Changes
to ICD-9-CM procedure and diagnosis codes as well as DRGs are effective October
1st of each year.
