Reimbursement — ICD-9-CM or CPT Coding Based?

Alicia: Alright! This is one where there can be so much explanation there, but again, put a little website on there that really expands it.

Q: Reimbursement, is it based on ICD-9-CM or CPT diagnosis or procedures?

A: The example I found was: How does the physician get paid for what they do? Well, physicians at this time are paid / reimbursed by what they do for the patient. These are called procedures and include the evaluation and management of the patient which is the exam and decision in treatment. Testing that is done is considered a procedure as well.

Let's say we have a brand new physician:

Dr. X case 1: Mrs. S is a 68 y/o female on Medicare who and presents to the clinic as a new patient with fever and sore throat. He performs a history of physical exam, he performed a rapid strep test, and he gives a diagnosis of viral pharyngitis. And then he recommends, in addition, that she takes Robitussin-DM.

So, here's our brand new physician, he's so excited to see his very first patient. Now, what did he provide? What services did he provide? Three main components for all visits to the physician: 1) Provider Visit -- History/Physical/Medical Decision Making, the Physician Performed Procedures; 2) Testing/Non-Physician Performed Procedures -- Immunizations, if any of those will be given, will be in that; 3) Office Work -- nurses and the front desk and stuff like that.