1. Numerical three-, four-, or five-digit code located in the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code book and assigned to a patient’s medical condition, symptoms, or reason for the encounter as documented in the patient’s medical record. 2. Up to seven-digit code located in the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) . The code is assigned to a patient’s medical condition, symptoms, or reason for the encounter that is documented in the patient’s medical record (see Figure D-1, A ). 3. When the physician’s office or an outpatient hospital is billing, the primary diagnosis code(s) is inserted in Block 21 of the CMS-1500 insurance claim form. For inpatient hospital billing, the principal diagnosis code is inserted in Field 66 and subsequent diagnosis codes in Fields 67 through 75 of the UB-04 insurance claim form. Diagnostic codes.

System of Medicare reimbursement for HMOs with risk contracts in which enrollees are classified into various DCGs on the basis of each beneficiary’s prior 12-month hospitalization history.

Coding that is inappropriately altered to obtain a higher payment rate. Also known as coding creep, DRG creep , or upcoding .

Procedures used to find the nature and underlying cause of an illness, disease, or condition.

Mechanical or machine laboratory tests that are necessary to identify a disease, syndrome, or condition (e.g., electrocardiograph, electroencephalograph, complete blood count, urinalysis).

Procedures, tests, and examination (scientific evaluation of history, physical signs, symptoms) done on a patient to identify a disease, syndrome, or condition.

Procedure performed that provides information about a known problem or looks for disease after an illness is suspected.

Radiographic and other related studies and procedures performed to identify a disease, syndrome, or injury including portable x-ray services.

Solution used in dialysis to remove excess fluids and waste products from the blood. Also called dialysate fluid .

1. Process by which dissolved substances are removed from a patient’s body by diffusion from one fluid compartment to another across a semi-permeable membrane. The two types of dialysis that are in common use are hemodialysis and peritoneal dialysis. 2. Treatment that cleans the blood when the kidneys do not work. It gets rid of harmful wastes and extra salt and fluids that build up in the body. It also helps maintain blood pressure and appropriate fluid levels. Dialysis treatments help the patient feel better and live longer but are not a cure for permanent kidney failure.