Feasibility of Using CPT-4 (Current Procedural Terminology, 4th Revision) Codes for DRG (Diagnosis Related Group) Assignment of Surgical Patients

摘要

The study examined the feasibility of assigning Medicare surgical patients to DRG's based on the CPT-4 procedure codes obtained from Physician billing forms. Rather than directly matching CPT-4 codes with ICD-9-CM procedure codes, efforts were made to link actual physician bills with hospital discharge abstract records. Successful merging was completed in over 96-percent of the 31,000 Medicare surgical cases at Mayo Affiliated Hospitals from 1981 thru 1983. Researcher believe it would be feasible to develop a DRG grouper program for surgical patient using CPT-4 codes in lieu of ICD-9-CM procedure codes. However, a number of issues would need to be further addressed and resolved before such a grouper could be produced for use in administering a high volume program like Medicare.