Bundled payments in health care are described as paying for hospital care in its entirety and are tied to what coding system?

• A. ICD 10 codes.
• B. CPT codes.
• C. DSM-5 codes.
• D. SNOMED codes.

Answer: (A)

Bundled payments are determined by grouping an entire episode of care into a single payment category, based on diagnoses and procedures that reflect the resources used. This grouping is done through diagnosis-related groups, or DRGs, which rely on standardized coding to classify cases. ICD-10 coding provides the uniform diagnoses (and, for procedures, ICD-10-PCS in inpatient settings) that feed into the DRG assignment. Because the DRG category sets the bundled payment amount, ICD-10 codes are the coding system that directly ties to how much is paid for the hospital episode.

CPT codes, by contrast, are used mainly for reimbursing individual professional services and outpatient procedures, not the inpatient DRG-based bundling. DSM-5 codes identify mental health diagnoses and aren’t used to determine bundled payments. SNOMED codes are a broad clinical terminology used in health records; while useful for documentation and interoperability, they don’t directly drive the DRG-based payment structure that bundles payments for an entire hospital stay.