Medical Coding (ICD-10-CM/CPT) Flashcards

In the ICD-10-CM coding system, what is the primary purpose of the 7th character extender?

Answer: To provide information about the episode of care

The 7th character in certain ICD-10-CM codes provides information about the episode of care. For injuries and poisonings, for example, 'A' typically stands for the initial encounter, 'D' for a subsequent encounter, and 'S' for sequela (a late effect).

CPT (Current Procedural Terminology) codes are used to report:

Answer: Medical services and procedures

CPT codes are used to report medical, surgical, and diagnostic procedures and services performed by healthcare providers. In contrast, ICD-10-CM codes are used to report diagnoses and reasons for encounters. CPT codes are essential for billing and reimbursement.

A patient sees a physician for a scheduled wellness exam. During the visit, the patient also complains of a new, persistent cough, which the physician evaluates and treats. Which CPT modifier should be appended to the E/M code for the cough evaluation?

Answer: Modifier -25

Modifier -25 is used to indicate a 'Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service'. It is used when a separate E/M service is performed on the same day as a preventive visit or a minor procedure.

What is the fundamental difference between the ICD-10-CM and CPT code sets?

Answer: ICD-10-CM reports diagnoses, while CPT reports procedures.

The ICD-10-CM code set is used to report diagnoses, telling the payer *why* the service was provided. The CPT code set is used to report procedures and services, telling the payer *what* service was performed. Both are required for a complete medical claim.

The fraudulent practice of billing for a more complex or expensive service than was actually performed is known as:

Answer: Upcoding

Upcoding is the illegal practice of assigning a higher-level code to a medical service than what the documentation supports, in order to receive higher reimbursement. Downcoding is billing for a less complex service, and bundling is grouping related services under a single code.

The three key components used to select the correct level of an Evaluation and Management (E/M) code are History, Examination, and:

Answer: Medical Decision Making

The three key components for selecting an E/M code level are History, Examination, and Medical Decision Making (MDM). The complexity of each of these components, as documented in the medical record, determines the appropriate E/M code to be assigned.

When using the ICD-10-CM codebook, a coder should first locate the term in the:

Answer: Alphabetic Index and then verify in the Tabular List

The correct coding process requires the coder to first locate the diagnosis or condition in the Alphabetic Index. The Alphabetic Index will then direct the coder to a specific code or range of codes in the Tabular List. The code must then be verified in the Tabular List to ensure accuracy and check for any instructional notes.