Medical Coding Systems (ICD-10-CM, CPT, HCPCS) Flashcards

The ICD-10-CM coding system is used to report which of the following?

Answer: Diagnoses and diseases

The International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) is used to code and classify diagnoses, symptoms, and inpatient procedures. It provides a high level of detail to describe a patient's condition.

A physician performs a physical examination. Which code set would be used to bill for this service?

Answer: CPT

Current Procedural Terminology (CPT) codes are used to report medical, surgical, and diagnostic procedures and services performed by healthcare providers. A physical examination is a service and would be reported using a CPT code from the Evaluation and Management (E/M) section.

HCPCS Level II codes are used to report which of the following?

Answer: Durable medical equipment and supplies

The Healthcare Common Procedure Coding System (HCPCS) Level II is used to identify products, supplies, and services not included in the CPT code set. This includes items like ambulance services, durable medical equipment (DME), prosthetics, and certain drugs.

What is the purpose of adding a modifier, such as -50, to a CPT code?

Answer: To specify that a procedure was performed on both sides of the body

CPT modifiers provide additional information about a service without changing the definition of the code itself. The -50 modifier specifically indicates that a procedure was performed bilaterally, meaning on both sides of the body.

In the ICD-10-CM code M19.011, what does the 'M' represent?

Answer: The chapter of the disease classification

In ICD-10-CM, the first character is always an alphabet letter that represents the chapter or category of the disease or condition. The letter 'M' corresponds to the chapter for 'Diseases of the musculoskeletal system and connective tissue'.

A patient is seen for an annual wellness visit with no specific complaints. Which type of ICD-10-CM code would be used as the primary diagnosis?

Answer: A Z code (Factors influencing health status)

Z codes are used to report encounters for reasons other than a disease or injury, such as health screenings, immunizations, or annual physicals. They describe circumstances that influence a patient's health status but are not a current illness.