ICD-10-CM Codes
What does ICD-10-CM stand for?
International Classification of Diseases, 10th Revision, Clinical Modification
What does CPT stand for?
Current Procedural Terminology
What is the first step in accurate code assignment?
Review the medical documentation.
What is one of the most common coding errors?
Using outdated codes or coding from memory.
A patient presents with acute bronchitis. What ICD-10-CM code might apply?
J20.9
How many characters can an ICD-10-CM code contain?
Up to 7 characters
Who publishes and maintains the CPT coding system?
American Medical Association (AMA)
Why is specificity important in diagnosis coding?
It ensures appropriate reimbursement and reflects the patient's true health status.
Why is double-checking the codebook before submitting claims important?
To avoid incorrect or denied claims due to coding mistakes.
A provider removes a benign skin lesion. What kind of CPT code should be used?
A minor surgical procedure code based on location and size (e.g., 11400–11446)
What is the purpose of the 7th character in some ICD-10-CM codes?
It provides information such as episode of care or type of encounter.
What type of procedures are included in Category I CPT codes?
Services and procedures commonly performed by healthcare providers that are approved by the FDA.
What is meant by 'upcoding'?
Assigning a code that provides a higher reimbursement than the service performed.
How can mismatched diagnosis and procedure codes affect a claim?
It may lead to claim rejection or denial by the insurance payer.
If a patient receives a flu shot, which codes might be used?
A CPT code for the vaccine (e.g., 90658) and a code for the administration (e.g., 90471)
What is the ICD-10-CM code for essential (primary) hypertension?
I10
What is the CPT code range for evaluation and management (E/M) services?
99202–99499
What coding term refers to using multiple CPT codes when one comprehensive code exists?
Unbundling
What should you do if documentation is unclear or incomplete?
Query the provider for clarification.
A patient is being seen for a routine physical. What diagnosis code type is used?
A Z code (e.g., Z00.00)
True or False: Z codes are used to describe factors influencing health status.
True
What symbol in the CPT manual indicates a new code?
A solid bullet (●)
What does “medical necessity” mean in coding and billing?
The service must be justified as reasonable, necessary, and/or appropriate based on clinical standards.
Name one consequence of frequent coding errors for a medical practice.
Loss of revenue, audits, or legal consequences.
The documentation states “possible pneumonia.” Should you code for pneumonia?
No, you should not code unconfirmed diagnoses in outpatient settings; code symptoms instead.