What is the ICD-10-CM? How will it impact the coding of claims?
The ICD-10-CM is a morbidity classification published by the United States for classifying diagnoses and reasons for visits in all healthcare settings. With this billing system, medical professionals are better able to keep track of their financial records and receipt of their medical payments.
Describe at least one of the outpatient coding guidelines listed in your text.
What is the CPT?
A basic rule of thumb is that outpatient care has a duration of 24 hours or less. Office or Other Outpatient Services CPT® Code range 99202- 99215.
What is one symbol that is used throughout the CPT coding book? Describe its purpose.
A solid circle preceding a code number identifies a new CPT code.
What is medical necessity, and how is it communicated to the insurance companies?
Medical necessity is a decision made by a health plan as to whether a treatment, test, or procedure is necessary for a patient's health or to treat a diagnosed medical condition. It is communicated by documentation.
Should physicians be required to prove the medical necessity of the services they have provided? Why, or why not?
Yes. Physicians need to prove medical necessity to ensure accurate coding and billing to reduce abuse and fraud.
Safian, S. (2022). Let's Code It! 2022-2023Code Edition (3rd ed.). McGraw-Hill Higher Education (US). https://bookshelf.vitalsource.com/books/9781266594182
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