ICD-10-CM is a standardized list of diagnosis codes. It is essential to use the correct ICD-10-CM code on a claim because it proves medical necessity for any procedures or services that were completed. The ICD-10-CM code also depicts an accurate reflection of the patient’s diagnosis to be taken into consideration during future appointments, so the patient receives the best care possible. CPT is a standardized list of procedures and services that may be provided by physicians. These codes are used on a claim form and sent to the patient’s insurance company to represent the procedure or service completed and then the provider or facility can be reimbursed. The CPT code book uses several symbols as guidelines. An example is the plus sign, used to distinguish add on codes. Medical necessity identifies the reason for tests, procedures, or services for a patient to be ordered. Medical necessity is communicated to insurance companies through ICD-10-CM codes and CPT codes found on an insurance claim for a particular date of service. All physicians should be required to prove medical necessity, as it ensures the patient is receiving adequate care and services are not rendered simply for reimbursement.
Reference
Safian, S. and Johnson, M. (2023).
Let’s code it! 2022-2023 code edition.
McGraw Hill LLC.
