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Coding Case Studies

The document discusses different medical coding systems: ICD-CM is used for diagnoses, CPT codes are used to bill for outpatient procedures and doctor services, ICD-10-PCS codes inpatient procedures with 7 characters, and HCPCS also covers outpatient billing and additional services. Case study 1 asks what system is used for an outpatient urgent care visit, which would be billed using CPT or HCPCS codes. Case study 2 involves rapid testing ordered at an outpatient visit, which again uses CPT or HCPCS codes. Case study 3 codes the positive flu diagnosis identified from rapid testing, using ICD-CM codes. Case study 4 asks what system codes an

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3K views

Coding Case Studies

The document discusses different medical coding systems: ICD-CM is used for diagnoses, CPT codes are used to bill for outpatient procedures and doctor services, ICD-10-PCS codes inpatient procedures with 7 characters, and HCPCS also covers outpatient billing and additional services. Case study 1 asks what system is used for an outpatient urgent care visit, which would be billed using CPT or HCPCS codes. Case study 2 involves rapid testing ordered at an outpatient visit, which again uses CPT or HCPCS codes. Case study 3 codes the positive flu diagnosis identified from rapid testing, using ICD-CM codes. Case study 4 asks what system codes an

Uploaded by

api-385484216
Copyright
© © All Rights Reserved
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Coding Case Studies

Name:

Date:

Define the Coding Systems


Write a short explanation in your own words of what is the difference between ICD-CM codes, CPT codes, and ICD-10-
PCS, and HCPCS.

1. ICD-CM: This is used for diagnoses.


2. CPT: 5 digit codes used to bill for services or procedures provided by doctors offices or for outpatient
procedures.
3. ICD-10-PCS: This is the coding system used to tell what procedure has been done and determines the payment.
It is used for inpatient procedures. Each code will have 7 characters.
4. HCPCS: This is used to bill for services and procedures provided by doctors offices or for outpatient procedures
just like a CPT code, but it is mainly used for Medicare and Medicaid and it also covers services that CPT codes
dont cover.

Case Study 1
A patient presents at an outpatient urgent care facility with an acute illness and is seen by a provider. A detailed history
with physical examination is performed. What coding system is used in this scenario? CPT or HCPCS

Case Study 2
Upon review of the symptoms, the provider orders a rapid strep test and a rapid flu test. What coding system is used
in this scenario? CPT or HCPCS

Case Study 3
The results of the rapid strep test were negative, but the rapid flu test was positive for the influenza virus, type A. What
coding system is used in this scenario? ICD-CM

Case Study 4
A patient presents to the hospital for a tonsillectomy. What coding system would the hospital use to bill for this service?

ICD-10-PCS
Coding Case Studies

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