Confirm Appropriate Diagnostic and Procedural Codes

Vocabulary flashcards covering diagnostic and procedural coding sets, structure, purpose, and documentation requirements.

Diagnosis codes (ICD-10-CM)

Codes assigned according to the reason for the visit (answering 'Why did the patient seek medical services?'), describing the condition, cause, manifestation, location, severity, and type of injury or disease.

ICD-10-CM code structure

Codes that are three to seven alphanumeric characters long and always begin with a letter.

Procedural codes

Codes assigned according to what medical services were provided relating to the diagnosis code, assigned from the CPT, HCPCS, and ICD-10-PCS code sets.

Current Procedural Terminology (CPT®)

A code set that identifies medical services and procedures performed by the provider (such as office visits, laboratory tests, and lesion removals), registered as a trademark of the American Medical Association.

Healthcare Common Procedure Coding System (HCPCS)

A code set that identifies supplies, procedures, and services not described by CPT, including medical supplies, therapies, and transportation.

International Classification of Diseases, 10th revision, Clinical Modification (ICD-10-CM)

A code set that identifies diseases, injuries, medical conditions, patient status affecting health care, and other reasons for health care encounters.

Medical necessity

The requirement that assigned diagnosis and procedure codes match the documentation and justify the medical services and treatments rendered.

Provider assessment for diagnosis coding

The clinical evaluation used to determine the diagnosis code, including the condition in the patient's own words, the provider's observations, and results from tests or diagnostic services.

Third-party payer

The reimbursement entity to which diagnosis and procedural codes are billed based on accurate medical record documentation.