Coding Case Studies

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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