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: used for diagnosis, medical services

2. CPT: Assure that medical provider receives appropriate reimbursement for their service
3. ICD-10-PCS: treatment in hospital. (in patient)
4. HCPCS: Used for reporting medical procedures ( Medicare or Medicaid)

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?

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

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