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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 to diagnose patients. They’re specific to prevent any miscommunication from happening.
2. CPT: Its 5 digit number that is used to identify procedures for insurance companies.
3. ICD-10-PCS: is an alphanumeric code that can have three or up to seven characters in it.
4. HCPCS: This was created by the centers for Medicare and medicate to report medical procedures and services

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?

ICD-10-CM codes

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 coding

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-10-PCS codes

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

HCPS codes