Coding Case Studies

Name: Genevieve Cervantes

Date: June 18, 2018

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 to determine diagnosis

2. CPT: Code set, maintained by AMA (American Medical Association)
3. ICD-10-PCS: Parodical codes
4. HCPCS: Codes utilized by health care providers to streamline the medical billing process

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 because its focusing on the detail history and is coming in to be a patient like a regular
office visit. Considered an office visit.

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 is used because it is the diagnosis and they are going fixed the problem by giving the
strep test and flu test. Wanting to get it done rapidly. These two are procedures and they were
done in the office.

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 because one was diagnosis already with influenza and found out by the test.

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 PCS because it was an inpatient and a procedure done.

Coding Case Studies