tci Medicare Compliance & Reimbursement - 2022 Issue Q1

Reader Questions: Pocket These Coding Basics on Medicare Reimbursement

Question: I’ve heard conflicting views on what’s more critical to include on Medicare claims to ensure swift and accurate payment — CPT® codes or ICD-10 codes. Does the CPT® code determine the reimbursement rate or does the ICD-10 code? I thought it was the CPT® code, but I keep hearing that our practice’s pay could suffer if we don’t use the right ICD-10 codes, so I’m confused. AAPC Forum Participant Answer: The CPT® code on your claim determines your reimbursement rates under Part B Medicare. On the other hand, ICD-10-CM codes support medical necessity...

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