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Medical Coding Case Studies Explained

The document discusses 4 case studies involving different coding systems used for medical billing. Case Study 1 involves an outpatient visit for an acute illness and uses ICD-CM codes. Case Study 2 involves ordering rapid tests and uses CPT/HCPCS codes. Case Study 3 confirms a positive flu test and uses ICD-10-PCS codes. Case Study 4 is about a tonsillectomy in the hospital which would be billed using HCPCS codes.

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27 views1 page

Medical Coding Case Studies Explained

The document discusses 4 case studies involving different coding systems used for medical billing. Case Study 1 involves an outpatient visit for an acute illness and uses ICD-CM codes. Case Study 2 involves ordering rapid tests and uses CPT/HCPCS codes. Case Study 3 confirms a positive flu test and uses ICD-10-PCS codes. Case Study 4 is about a tonsillectomy in the hospital which would be billed using HCPCS codes.

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© All Rights Reserved
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Coding Case Studies

Name: Cierra Patillo

Date: 9/25/2018

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: giving a diagnosis of the patients illness


2. CPT: outpatient at hospital/ physician office service
3. ICD-10-PCS: hospital inpatient service
4. HCPCS: outpatient at hospital/ physician office service

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-CM Code

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/HCPCS Code

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 Code

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

HCPCS Code

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