Assignment task: Help me answer my peer about her discussion post
Diagnosis codes are essential in the claim submission process within healthcare. ICD-10 codes are utilized to report all diagnoses in various healthcare settings, including physician offices, home healthcare, hospitals, assisted living facilities, and skilled nursing facilities. Specifically, ICD-10-CM codes classify diseases in provider-based offices, while ICD-10-PCS codes categorize procedural data in hospital settings. The ICD-10-CM code consists of seven alphanumeric characters, which enhance the accuracy of payments for the services provided. In contrast, ICD-10-PCS employs a multiaxial structure of seven alphanumeric characters for all procedures stated by Michelle A. Green. (Green, 2025)
Your ICD codes must support your CPT and HCPCS Level I and II codes. CPT codes are used to report medical services and procedures in outpatient settings. They are divided into three categories: Category I for evaluation and management, Category II for evidence-based performance measurements, and Category III for emerging technologies, procedures, and services. Meanwhile, Medicare and Medicaid primarily use HCPCS codes for durable medical equipment.
The Centers for Medicare and Medicaid Services (CMS) was established to enhance overall healthcare quality and reduce costs for patients. CMS has implemented pay-for-performance programs that incentivize healthcare providers based on their performance. Hospitals are required to report data following post-acute care. Each fee schedule is divided into several sections, including physicians' offices, federal healthcare programs, ambulances, laboratories, durable medical equipment (DME), and the Medicare physician fee schedule. This fee schedule includes geographic adjustment factors and annual conversion factors that are tied to the payment incentives
Non-participating Medicare physicians opt not to engage in Medicare billing programs. As a result, these physicians set their fees higher than Medicare's reimbursement rates and collect the difference directly from patients. Since non-participating physicians are reimbursed at only 95% of the Medicare fee schedule, patients often incur higher out-of-pocket costs. Typically, patients pay the physician directly, and Medicare then reimburses the patient for a portion of the expenses incurred. Need Assignment Help?