Certified Revenue Cycle Representative (CRCR) Practice Exam

The combination of ICD-10 codes and CPT/HCPCS code sets is important for what reason?

1. They provide pricing floors for services

2. They give patients an overview of covered services

3. They offer the specificity needed for reimbursement claims

4. They are used to assess financial data for activity-based costing

The correct answer is: They offer the specificity needed for reimbursement claims

The combination of ICD-10 codes and CPT/HCPCS code sets is crucial because they provide the specificity needed for reimbursement claims. ICD-10 codes are used to describe diagnoses, whereas CPT and HCPCS codes are employed to detail the services and procedures performed. This specificity ensures that healthcare providers submit accurate and detailed charges to payers, which is essential for securing appropriate reimbursement for the services rendered. When the coding is precise and aligns accurately with the services provided, it reduces the likelihood of claim denials and facilitates a smoother reimbursement process. Therefore, utilizing both coding systems effectively is fundamental in the financial aspects of healthcare management and reimbursement strategies.