How do ICD-10-CM and CPT codes interact on a claim?

• A. ICD-10-CM codes describe the service performed.
• B. CPT codes provide the diagnosis reason.
• C. ICD-10-CM codes provide the diagnosis reason for the service; CPT codes describe the service performed; payer uses both for payment.
• D. They are used in separate claims and never together.

Answer: (C)

The main idea is that diagnosis codes and procedure codes work together to justify and describe the encounter for payment. ICD-10-CM codes provide the diagnosis or reason for the visit, while CPT codes describe the specific service or procedure performed. The payer uses both: the diagnosis shows medical necessity and the CPT code shows what was done, and together they determine the payment amount. ICD-10-CM does not describe the service, and CPT codes do not provide the diagnosis by themselves, so both are needed on the same claim to explain why the service was done and what was done.