This document provides an overview of diagnosis codes (ICD-10-CM), Current Procedural Terminology (CPT) codes, and how to handle denials related to invalid or missing codes. It discusses the history and purpose of diagnosis codes, how CPT codes are organized and updated annually, and steps to take if a code is found to be incorrect, such as sending to coding for correction or reprocessing a denial.

1. Company
LOGO Invalid DX & CPT
Refresher Training Series

2. Agenda
1. Diagnosis codes
2. Denial Details & How to Handle.
3. CPT codes
4. Denial Details & How to Handle.

3. Diagnosis
• DX – Condition of Illness.
• ICD 10 CM – 5-7 digit - 10/1/14
• World Health Organization.
• Every year this will be updated
• Numeric & Alpha codes ( V codes & E
codes)
• Deleted codes
• New codes

4. DX
• Originated in the 17th century England.
• Developed by the World Health
Organization (WHO).
• Introduced in 1979.
• Diagnosis codes serve to identify and justify
the medical necessity of services provided
by describing the circumstances of the
patient’s condition..
• XXX.XX Sub-category
Sub-category
Sub-category

5. Denial Handling
• Check which DX billed and check in Code
correct/Encoder is it valid or Missing any
digits.
• Confirm if the insurance also received the
same code or any truncations
• If DX is not correct send to Coding for
correction
• If it is incorrect denial send back for
reprocessing

6. CPT
• Current Procedural Terminology
• AMA
• 5 digits
• Every year this will be updated
• Deleted CPT Codes
• New CPT Codes

7. CPT - HCPCS
• CPT – Numeric codes
• HCPCS – Alpha numeric codes
• CMS
• A to V codes
• Local Medicare Carrier or Fiscal
Intermediary
• S,W & Z codes

8. CPT Description
• Anesthesia
“00” Series
• Surgery
10000-69999
• Radiology
70000-79999
• Pathology & lab
80000-89999
• Medicines
“9” Series
• Evaluation & Management Services
“99” Series

9. Surgery Classification
• “1” - Skin Related Surgeries
• “2” - Muscle & Bone Related Surgeries
• “3” - Respiratory Related Surgeries
• “4” - Digestive System Related Surgeries
• “5” - Urinary & Reproductive System
Related
• “6” - Nervous system Related Surgeries

10. Handling the Denial
• Check which CPT billed and check in
Code correct/Encoder is it valid or Missing
any digits.
• Confirm if the insurance also received the
same code or any truncations
• If CPT is not correct send to Coding for
correction
• If it is incorrect denial send back for
reprocessing

11. THANK YOU
Thank you