ICD-10-CM codes reported in which claim form should reflect the documentation in the medical record?

ICD-10-CM codes reported in which claim form should reflect the documentation in the medical record?

• A. CMS-1500
• B. UB-04
• C. HCFA-1500
• D. EDI-claim

Answer: (A)

The main point is that which claim form is used to bill for professional (non-institutional) services, and the codes on that form must be supported by the patient’s medical record. For professional services, the standard form is the CMS-1500. This form is designed to carry ICD-10-CM diagnosis codes along with CPT/HCPCS procedure codes and is used to bill outpatient and physician services. The older name HCFA-1500 refers to the same form, but today we generally say CMS-1500. The UB-04 is used for institutional claims (hospitals, facilities), and an EDI-claim is just the electronic submission method, not a specific form. Because the professional claim form is the one used to report diagnoses documented in the medical record, ICD-10-CM codes on the CMS-1500 should reflect that documentation.

The main point is that which claim form is used to bill for professional (non-institutional) services, and the codes on that form must be supported by the patient’s medical record. For professional services, the standard form is the CMS-1500. This form is designed to carry ICD-10-CM diagnosis codes along with CPT/HCPCS procedure codes and is used to bill outpatient and physician services. The older name HCFA-1500 refers to the same form, but today we generally say CMS-1500. The UB-04 is used for institutional claims (hospitals, facilities), and an EDI-claim is just the electronic submission method, not a specific form. Because the professional claim form is the one used to report diagnoses documented in the medical record, ICD-10-CM codes on the CMS-1500 should reflect that documentation.