Which statement describes how CPT codes should be linked to ICD-10 codes?

Which statement describes how CPT codes should be linked to ICD-10 codes?

• A. Directly related to the diagnosis code it is addressing
• B. Linked randomly
• C. Only used for inpatient care
• D. Not required to be linked

Answer: (A)

Linking CPT codes to ICD-10-CM codes shows that the procedure or service was performed for a specific diagnosed condition and that there is medical necessity for the service. CPT describes what was done; ICD-10-CM describes why it was done. Payers require this relationship to justify payment; if the service isn’t tied to a supporting diagnosis, claims can be denied or flagged for review. For example, a knee X-ray performed because of knee pain due to osteoarthritis should be linked to the ICD-10-CM code for that knee diagnosis, not to an unrelated condition. While you can include multiple diagnoses if the visit supports them, the service must be justified by the diagnosis codes used.

Linking CPT codes to ICD-10-CM codes shows that the procedure or service was performed for a specific diagnosed condition and that there is medical necessity for the service. CPT describes what was done; ICD-10-CM describes why it was done. Payers require this relationship to justify payment; if the service isn’t tied to a supporting diagnosis, claims can be denied or flagged for review. For example, a knee X-ray performed because of knee pain due to osteoarthritis should be linked to the ICD-10-CM code for that knee diagnosis, not to an unrelated condition. While you can include multiple diagnoses if the visit supports them, the service must be justified by the diagnosis codes used.