Which two code sets are used to categorize diagnoses and procedures in billing?

• A. CPT and ICD-10-CM
• B. ICD-10-CM and CPT
• C. NCCI and EOB
• D. UB-04 and CMS 1500

Answer: (B)

Diagnoses and procedures are reported using two widely used coding systems. ICD-10-CM is used to describe and categorize diagnoses, conditions, and symptoms. CPT is used to code the specific procedures and services provided to the patient. Using ICD-10-CM for the diagnosis and CPT for the procedure gives a complete picture of what condition was treated and what service was performed, which is essential for accurate billing and reimbursement.

The other terms aren’t coding sets: NCCI and EOB relate to payment rules and explanations of benefits; UB-04 and CMS 1500 are claim forms. In inpatient settings, ICD-10-PCS may be used for procedures, but CPT is the standard for many outpatient and professional services, aligning with the scenario described.