Lesson 5 Summary
- Use current, valid diagnosis and procedure codes and code them to the highest level of specificity
- Enter the principal diagnosis on a claim based on the reason chiefly responsible for an admission
- Inpatient hospital claims require principal procedure codes for procedures performed
- Report the ICD-10-PCS code that identifies the inpatient principal procedure you performed at the claim level during the period covered by the bill and the corresponding date
- In most cases, Medicare automatically crosses over patients’ claims to supplemental insurers, provided those insurers participate in the Coordination of Benefits Agreement (COBA) crossover process
- The PWK segment is used to submit additional claim documentation electronically and must include a completed cover sheet provided by the MAC