In ICD-10-CM when a patient is seen for routine examination what additional information needed in order to accurately code the examination?
In ICD-10-CM, when a patient is seen for a routine examination, the following additional information is needed in order to accurately code the examination:
* The type of examination. This could be a physical examination, a laboratory test, an imaging study, or another type of examination.
* The reason for the examination. This could be for a routine checkup, to diagnose a medical condition, or to monitor a medical condition.
* The results of the examination. These could be normal results, abnormal results, or inconclusive results.
This information is needed in order to assign the correct ICD-10-CM code for the examination. For example, the code for a routine physical examination is Z00.1, while the code for a laboratory test for blood glucose is 830.0.
By providing this additional information, you can help ensure that the examination is coded correctly and that the patient's medical record is accurate.