It is important for a healthcare manager to understand diagnosis codes like ICD-10-CM, and CPT, DRG, and HCPCS.
This is because these diagnosis codes are used together with procedure information from claims as supporting evidence of the medical necessity for the health services given to a patient and to determine appropriate reimbursement (CMS, 2020).
Medical facilities rely on healthcare insurance providers and other healthcare programs like Medicare and Medicaid.
This calls for health facilities to document patient information correctly to avoid loopholes of bouncing reimbursement, leaving patient with huge bills to pay among other reasons.
The managers need to understand these codes well as they are the ones used in processing claims. Two, these codes can be used to identify fraud and abuse of funding programs (CDC, 2015).
