Question

Diagnosis reference numbers are entered on the CMS-1500 claim to__________

1) Report mortality data
2) Report morbidity data
3) Analyze quality of services provided
4) Justify medical necessity

Answer 1

Diagnosis reference numbers on the CMS-1500 claim are used to justify medical necessity. They ensure that treatments and tests are appropriate for the diagnosed condition and facilitate accurate billing and insurance reimbursement.

Step-by-step explanation:

Diagnosis reference numbers are entered on the CMS-1500 claim form primarily to justify medical necessity for the treatments provided. This system utilizes the International Classification of Diseases (ICD) codes, which are integral in clinical fields for the classification of diseases and the monitoring of morbidity (the number of cases of a disease) and mortality (the number of deaths due to a disease). These codes help in ensuring that the treatments and laboratory work performed align with the specific health issue diagnosed. For instance, if a patient is treated for a viral infection, the relevant ICD code is essential for the healthcare management system to verify that the treatments and laboratory tests ordered are appropriate for that virus. In the context of completing the CMS-1500 claim form, the correct answer to the student's question is to justify medical necessity. Diagnosis reference numbers help to confirm that the services billed are necessary and appropriate for the condition diagnosed. This process also involves medical coders and billers utilizing these codes to process claims accurately for insurance reimbursement.