What do ICD-10-CM codes establish for the services and procedures provided to a patient?

ICD-10-CM codes are primarily used to establish medical necessity. This means that these codes help to confirm that the services and procedures performed for a patient are justified based on the patient's diagnosis. When healthcare providers submit claims for reimbursement, insurers require evidence of medical necessity, which is often conveyed through the appropriate diagnosis codes assigned using ICD-10-CM.

Medical necessity ensures that healthcare services are reasonable and necessary for the diagnosis or treatment of a patient's condition, making it a crucial component in the reimbursement process. Accurate coding also supports clinical decision-making and demonstrates the need for specific treatments or interventions, as it links the care provided to the specific health issues diagnosed.

While coding does relate to billing accuracy, diagnostic codes, and procedure classification, the primary function of ICD-10-CM in the context of patient services is to establish that those services were medically necessary based on the diagnosis.