An ICD-10-CM code title uses the word ‘and’ between two conditions. How should a physician-office coder interpret ‘and’ in code titles under ICD-10-CM conventions?
Select an answer to reveal the explanation.
Short Explanation
In ICD-10-CM titles, ‘and’ is the sneaky one—it usually means ‘and/or.’ You don’t automatically need both listed conditions unless the context truly demands it. Read the convention, not everyday English.
Full Explanation
ICD-10-CM coding conventions state that ‘and’ in a code title should be interpreted as ‘and/or’ unless the classification context clearly indicates both conditions are required. This convention prevents incorrect refusal of a code when only one of the titled conditions is present. Coders still follow any instructional notes that explicitly require multiple conditions. The convention applies to diagnosis coding on professional claims as well as other settings.