For reimbursement, what must be included in the submission for linking ICD-10-CM and CPT codes?

The inclusion of the diagnosis pointer is essential for linking ICD-10-CM and CPT codes during the reimbursement process. The diagnosis pointer serves as a crucial element that connects the physician's diagnosis, represented by the ICD-10-CM codes, to the specific procedures or services provided, which are indicated by the CPT codes. This linkage is vital because it helps payers understand the medical necessity of the services billed.

By clearly identifying the diagnosis pointers, healthcare providers ensure that the claims submission accurately reflects the patient's condition and the relevant treatments performed, facilitating proper reimbursement. Without this linkage, insurance claims may be denied due to insufficient justification of the procedures based on the diagnosis.

Other options such as claim status, prior authorization, and detailed operative reports may play significant roles in the billing process but do not establish the direct connection needed between the diagnosis codes and the procedure codes for reimbursement.