What is meant by code to the fullest extent of the procedure?

Answer 1

It's asking that you use the most specific code that applies to the procedure/diagnosis. An diagnosis example is:

code 729.7 is Non-traumatic Compartment syndrome

code 729.71 is Non-traumatic Compartment syndrome of upper extremity

So on the bill to the insurance company they'll want the code similar to the 729.71 since it is more specific than the 729.7 code.

For the above code, there are additional ones for lower extremity and other locations as well as a final "catch-all" for unknown location which I didn't list. In all cases you would put the 729.7x code.

A procedure code would follow the same lines as the diagnosis example listed above. You simply select the procedure code that meets the requirements of the highest listed procedure. Most often this is measure by a count of some specific item such as minutes, units, or number of locations. This may require an additional modifier to narrow the code even further.

I would think your original question was intended to be directed toward the diagnosis version since doctors have more flexibility with the procedure side. It is common to use a lower paying procedure in an effort to give a break to a patient (and insurance companies aren't going to complain about that one)