1. Explain terminology as related to the outpatient setting 2. Identify major differences between ICD-9-CM and ICD-10-CM related to outpatient conditions 3. Describe the difference between inpatient coding guidelines and outpatient coding guidelines 4. Describe what CPT coding is, when it is used, and the official guideline source 5. Apply Diagnostic Coding and Reporting Guidelines for Outpatient Services 6. Assign ICD-9-CM codes for outpatient services CPT only copyright © 2011. Current Procedural Terminology, 2012, American Medical Association. All Rights Reserved. Please refer to the companion Evolve website for the most current guidelines. Section IV. Diagnostic Coding and Reporting Guidelines for Outpatient Services Diagnoses often are not established at the time of the initial encounter/visit. It may take two or more visits before the diagnosis is confirmed. The most critical rule involves beginning the search for the correct code assignment through the Alphabetic Index. Never begin searching initially in the Tabular List as this will lead to coding errors. It is common in the outpatient setting for a patient to present to a physician’s office with symptoms, for administrative reasons, for follow-up on conditions that no longer exist, or with abnormal findings. A code from the Supplementary Classification of Factors Influencing Health Status and Contact with Health Services (V codes) may often be the most appropriate code. Refer to Chapter 8 for greater detail on assigning V codes. B Codes from 001.0 through V89 C Accurate reporting of ICD-9-CM diagnosis codes D Selection of codes 001.0 through 999.9 E Codes that describe symptoms and signs Codes that describe symptoms and signs, as opposed to diagnoses, are acceptable for reporting purposes when a diagnosis has not been established (confirmed) by the provider. Chapter 16 of ICD-9-CM, Symptoms, Signs, and Ill-defined conditions (codes 780.0-799.9) contain many, but not all codes for symptoms. F Encounters for circumstances other than a disease or injury
Outpatient Coding
Outpatient Terminology
Ambulatory surgery, which may also be called outpatient surgery, “in and out” surgery, same day surgery, or same day care
Observation unit, a unit to which unstable patients are admitted for a stay of less than 48 hours
Ancillary service visits/clinic visits (i.e., radiology, laboratory, chemotherapy, radiation therapy)
ICD-9-CM Official Guidelines for Coding and Reporting
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Outpatient Coding
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