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Questions and Answers
What are outpatient services also known as?
Which forms are used for billing outpatient services?
What is the term used for the primary diagnosis in outpatient coding?
When assigning a first-listed diagnosis for outpatient surgery, what should be coded?
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What is crucial when searching for the correct code assignment?
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If a patient develops complications after outpatient surgery and requires admission for observation, what should be coded first?
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Which setting is NOT typically considered an outpatient service?
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When may diagnoses not be established in outpatient settings?
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Study Notes
Outpatient Services Overview
- Outpatient services, or ambulatory services, are provided without hospital admission or overnight stays.
- Examples include labs, x-rays, ultrasounds, and outpatient surgeries.
- Billing for outpatient services utilizes the CMS1500 claim form.
Outpatient Settings
- Common settings for outpatient services include:
- Doctor’s offices
- Clinics
- Ambulatory surgery centers
- Emergency rooms
- Outpatient hospital departments
- Outpatient surgical centers
- Home health care services
Guidelines for Outpatient Services
- Outpatient services are governed by specific guidelines found in Section IV of Diagnostic Coding and Reporting Guidelines for Outpatient Services.
- Coders must be familiar with these guidelines when coding for outpatient physician services.
Coding Considerations
- In outpatient settings, the term "first-listed diagnosis" replaces "principal diagnosis."
- The coding conventions of ICD-10-CM should be prioritized along with general and disease-specific guidelines to determine the first-listed diagnosis.
- Initial visits might not establish a diagnosis, requiring additional visits for confirmation.
Coding Procedure for Outpatient Surgery
- Code the reason for surgery as the first-listed diagnosis, even if the procedure is not performed due to contraindications.
Observation Stay Coding
- Assign a code for the primary medical condition as the first-listed diagnosis when a patient is admitted for observation.
- If complications arise from outpatient surgery that requires observation admission, code the reason for surgery first, followed by codes for complications as secondary diagnoses.
Coding Search Process
- Always begin code searching in the Alphabetic Index to avoid coding errors; do not start in the Tabular List.
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Description
This quiz covers the essentials of outpatient services, also known as ambulatory services. It includes various types of outpatient settings such as doctor's offices, clinics, and outpatient surgical centers. Test your knowledge on the services provided and the billing process associated with these services.
