Outpatient Services Overview (Pg.65-66)
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Questions and Answers

What are outpatient services also known as?

  • Ambulatory services (correct)
  • Long-term care services
  • Inpatient services
  • Emergency services

Which forms are used for billing outpatient services?

  • HCFA 1500 form
  • CMS-1450 form
  • CMS1500 claim form (correct)
  • UB-04 claim form

What is the term used for the primary diagnosis in outpatient coding?

  • First-listed diagnosis (correct)
  • Principal diagnosis
  • Primary condition
  • Main diagnosis

When assigning a first-listed diagnosis for outpatient surgery, what should be coded?

<p>Reason for the surgery (D)</p> Signup and view all the answers

What is crucial when searching for the correct code assignment?

<p>Start with the Alphabetic Index (A)</p> Signup and view all the answers

If a patient develops complications after outpatient surgery and requires admission for observation, what should be coded first?

<p>The reason for the surgery (C)</p> Signup and view all the answers

Which setting is NOT typically considered an outpatient service?

<p>Inpatient hospital ward (B)</p> Signup and view all the answers

When may diagnoses not be established in outpatient settings?

<p>During the first visit (B)</p> Signup and view all the answers

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.

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