November 07, 2013 | | Comments 2
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Outpatient coding and ICD-10-PCS

Initially, we thought that outpatient coders didn’t have to learn to code in ICD-10-PCS. They would still use CPT® codes to report physician services in the outpatient world.

question marksNow it looks like that might not be the case everywhere. During the AHIMA Conference in Atlanta October 26-30 the topic of outpatient coders using ICD-10-PCS came up repeatedly.

Some facilities now require coders to report ICD-9-CM procedure codes for outpatient services so they can compare data for inpatient and outpatient services, outcomes, etc. Some commercial payers also require ICD-9-CM procedure codes for outpatient services.

The jury is still out on what payers will do once we transition to ICD-10. But facilities should start to think about training outpatient coders on ICD-10-PCS. Outpatient coders are used to looking for information in the operative report that inpatient coders don’t need to see now. That should help outpatient coders in ICD-10-PCS.

However, what physicians need to document for CPT code assignment is not always the same as what they need to document for ICD-10-PCS. You knew it couldn’t be easy, right?

Having everyone code in ICD-10-PCS could be a good thing. We would get standardized data on all procedures, regardless of the setting. We would also have more coders who can fill in when someone is on vacation, out sick, or leaves the organization.

On the downside, training all coders on ICD-10-PCS costs money and takes time. It will also probably decrease productivity, which could result in a slowdown in reimbursement.

Weigh the pros and cons at your organization and talk to your payers. Then decide whether to bring the outpatient coders into the ICD-10-PCS world.

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Filed Under: Plan for implementation

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Michelle A. Leppert About the Author: Michelle A. Leppert, CPC, is a senior managing editor for JustCoding.com. JustCoding provides coders, coding supervisors, and health information management (HIM) directors with educational resources to test their coding knowledge, employ correct coding guidelines, and stay abreast of CMS transmittals.

In addition, she writes and edits the HCPro publication, Briefings on Coding Compliance Strategies. Email her at mleppert@hcpro.com.

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  1. Debbie Mackaman

    This is an excellent point that providers should take into thoughtful consideration. Most, if not all payers will be moving to I-10 like the rest of us. Although it may appear to cost more and may reduce coder productivity to train outpatient coders in PCS now, it makes more sense to have the skill and not need it rather than need the skill and not have it on October 1. Conversion to I-10 has been a costly and labor intensive “adventure” and most hospitals cannot afford to have reimbursement withheld because they were not prepared to assign PCS to its outpatient service line.

  2. We currently use ICD and CPT to code “surgical” procedures on an outpatient basis. However, we also code some things like PT/OT with an ICD code while the CPT is assigned by the chargemaster. I am trying to decide what we need to ICD code and what we don’t. Has anyone out there set up guidelines for this? I would sure appreciate the input.

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