Outpatient Facility Coding Alert

Published on Fri Dec 20, 2013 PDF

Question: Should we be capturing ICD-9 procedure codes for ED facility coding? I understand it is not required; however, I’d like to get an idea of the standard practice among other hospitals.

Virginia Subscriber

Answer: These are special ICD-9 procedure codes, not diagnosis codes. They are different than the more common and ICD-9-CM diagnosis and CPT® codes. ICD-9 procedure codes are typically only applicable when the patient is assigned to inpatient status. Most hospitals don’t assign ICD-9 procedure codes to any procedure performed for a patient who is in an outpatient status (such as the ED) since the code set isn’t applicable in that setting of care. Note that, if for some reason, the ICD procedures are included on outpatient claims or if a payer requests them for some reason, the CPT® procedure codes correlate appropriately with the ICD-9 procedure codes.

Note: Just as ICD-9-CM will be transitioning to ICD-10-CM in October 2014, the PCS system will also undergo extensive reporting changes. Watch for updates on changes applicable to hospitals in Outpatient Facility Coding Alert.