Wiki outpatient facility coding

[kengel1975]

Anyone out there do this? I am a bit rusty and have a question or two about ICD procedures vs CPT's.
I have always been under the impression and understanding that outpatient facility uses CPT which correlate to APC's for payment.
Is there EVER a time you would use ICD procedures on OUTPATIENT facility procedures performed?

 

[Dorothy Steed]

Outpatient facility coding

It is usually up to the payer. The encoders that facilities typically use will apply both CPT & Volume 3 codes. However, if a payer does not want the volume 3 codes, they will be removed before releasing the claim. Example: Medicare does not want the volume 3 codes on outpatient claims. Some managed care payers want both CPT & volume 3 codes on the claim.

 

[Alta]

ICD-9 Procedure codes

We use both ICD-9 codes and CPT at our outpatient facility for procedures. The encoder gives both and we submit them to billing that way. I think it is facility specific, but some utilize those codes for tracking purposes and want them entered even though they may not go out on the bill.

 

[kengel1975]

Thanks. I have always used only CPT's on outpatient facility but recently took a test and they apparently only wanted ICD's which wouldn't always be correct anyway. Grrrrr LOL
Thanks for your replies!