For billing purposes, facilities are only required to code and submit CPT® codes for outpatient services; however, pre-ICD-10 implementation, many facilities captured both CPT and ICD-9 procedure codes for purposes other than billing.
On Sept. 1, 2015, the Talk Ten Tuesdays Internet radio broadcast produced by ICD10monitor presented a poll to see how many of our listeners were planning to code their outpatient services in ICD-10-PCS. We asked the same question on the July 19, 2016 broadcast, and the following is a comparison of the results, pre- and post- ICD-10 implementation.
What hospital outpatient services are you coding/planning to code in ICD-10-PCS? | |||||||
| 2016 | 2015 | |||||
HIM historically ICD-9 coded outpatient procedures | 7% | 9% | |||||
Outpatient surgery procedures | 6% | 3% | |||||
Observation/ED procedures | 0% | 4% | |||||
Clinic type procedures | 0% | 1% | |||||
Ancillary type procedures | 1% | 1% | |||||
Combination of the above | 27% | 19% | |||||
I don't know what our facility is doing/not sure yet | 17% | 7% | |||||
None or not applicable | 41% | 57% |
Some of the reasons facilities are coding ICD-10-PCS codes for outpatient procedures are:
- Their states require this data.
- The internal quality program leverages the ICD-10-PCS codes to group inpatient and outpatient procedure data.
- The payer contract requires this data.
- The facility has always collected the ICD procedure codes for outpatient procedures.
- Medical registries are using ICD-10-PCS codes to compare inpatient and outpatient procedure data.
- It increases the flexibility of their inpatient and outpatient coding staffs.
- Using the additional codes decreases coder productivity.
- Coding CPT only maintains consistency with HIPAA and national code set regulations.
- Doing so decreases the number of staff members requiring ICD-10-PCS training.
- The data is not useful internally and not required externally.
Need I remind everyone that we went from about 4,000 to 75,000 procedure codes when we transitioned from ICD-9-CM to ICD-10-CM/PCS? Consequently, understanding the use of the data is important.
If your facility is going to spend the extra coding resources to code all outpatient procedures in CPT/HCPCS and ICD-10-PCS, ensure that the data has a purpose.