Which code set is used to report outpatient procedures?
Asked by: Florida Rath | Last update: July 11, 2025Score: 4.5/5 (15 votes)
What codes do outpatient coders use to report procedures?
The three main coding systems used in the outpatient facility setting are ICD-10-CM, CPT®, and HCPCS Level II. These are often referred to as code sets.
Which coding system is used to report outpatient procedures?
The coding system used to report outpatient and physician office procedures and professional services is CPT (Current Procedural Terminology).
What is the CPT code for outpatient procedure?
Office or Other Outpatient Services CPT® Code range 99202- 99215. The Current Procedural Terminology (CPT) code range for Office or Other Outpatient Services 99202-99215 is a medical code set maintained by the American Medical Association.
What coding is used for outpatient?
Inpatient coding utilizes ICD-10-CM and ICD-10-PCS codes to transcribe the details of a patient's visit and stay, while outpatient coding on the other hand utilizes ICD-10-CM and HCPCS Level II codes to report healthcare services.
Navigating Outpatient Procedural Coding Changes
What code set will be used for outpatient procedural coding?
CPT® refers to a set of medical codes used by physicians, allied health professionals, nonphysician practitioners, hospitals, outpatient facilities, and laboratories to describe the procedures and services they perform.
Are ICD 10 codes used for outpatient?
In the outpatient setting, the term first-listed diagnosis is used in lieu of principal diagnosis. In determining the first-listed diagnosis the coding conventions of ICD-10-CM, as well as the general and disease-specific guidelines take precedence over the outpatient guidelines.
Which of the following is used for coding outpatient procedures?
Final answer: The reference for coding services such as vaccinations and other outpatient procedures is the CPT (Current Procedural Terminology). CPT codes are used for documenting and billing outpatient services. ICD-10-CM, HCPCS Level II, and DSM-5 serve different purposes in the medical coding process.
What is the CPT code set?
Current Procedural Terminology, more commonly known as CPT®, refers to a medical code set created and maintained by the American Medical Association — and used by physicians, allied health professionals, nonphysician practitioners, hospitals, outpatient facilities, and laboratories to represent the services and ...
What is the classification system used for outpatient coding?
CPT. The Current Procedural Terminology (CPT) coding system is used for medical procedures and services, including inpatient and outpatient procedures. While the WHO maintains the ICD system, the American Medical Association (AMA) owns and maintains the CPT coding system.
What CPT code is used to report?
The CPT terminology is the most widely accepted medical nomenclature used across the country to report medical, surgical, radiology, laboratory, anesthesiology, genomic sequencing, evaluation and management (E/M) services under public and private health insurance programs.
What is the claim form used for outpatient hospital procedure billing?
The UB-04 claim form is used to submit claims for outpatient services by institutional facilities (for example, outpatient departments, Rural Health Clinics and chronic dialysis centers).
Which coding system is used to report outpatient procedures and professional services?
CPT® is a uniform coding system consisting of descriptive terms and identifying codes used primarily to identify medical services and procedures furnished by physicians and other health care professionals for which they bill public or private health insurance programs.
What is the outpatient coding policy?
In the outpatient setting, ICD-10-CM coding guidelines are used and they take priority over other coding rules. A first-listed diagnosis is the term used by medical coders in an outpatient setting, in lieu of the term “principal diagnosis,” because a diagnosis may not be established at the time of the initial visit.
Is CPC inpatient or outpatient?
The AAPC CPC credential is considered the industry standard for outpatient coding. While the AHIMA CCS credential is considered the industry standard for experienced inpatient coders, the AHIMA CCA credential is for the only entry-level coding credential that encompasses both inpatient & outpatient coding.
Are CPT codes used for outpatient?
CPT codes are used throughout the U.S. for coding in outpatient settings and for professional services provided in inpatient settings. The VHA adopted the national coding rules around 2000 for outpatient coding; national standards for coding inpatient care were implemented earlier.
What is the CPT code for additional time outpatient?
the date of an outpatient service, home or residence service, or cognitive assessment and care plan, use 99417. nursing facility E&M prolonged services on the date, use 99418 is only used when the primary service highest-level has been exceeded by 15 minutes.
What is the CPT code for outpatient psychotherapy?
Recipients may self-refer for any form of psychotherapy (CPT® codes 90832 thru 90853) delivered in an outpatient setting.
What coding system is used for outpatient?
For the most part, Outpatient uses Current Procedural Terminology (CPT) for procedures, while Inpatient utilizes ICD-10-PCS (AMA, 2022). In the CPT code set, there are three levels.
What is CPT code 99213 used for?
CPT® code 99213: Established patient office or other outpatient visit, 20-29 minutes. As the authority on the CPT® code set, the AMA is providing the top-searched codes to help remove obstacles and burdens that interfere with patient care.
How will a coder code outpatient cases differently than inpatient cases?
Outpatient coding typically involves treatments given in one visit and uses CPT/HCPCS for procedures. Inpatient coding is for patients admitted to the hospital and uses ICD-10-PCS for procedures.
Is ICD an outpatient procedure?
How is an ICD implanted? You may have an ICD implanted as an outpatient or as part of your stay in a hospital. Procedures may vary depending on your condition and your healthcare provider's practices.
Is ICD-10-PCS used to capture outpatient procedures?
ICD-10-PCS is used only for inpatient, hospital settings in the U.S., while ICD-10-CM is used in clinical and outpatient settings in the U.S. ICD-10-PCS has about 87,000 available codes while ICD-10-CM has about 68,000.
What is the procedure code for outpatient therapy?
Outpatient Mental Health CPT Codes:
90832 – Psychotherapy, 30 minutes (16-37 minutes). 90834 – Psychotherapy, 45 minutes (38-52 minutes). 90837 – Psychotherapy, 60 minutes (53 minutes and over). 90846 – Family or couples psychotherapy, without patient present.