When you own a small medical practice, you know all about the fine line you have to balance between providing quality patient care while also staying on top of your medical coding and billing – not to mention adhering to all the inpatient and outpatient coding guidelines.

Whether it’s for securing the right amount of reimbursement for your medical services rendered or simply ensuring your patients’ diagnoses are properly documented, your medical coders play a major part in the overall stability of your medical practice.

As a result, your medical billing team must always be aware of the official coding guidelines for both inpatient coding and in an outpatient setting.

This can be a fairly convoluted experience without the time and resources available to larger practices, so we’ll be breaking down all you need to know about outpatient medical coding within this article.

Current Procedural Terminology (CPT) Codes

First on our list, we have CPT codes. These are fairly integral codes for following outpatient and inpatient coding guidelines and are ultimately used for describing things like medical procedures, services, and tests, too.

Let’s take a look at the three main categories CPT codes are organized into:

Evaluation and Management (E/M) Codes

E/M codes are primarily used for describing patient encounters – think of things such as office visits, consultations, and even hospital follow-ups.

Basically, they take into account factors like the complexity of their medical history and the level of physical examination provided.

Procedure Codes

These are slightly different as they refer to medical interventions instead. For example, surgeries, diagnostic tests, and therapeutic procedures, too. Each one of these procedures is then assigned a specific CPT code which essentially allows for accurate billing.

Ancillary Service Codes

Lastly, ancillary service codes are used for things such as laboratory tests and radiology services which help categorize all the different tests used to diagnose and treat a patient.

ICD 10 CM

Next up, we have ICD-10-CM codes which are used for labeling and grouping together different health problems, from basic things like common colds all the way to rare cancers.

In essence, they’re composed of up to seven different characters – a letter and two numbers for the main category and then a few more letters or numbers for any more relevant details.

As an example, “M54.50” refers to low back pain. The ‘M’ here stands for musculoskeletal diseases, while the ’54’ refers to dorsalgia (back pain). The ‘5’ stands for low back pain, but the ‘0’ signifies that it’s an unspecified kind of back pain. For some more context, the ‘0’ would change if the back pain was properly specified, such as M54.51 for vertebrogenic back pain.

Healthcare Common Procedure Coding System (HCPCS) Codes

Lastly, let’s take a look at the HCPCS – a coding system used for grouping different services and nonphysician services provided to Medicare and Medicaid patients.

Generally speaking, it’s vital to get these codes rights to properly adhere to the outpatient prospective payment system (whereas the inpatient prospective payment system is used in inpatient facilities).

Similarly to ICD 10 CM codes, HCPCS codes are composed of five characters: either a letter followed by four numbers or four numbers then followed by a letter.

Why Are They Important?

In essence, these codes are vital for overall billing and reimbursement purposes. They’re not limited to, but they generally help with:

– Identifying and reporting the items and services provided to patients

– Determining the correct payment rates and policies for various different payers

– Ensuring compliance with Medicare and Medicaid rules and regulations

PMN

Naturally, there’s a lot here to remember for small medical practice owners and their billing teams, with little to no margin for error if you wish to remain profitable.

So, to aid your overall medical billing process for both inpatient and outpatient coding, consider partnering with PMN! Their team of experienced coders possess all the relevant knowledge and skills necessary to receive proper reimbursement for your services without the added risk of claim denials.

Aside from ensuring that all your claim submissions are sent without any errors that could lead to delays, the PMNs team of experts is also incredibly well-versed in the ever-evolving changes to medical coding guidelines and regulations, having over 20+ years of experience in compliance.

This means that not only does the team at PMN have the technical skills needed to manage your billing and coding process, but they also understand the general importance of compliant coding practices and the implication this can have on your practice’s success.

If you wish to hear more about the impact PMN can have on your healthcare facility, do not hesitate to get in touch with one of their friendly staff members by calling (949) 215-5055. In addition, you can also visit their office in Laguna Hills, Orange County, California, if you’d prefer to chat in person.

FAQs

How Can I Stay Updated With Changes In Outpatient Coding?

Staying informed about changes in outpatient coding is undeniably essential for medical practice owners, regardless of the size. While you can always subscribe to reputable coding newsletters and attend things such as coding conferences or webinars, the best means of staying compliant is always to outsource to a third-party medical billing company.

What Are The Consequences For Inaccurate Outpatient Coding?

Inaccurate outpatient coding can have significant consequences for small medical practices. Aside from the more obvious issues such as claim denials, delayed payments, and things such as audits and investigations, you also run the risk of under or over-billing, which can have a serious impact on your revenue and create financial instability in your practice.