Today there is a lot of emphasis on inpatient coding and billing given that we are just days away from the implementation of the ICD-10 coding system. The necessity of looking at coding for the outpatient procedures is almost negligible, given that just the CPT/HCPCS procedures will be employed and no change is required in outpatient coding procedures.
As part of ICD-10 implementation:
However, federal law does not require any change especially for the outpatient procedures. But, it has to be noted that some CPT codes will now be required for reimbursement, especially for the non-covered entities. Further, based on certain Medical necessity criteria, reimbursements of certain outpatient services are restricted by Medicare. And if the diagnosis codes do not support the medical necessity for the procedures submitted, then the claim for payment can be denied. Moreover, outpatients have several other riders, one being that unless a patient signs an Advanced Beneficiary Notice (ABN) prior to receiving the service, the provider may not bill the patient for these services and thus the hospital is left without any payment despite the service rendered.
So although the outpatient procedures under the ICD-10 codes will not be impacted directly, there will be some underlying changes that will be required for the following reasons-
According to MedPac’s report to Congress in March 2012 on Medicare Payment Policy, in 2010, the 4,800 hospitals that participated in the Medicare system showed that Hospital-based outpatient business grew by 8.8% over that period, contrasted with inpatient volume increase of 2.7%. Today, outpatient visits account for over 31% of total hospital reimbursement. Given the ACA which plans to bring in nearly 40 million people who have so far had no coverage, the number of outpatients will increase. So if you want to keep those reimbursements flowing, then employing ICD-10 codes also for the outpatient procedures is essential as the benefits far outweigh that of using just the CPT codes for outpatient procedures.
But the most beneficial advantage that ICD-10 coding brings to outpatient procedures will be standardization and better quality research on how to improve health care for the masses.