Outpatient Encounters: First Listed or Primary Diagnosis Assignment Course

Description

In this course, participants will gain comprehensive insights into the critical process of selecting the 'first listed' or 'primary' diagnosis for outpatient encounters, including those in ancillary, emergency room, clinic, and outpatient surgery settings. This course offers a deep dive into both facility coding and professional fee coding and billing, with a primary focus on facility coding. Participants will explore the official coding guidelines for outpatient reporting, as well as CMS transmittals addressing this topic. Through in-depth instruction, real-world examples, and practical guidelines, learners will enhance their proficiency in ensuring accurate and compliant diagnosis assignment, a crucial aspect of outpatient medical coding.

Included Lessons:

Introduction
Facility Primary Diagnosis Coding of Outpatient Encounters
Professional Fee Primary Diagnosis Coding of Outpatient Encounters
Common Errors Found in Primary Diagnosis Identification

CEUs available for the following credentials:

AAPC

COC, CPC, CPC-P, CANPC, CASCC, CCC, CCPC, CCVTC, CDEI, CDEO, CEDC, CEMC, CENTC, CFPC, CGIC, CGSC, CHONC, CIC, CIMC, COBGC, COPC, COSC, CPB, CPCD, CPCO, CPEDC, CPMA, CPMS, CPPM, CPRC, CRC, CRHC, CSFAC, CUC

AHIMA

CCA, CCS, CCS-P, RHIT, RHIA, CDIP, CHDA, CHPS

Key Takeaways

Medical coders who complete this course will be equipped with several key takeaways. Some key

Understanding of Primary Diagnosis Significance: Participants will grasp the significance of selecting the appropriate "first listed" or "primary" diagnosis for outpatient encounters, recognizing its impact on insurance claims, reimbursement, and accurate medical coding.
Application of Official Guidelines: Coders will become proficient in applying the official coding guidelines for outpatient reporting, ensuring compliance with industry standards and regulations.
Differentiated Facility and Professional Fee Coding: Learners will be equipped to differentiate between facility coding and professional fee coding, with a primary focus on facility coding practices, enhancing their coding accuracy and efficiency in outpatient settings.
Handling Symptoms and Uncertain Diagnoses: Coders will learn how to handle cases where diagnoses are uncertain or where symptoms are the primary reason for the encounter, ensuring proper coding practices in these situations.
Incorporating Disease-Specific Guidelines: Participants will understand the importance of disease-specific guidelines in outpatient coding and how they take precedence over outpatient-specific guidelines in certain cases.
Managing Incidental Findings: Coders will be skilled in managing incidental findings in diagnostic tests, knowing when and how to report them as secondary diagnoses.
Applying Z Codes: Learners will gain proficiency in using Z codes for encounters related to circumstances other than diseases or injuries, such as preoperative evaluations or routine health screenings.
Proper Sequencing of Diagnoses: Participants will understand the proper sequencing of diagnoses, ensuring that the primary diagnosis accurately reflects the reason for the outpatient encounter.

Why is it important to select the "first listed" or "primary" diagnosis for outpatient encounters?

Choosing the correct primary diagnosis is crucial because it determines how the encounter is categorized for billing and reimbursement. It impacts the overall claim, influences insurance coverage decisions, and ensures proper reporting of the patient's primary reason for the visit.

What should I do when a diagnosis is uncertain or not established during an outpatient encounter?

When a diagnosis is uncertain or not yet established, code the symptoms or signs that prompted the encounter. Avoid coding "probable," "suspected," or similar terms. Code the condition(s) to the highest degree of certainty for that specific encounter/visit.

How should I handle incidental findings in diagnostic tests?

Incidental findings should not be listed as primary diagnoses. Instead, report them as secondary diagnoses if relevant to the patient's condition. The primary diagnosis should accurately reflect the reason for the patient's visit or the specific condition addressed during the encounter.

About our Medical Coding Courses

HIAlearn, powered by Health Information Associates (HIA)—a leader in medical coding and auditing for more than three decades—offers a comprehensive online education platform for medical coders. With a catalog of over 200 medical coding courses accepted by the American Health Information Management Association (AHIMA) for Continuing Education Units (CEUs) and a selection approved by the American Academy of Professional Coders (AAPC), HIAlearn caters to both beginners and experienced medical coders seeking to enhance their skills. The platform provides an array of training plans tailored to meet individual learning needs, from mastering challenging coding procedures to understanding broad conceptual frameworks within the coding world. Courses are available across various coding types including CPT, E/M, ICD-10-CM, ICD-10-PCS, and are designed to cater to different coder levels and coding specialties such as inpatient, outpatient, profee, and CDI. Additionally, HIAlearn offers a Coding Updates bundle to ensure coders are up-to-date with the annual changes in ICD-10-CM, ICD-10-PCS, CPT, and IPPS. Beyond individual learning, HIAlearn supports organizations with group discounts, promoting enhanced coding accuracy, efficiency, and compliance across teams.