What codes are used for outpatient services?

• A. DRGs for hospital reimbursement, ICD-10-CM, and CPT for surgeries
• B. CPT codes for services performed, ICD-10 codes to justify medical necessity, and E/M codes for time and complexity
• C. ICD-10-CM only
• D. E/M codes only

Answer: (D)

Outpatient encounters are coded with evaluation and management (E/M) codes. These codes specifically capture the work involved in an outpatient visit—the history taken, the examination performed, and the level of medical decision making (or the time spent with the patient). This coding directly reflects the nature and intensity of the office or clinic visit and drives reimbursement for that encounter.

DrGs are designed for inpatient hospital stays, not outpatient visits. ICD-10-CM codes list the patient’s diagnoses but don’t describe the service performed. CPT encompasses a broad range of procedures and services, but when describing the outpatient visit itself, the E/M level is the primary coding used to reflect the encounter’s complexity and time. Additional CPT codes for procedures and ICD-10-CM codes for diagnoses are used as appropriate, but the outpatient visit’s billing is centered on the E/M code.