What codes are used for inpatient services?

• A. DRGs for hospital reimbursement, ICD-10-CM, and CPT codes for surgeries and consults
• B. CPT codes for outpatient services
• C. ICD-10-CM for diagnoses only
• D. E/M codes only

Answer: (A)

In inpatient coding and reimbursement, the payment system relies on a mix of coding methods that together capture what happened during the stay and how the stay is paid. Diagnosis information is coded with ICD-10-CM, which records why the patient was admitted. The hospital uses DRGs—Diagnosis-Related Groups—to categorize the stay for payment, with the DRG reflecting the overall complexity and resources used. For the procedures performed, CPT codes are used to report surgeries and other professional services provided by physicians, including consults. This combination—DRGs for hospital reimbursement, ICD-10-CM for diagnoses, and CPT for procedures and professional services—provides a full picture of the inpatient encounter and how it’s paid.

Outpatient CPT codes cover services outside the inpatient setting, ICD-10-CM isn’t used alone for procedures, and E/M codes alone don’t address the full inpatient payment framework.