COC Outpatient Coding Guidelines 1 — Questions and Answers
Question 1: According to the UHDDS/OGCR, what is the principal diagnosis for outpatient coding?
- The condition established after study to be chiefly responsible for occasioning the visit (Correct answer)
- The most chronic condition present
- The reason the patient called to make the appointment
- The diagnosis with the highest RVU
Correct answer: The condition established after study to be chiefly responsible for occasioning the visit
For outpatient coding, the principal diagnosis is the condition established after study to be chiefly responsible for the visit, as defined in the Uniform Hospital Discharge Data Set.
Question 2: For outpatient encounters, when a diagnosis is qualified as 'probable' or 'suspected,' the coder should:
- Code the sign, symptom, or abnormal finding — NOT the unconfirmed diagnosis (Correct answer)
- Code the qualified diagnosis as if confirmed
- Query the physician before coding
- Leave the diagnosis field blank
Correct answer: Code the sign, symptom, or abnormal finding — NOT the unconfirmed diagnosis
Unlike inpatient coding, outpatient guidelines prohibit coding uncertain diagnoses ('probable,' 'suspected'); instead, code the presenting sign, symptom, or test result.
Question 3: When coding an outpatient surgery visit, if the postoperative diagnosis differs from the preoperative diagnosis, the coder should code:
- The postoperative (confirmed) diagnosis (Correct answer)
- The preoperative diagnosis
- Both diagnoses with equal sequencing
- The diagnosis with the higher severity weight
Correct answer: The postoperative (confirmed) diagnosis
Per outpatient coding guidelines, the postoperative diagnosis is coded because it represents the most definitive diagnosis established after the procedure.
Question 4: In outpatient coding, a 'chronic condition' may be coded:
- As many times as applicable to the encounter when it affects care (Correct answer)
- Only once per fiscal year
- Only when it is the primary reason for the visit
- Only if it changed during this encounter
Correct answer: As many times as applicable to the encounter when it affects care
Chronic conditions are coded whenever they are relevant to and affect the management of the patient during the encounter.
Question 5: For an outpatient encounter, how should an abnormal diagnostic test result be coded when no diagnosis has been confirmed?
- Code the abnormal finding directly using the appropriate code (Correct answer)
- Wait for the physician to query before coding
- Code as 'examination, unspecified'
- Do not code until a definitive diagnosis exists
Correct answer: Code the abnormal finding directly using the appropriate code
If a definitive diagnosis has not been confirmed, the abnormal finding or sign/symptom should be coded directly using the appropriate ICD-10-CM code.
Question 6: Which coding guideline applies when a patient is seen for a pre-operative physical examination?
- Code the pre-op examination code plus the condition requiring surgery (Correct answer)
- Code the condition requiring surgery as the principal diagnosis
- Code only the examination; omit the condition
- Code status codes only
Correct answer: Code the pre-op examination code plus the condition requiring surgery
For pre-operative physicals, code the encounter for pre-op exam (Z01.810–Z01.818) along with the condition that necessitates the surgery.
COC Outpatient Coding Guidelines 1
According to the UHDDS/OGCR, what is the principal diagnosis for outpatient coding?