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For the Week of September 1, 2014


If I use HCPCS codes to report hospital outpatient services at the “required” service line level segment for a claim, may I use the ICD-9-CM procedure codes to report hospital outpatient services at the claim level “situational” segment?


NO. ICD-9-CM procedure codes were named as the HIPAA standard code set for inpatient hospital procedures but not for procedures in other settings such as hospital outpatient services or other types of ambulatory services.

Hospitals may capture the ICD-9-CM procedure codes for internally tracking or monitoring hospital outpatient services, but when conducting standard transactions, hospitals must use HCPCS codes to report outpatient services at the service line level and the claim level, if the situation applies. Even though an ICD-9-CM procedure code qualifier is available, in addition to a HCPCS code qualifier, at the "situational" claim level segment, the Transactions and Code Sets regulation states that ICD-9-CM procedure code system is the adopted standard code set for hospital inpatient services.

Reminder: October 1, 2015 the ICD-9-CM procedure code set is replaced by the ICD-10-PCS procedure code set.

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