Module 02 Assignment Inpatient vs Outpatient Apply Coding Guidelines Module 02 Assignment Inpatient vs Outpatient Apply Coding Guidelines Background As shown in the table below, the ICD 10 CM Coding Guidelines are organized into four sections The guidelines are in the front of the ICD 10 CM code book Chapter specific coding guidelines are also located in the Tabular List of Diseases and Injuries at the beginning of the applicable chapter It is necessary to review all sections of the guidelines to fully understand the rules and instructions needed to code properly Section Description Section I Structure and conventions, general guidelines and chapter specific guidelines Section II Guidelines for selection of the Principal Diagnosis for non outpatient settings Section III Guideline for reporting additional diagnoses in non outpatient settings Section IV Outpatient coding and reporting Instructions Using the Official Coding Guidelines in the ICD 10 CM Code Book, research each Guideline Narrative presented in the table below Based on your research, enter the Section (I, II, III, IV) and Encounter Type (Inpatient, Outpatient, or Both) in the appropriate columns provided Guideline Narrative Section Encounter Type 1 Locating a code in ICD 10 CM use both the Alphabetic Index and the Tabular List Section I Both 2 Previous conditions resolved conditions or diagnoses that have no bearing on the current stay Section III Inpatient 3 Codes for symptoms, signs and ill defined conditions are not to be used as the principal diagnosis when a related definitive diagnosis has been established Section II Inpatient 4 Selection of First Listed Conditions Section IV Outpatient 5 Site and laterality most of the codes in Chapter 13 have both site and laterality designations Section I BOTH 6 Uncertain diagnosis a diagnosis documented at the time of discharge as probable, suspected, still to be ruled out, etc indicating uncertainty, is to be coded as if the condition existed or was established based on the diagnostic workup and therapeutic approach that aligns most closely with the established diagnosis Section II Section III Inpatient 7 Patients receiving diagnostic services only Section IV Outpatient 8 Reporting the same diagnosis code more than once each ICD 10 CM code is unique and may be reported only once per an encounter Section I BOTH 9 Observation stay Section IV Outpatient 10 Uncertain diagnosis Do not code probable, suspected, rule out or other terms indicating uncertainty Code the condition to the highest degree of certainty for that encounter such as symptoms, signs, abnormal test results etc Section IV Outpatient

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Module 02 Assignment - Inpatient vs. Outpatient: Apply Coding Guidelines Module 02 Assignment - Inpatient vs. Outpatient: Apply Coding Guidelines Background: As shown in the

Module 02 Assignment - Inpatient vs. Outpatient: Apply Coding Guidelines

Background: As shown in the table below, the ICD-10-CM Coding Guidelines are organized into four sections. The guidelines are in the front of the ICD-10-CM code book. Chapter-specific coding guidelines are also located in the Tabular List of Diseases and Injuries at the beginning of the applicable chapter. It is necessary to review all sections of the guidelines to fully understand the rules and instructions needed to code properly.

Section	Description
Section I	Structure and conventions, general guidelines and chapter-specific guidelines
Section II	Guidelines for selection of the Principal Diagnosis for non-outpatient settings
Section III	Guideline for reporting additional diagnoses in non-outpatient settings
Section IV	Outpatient coding and reporting

Instructions: Using the Official Coding Guidelines in the ICD-10-CM Code Book, research each Guideline Narrative presented in the table below. Based on your research, enter theSection (I, II, III, IV) andEncounter Type (Inpatient, Outpatient, or Both) in the appropriate columns provided.

Guideline Narrative	Section	Encounter Type
1. Locating a code in ICD-10-CM; use both the Alphabetic Index and the Tabular List.	Section I	Both
2. Previous conditions; resolved conditions or diagnoses that have no bearing on the current stay.	Section III	Inpatient
3. Codes for symptoms, signs and ill-defined conditions are not to be used as the principal diagnosis when a related definitive diagnosis has been established.	Section II	Inpatient
4. Selection of First-Listed Conditions	Section IV	Outpatient
5. Site and laterality; most of the codes in Chapter 13 have both site and laterality designations.	Section I	BOTH
6. Uncertain diagnosis; a diagnosis documented at the time of discharge as probable, suspected, still to be ruled out, etc. indicating uncertainty, is to be coded as if the condition existed or was established based on the diagnostic workup and therapeutic approach that aligns most closely with the established diagnosis.	Section II Section III	Inpatient
7. Patients receiving diagnostic services only.	Section IV	Outpatient
8. Reporting the same diagnosis code more than once; each ICD-10-CM code is unique and may be reported only once per an encounter.	Section I	BOTH
9. Observation stay.	Section IV	Outpatient
10. Uncertain diagnosis; Do not code probable, suspected, rule out or other terms indicating uncertainty. Code the condition to the highest degree of certainty for that encounter such as symptoms, signs, abnormal test results etc.	Section IV	Outpatient