What codes are typically used to report outpatient procedures on UB-04?

• A. DRG codes.
• B. CPT/HCPCS codes for outpatient procedures, often in combination with revenue codes and diagnosis codes.
• C. ICD-10-CM codes only.
• D. ICD-10-PCS codes only.

Answer: (B)

Outpatient procedures on the UB-04 are reported using CPT/HCPCS codes because these codes are specifically designed to identify the procedures, services, and supplies provided in outpatient settings. They capture what was done during the visit or treatment, and are typically paired with revenue codes that indicate the department or service area (such as radiology, ambulatory surgery, or laboratory). Diagnosis codes (ICD-10-CM) may be included to show the medical reason for the procedure, but the actual procedural item is coded with CPT/HCPCS.

DRG codes are used to classify inpatient stays for payment purposes, not outpatient procedures. ICD-10-CM codes alone are diagnosis codes and do not describe the procedures performed. ICD-10-PCS codes are inpatient procedure codes used for hospital facility procedures on inpatient claims, not for outpatient services.