Chapter 18: FACILITY PROGRAMS AND SERVICES 2025

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Nursing homes, also called skilled nursing facilities, provide a wide range of health and personal care services. Their services focus more on medical care than most assisted living facilities or board and care homes.
Inpatient medical coding is reported using ICD-10-CM and ICD-10-PCS codes, which results in payments based on Medicare Severity-Diagnosis Related Groups (MS-DRGs). Outpatient medical coding requires ICD-10-CM and CPT/HCPCS Level II codes to report health services and supplies.
The Healthcare Common Procedure Coding System (HCPCS) is used to report hospital outpatient procedures and physician services. These coding systems serve an important function for physician reimbursement, hospital payments, quality review, benchmarking measurement and the collection of general medical statistical data.
Setting: Ambulatory Surgery Centers (ASCs), also known as outpatient surgery centers or day surgery centers, are healthcare facilities designed specifically for performing same-day surgical procedures. They are not attached to a hospital and are usually more streamlined in terms of services.
True or False: CPT-4/HCPCS codes are used only in physicians offices and outpatient clinics. False.
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Health facilities are places that provide health care. They include hospitals, clinics, outpatient care centers, and specialized care centers, such as birthing centers and psychiatric care centers.

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