What is a key function of the outpatient code editor?

A key function of the outpatient code editor is to identify unbundling of codes. Unbundling refers to the practice of billing separately for procedures that are typically bundled together under a single code in order to increase reimbursement. The outpatient code editor is specifically designed to assess the coding of outpatient services to ensure compliance with coding guidelines and to detect instances where unbundling may have occurred. By identifying these discrepancies, the editor helps ensure accurate coding and compliant billing practices, ultimately safeguarding against potential audits and penalties.

In contrast, while assigning procedures accurately, creating patient billing statements, and analyzing payer reimbursement rates are important aspects of the revenue cycle and coding processes, they do not represent the primary function of the outpatient code editor. The editor focuses explicitly on the identification of coding practices, including the prevention of unbundling and ensuring adherence to coding standards.