Medical coding is a system that translates complex medical information from patients into alphanumeric codes. This makes it easier to transport the information from the hospital to insurance companies.
The patient information from their very first visit to the diagnosis and finally the treatment is all recorded in codes. It is essential that the information is well documented and medical coding is the best way to put together all the information in a comprehensive manner. There are two dimensions of medical coding – inpatient and outpatient coding. Both the codes vary with different method of documentation, let’s look at what inpatient and outpatient coding is.
What Is Inpatient Coding?
To understand inpatient coding, one must first understand what inpatient means. Inpatient is a term used to refer to a patient who is admitted to a hospital for an extended stay. The translation of the information of such as patient is called outpatient coding. This coding system keeps a track of the patient’s admission details and the services they receive.
The inpatient coding system uses ICD-9/10-CM diagnostic codes to translate the billing and reimbursement codes. On the other hand, ICD-10-PCS is used to translate the procedural coding system. Different methodology is used to translate different information such as: the Inpatient Prospective Payment System is used as a reimbursement methodology.
What Is Outpatient Coding?
Outpatient coding is the coding method designed to cater to outpatients. Outpatients are patients who receive medical treatment but are not admitted to a facility. If they are released from a facility before 24 hours are up, they are considered outpatients. The diagnostic codes used for outpatient coding are ICD-9/10-CM for the billing and reimbursements. For the report procedures, they use CPT or HCPCS.
Coders need to be very specific with their documentation if they use the CPT and HCPCS codes.
What Are the Differences Between Inpatient and Outpatient Coding?
The Basics
Since coding depends on the documentation of every single detail, you may find more information to document with an inpatient. They stay in the facility for longer and may need extensive care and treatments. Outpatients are not required to stay within the facility and therefore, there is not a lot of information to be documented. The outpatient coding of such a patient is usually related to their doctor visits. The report has more details but only curtails to the information from a singular visit.
On the other hand, the inpatient coding depends on the complete stay of the patient within the facility. It is more detailed and caters to every single treatment the patient receives.
Coding Systems
The coding systems for both in-patient and outpatients are different. The code ICD09/10-CM is used to assess the billing and reimbursement for the inpatients. These codes are the standard for physicians and other healthcare professionals. These experts use this code for their diagnosis and further classifications. Moreover, they use the ICD-10-PCS to record the information of all the procedures.
Here, you can find some similarity, as outpatient coding also uses IC-9/10-CM for their outpatient coding services with the exception of reimbursements. For the reimbursements, they depend on the code assignments delivered by the CPT and HCPCS. They contribute greatly to the codes for services for documentation.
Inpatient coding system can be more complex as it focuses on every aspect of the treatment. Since inpatient treatment is extensive, there is a lot of detail for coders to document such as the services they receive from the anesthesiologist, the nurses and of course, the main practitioner. The details may also include every single medical test the patient needs for diagnosis. For instance, they may need regular blood work or x-rays to keep up with the advancements of their medical problem.
Diagnosis
Before coders focus on the main diagnosis, they also have to focus on the principal diagnosis. Principal diagnosis is basically the initial diagnosis that explains the purpose of admission for the inpatient. This principal diagnosis is the first thing to be documented in inpatient coding and it decides the services the patient is to receive further during treatment. If the assignment is correct, it will determine if the payment is correct and paid properly. This term does not relate to outpatients as they are not admitted, and do not have a proper diagnosis in the very first visit.
Payment Methods
The payment methods involved in both the dimensions are different. IPPS methodology is used for inpatient treatment. The IPPS (Inpatient Prospective Payment System) is used by health care experts and the government programs who reimburse inpatient treatments. There are groupings of patients with the same diagnoses so that they can share hospital resources. The groups are called GRG’s.
On the other hand, the outpatient coding uses the OPPS (Outpatient Prospective Payment System) this prospective payment system is responsible for the reimbursement for hospital outpatient treatment. This payment system is called the Ambulatory Payment Classifications.
There are several differences between the two, including the qualifications required to be an inpatient or an outpatient coder. If you want a job in a medical coding company, it is important that you get the right kind of qualification, depending on the coding field you want to pursue. Even though the basics may be same, but the details and complexities bring up many differences.
