Hospital Inpatient and Outpatient Coding

Both Inpatient and Outpatient coding greatly impacts the compliance and reimbursement success of a facility wherein the two have a different procedures, diagnoses, and reimbursement methodologies.

Inpatient and Outpatient Coding

Inpatient Coding uses ICD-10-CM/PCS, and Outpatient coding uses CPT and HCPCS Level II Codes for procedures and services.

Inpatient coding is a review of the entire medical record for the length of stay and the selection of the principal diagnosis. Inpatient coding refers to the procedures (and the associated codes) for an individual who has been officially admitted to the hospital under a physician’s order. The patient is classified as an inpatient until one day before discharge. Inpatient coding is usually more complex than outpatient coding because the inpatient records are typically long and very detailed.

Outpatient coding is a review of medical records from a particular date of service and the selection of the first-listed diagnosis code. Outpatient coding also included selecting codes for any secondary diagnoses. The selected codes support the services provided on the same day as the appointment, or trip to the outpatient facility. Outpatient coding comprises most of the coding performed in the healthcare industry. All coding for doctors’ offices, clinics, outpatient and ambulatory care facilities, hospital emergency rooms, etc. is classified as outpatient coding. In the outpatient setting, ICD-10-CM coding guidelines are used and they take priority over other coding rules. A first-listed diagnosis is the term used by medical coders in an outpatient setting, in lieu of the term “principal diagnosis,” because a diagnosis may not be established at the time of the initial visit. It often takes two or more visits before a diagnosis is confirmed. The chief complaint is the patient’s reason for the medical visit. It is one of the keys in determining the first-listed diagnosis. From the patient’s perspective, the chief complaint is the reason for the visit.

For Reimbursement in the Inpatient setting, codes are based on IPPS, which is determined by MS-DRGs, and reimbursement used for outpatient setting is based on OPPS and APC

With HIA’s staff’s broad knowledge and understanding of coding, we guarantee that all entries are accurate and updated to ensure proper service delivery and let your facility focus on your patient. HIA’s encoders primarily use International Classification of Diseases (ICD) codes that are designed to describe a patient’s diagnoses or medical conditions. HIA understand that accuracy is extremely important in medical coding.

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