What Is The Difference Between Inpatient And Outpatient Coding?

The foremost stage in the process of medical billing is medical coding. It requires the assignment of some standardized codes that will be helpful in the medical procedures and diagnosis process. The prime challenge for medical organizations is to understand all the thousands of ICD 10 codes and CPT codes. It is also challenging for most healthcare organizations to keep track of all updates and report the right code for doctors’ medical services. It is highly important for patient care and reimbursement since most organizations rely on specialists’ medical coding and billing services to ensure clean, accurate claim submission and correct payment. The knowledgeable and experienced medical coders know the key differences between outpatient and inpatient visits.

Inpatient vs. Outpatient

Understanding the difference between outpatient coding and inpatient coding is needed to understand the terms, outpatient and inpatient.

Inpatient refers to patients admitted on the order of physicians to a hospital or medical setting. It can also be a rehab facility, nursing home, or long-term care facility. However, if a patient stays in a hospital for a night, it does make him Inpatient.

Outpatient means a patient treated by a doctor but is not admitted to any hospital nor stays for an extended period in any medical setting. In the majority of the cases, patients are released within twenty-four hours from the hospital. The patient has outpatient status even if they stay within the healthcare setting for more than 24 hours, but the doctor hasn’t given an order for their admission.

Inpatient Coding vs. outpatient Coding 

The differences between inpatient coding and outpatient coding include the following key points-

  • Codes

Inpatient coding means those codes that help report the diagnosis and medical procedures of inpatient patients. Both ICD 10 PCS and ICD 10 CM coding manuals are used for inpatient coding.  On the other hand, outpatient coding uses HCPCS /CPT codes and ICD 10 CM diagnostic codes. These codes apply especially to supplies and services offered within an outpatient setting.

  • Length of patient’s Stay

Compared to outpatient coding, inpatient coding is more complicated and complex. The inpatient codes include a wide range of services given to the patient during the hospitalization period or over a stipulated period. Inpatient coding includes POA (present on admission) reporting requirements as well. In the case of outpatient coding, the assignment of code is based on the patient’s visit. This type of coding is applied when patients get treatment from doctors but stay within the facility for lesser than 24 hours.

  • Reimbursement

Outpatient coding and services are covered by Medicare Part B. Inpatient coding and services are covered by Hospital insurance or Medicare Part A. Coding for inpatient services takes place as per MS – DRGs ( Medicare Severity Diagnosis Related Group). Appropriate tools based on PCS codes and ICD 10 CM codes are needed for the assignment of MS DRG.

  • Symptoms

Inpatient coders can code extra symptoms and signs and suspected conditions if a definitive diagnosis is not mentioned in the documentation. However, outpatient coders cannot assign any diagnosis code unless it is confirmed through diagnostic testing.

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