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Differences Between Outpatient Coding and Inpatient Coding

Typically, coding involves assigning numeric or alphanumeric codes to all healthcare data elements of outpatient and inpatient care. Therefore, one of the most key aspects of hospital coding and billing process is determining whether the patient is an outpatient or an inpatient.

What is Outpatient Coding?

Outpatient refers to a patient who is treated but not admitted under the care of the hospital. In this case, the patient does not have an extended stay and is released from the hospital within 24 hours. Although a patient stays for over 24 hours, he or she can be considered an outpatient. The outpatient coding is based on the ICD-9/10-CM diagnostic codes for billing and suitable reimbursement. However, it uses the CPT or HCPCS outpatient coding system to report procedures. Documentation plays a fundamental role in the CPT and HCPCS codes for services.

What is Inpatient Coding?

Inpatient refers to a patient admitted to a hospital upon the physician’s recommendations, who then admit the patient for an extended stay. The inpatient coding system is used to report a patient’s diagnosis and services based on his or her extended stay. It also uses ICD-9/10-CM diagnostic codes for billing and applicable reimbursement but uses ICD-10-PCS as the procedural coding system. The Inpatient Prospective Payment System (IPPS) is the reimbursement methodology applied by Medicare to reimburse hospital inpatient services.

Difference between Outpatient and Inpatient Coding

Basics of Outpatient Vs. Inpatient Coding

As stated above, outpatient refers to a patient who checks into the ER and is treated. However, the patient is not admitted to the hospital for an extended stay. The patient is typically released from the hospital the same day within 24 hours. When a patient is formally admitted to a hospital upon the physician’s recommendations to take care of your extended stay at the hospital stay, he is considered an inpatient. Outpatient coding refers to a comprehensive diagnostic report in which the patient is generally treated in one visit. In this case, an inpatient coding system is used to report a patient’s diagnosis and services based on his extended stay.

 Coding for Outpatient Vs. Inpatient

The inpatient coding system is exclusively based on the assignment of ICD-9/10-CM diagnostic and procedural codes for billing and applicable reimbursement. Physicians and other healthcare providers use the standardized coding system for the classification and coding of all medical diagnoses. Notably, it uses ICD-10-PCS to report procedures. The process of the tracing the appropriate ICD-9/10-CM diagnostic codes remains the same for outpatient coding but the outpatient facility services are reimbursed based on the code assignments from the Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) coding system. It is important to note that documentation plays a crucial role in the CPT and HCPCS codes for services.

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