Inpatient and Outpatient Coding in Medical Billing

Inpatient Coding and Outpatient Coding

Inpatient and outpatient coding are different processes that have to be appropriately executed to generate accurate medical bills. They have an almost equal share of differences and similarities with a combined impact on their role in the healthcare sector.

This blog will identify the major differences and similarities between inpatient and outpatient coding. We will also link them with the functioning of healthcare organizations to define how they contribute to the implementation of medical services.   

What Is Inpatient Coding?

Inpatient coding assigns code for those medical services that have been availed through multiple visits. Those services include procedures and diagnoses provided during that entire stay. They usually include the supplies used and the days spent in the healthcare organization.

What Is Outpatient Coding?

Outpatient coding assigns codes for a single visit as the relevant medical services are executed fairly quickly. Those codes are also primarily assigned to the signs and symptoms of patients instead of their diseases.

Differences Between Outpatient and Inpatient Coding

Differences Between Inpatient and Outpatient Coding

Most healthcare organizations implement inpatient and outpatient coding as two distinct processes. Both of them have a range of differences in terms of medical codes, patient duration, reimbursement, and many more healthcare functions.

    1. Medical Codes   

Inpatient and outpatient coding use different categories of medical codes. They also have different mechanisms of reporting the healthcare procedures and treatments availed by your inpatients.

You have to consider the ICD-10-PCS and ICD-10-CM manuals to assign codes for your services. The ICD-10-PCS manual is used by healthcare organizations for their inpatient coding. You cannot consult with it for common procedures like instructional sessions and lab tests.

Moreover, you can execute outpatient coding based on the ICD-10-CM manual, as it mostly includes HCPCS and CPT codes. These codes are specifically applied to outpatient supplies and treatments. Therefore, you can accurately assign medical codes through its documentation.

    2. Patient Duration

The duration of stay for patients with different provider credentialing is longer for inpatient coding as it is more complex. It covers an extended period of time and reports a complete description of the healthcare procedures and treatments availed by inpatients. 

Furthermore, inpatient coding also fulfills the key requirement of executing present-on-admission (POA) reporting for the entire period of hospitalization. This reporting facilitates you by providing a list of conditions applicable for specific times of inpatient admission.

In this way, you can differentiate the medical conditions that originated at the time of patient admission from the ones developed during their stay. Inpatient coding is based on the total number of visits, whereas outpatient coding is only applicable for less than 24 hours.

    3. Reimbursement Claims

There are two parts of Medicare, and your reimbursement claims lie in any one of them based on outpatient and inpatient medical coding. Your inpatient services come under Part A, and the outpatient ones fall in Part B.

Medicare has specific regulations set in place that manage your reimbursement claims. They also monitor the copays that have to be paid by your patients. Inpatient coding assigns codes for the reimbursement claims based on insurance eligibility and nursing facilities.

You can cover your outpatient services with reimbursement claims for specific healthcare expenses. These expenses can be most likely for diagnostic tests, practitioner visits, and preventative care.

    4. Patient Symptoms

The implementation of inpatient and outpatient coding can also vary based on the signs and symptoms experienced by patients. You should not assign codes to initial diagnosis according to the regulations of the inpatient coding practice. 

However, you can add potential conditions and symptoms based on inpatient coding if a definitive diagnosis is absent. In addition, you can execute outpatient coding for the patients who remain undiagnosed even after they are discharged.

This means that outpatient coding requires you to assign codes only for the medical services confirmed as ideal by the diagnosis. You can categorize such diagnoses into suspected, probable, differential, ruled out, and questionable cases.

    5. Patient Complications

Your patients can experience different types of complications during treatment depending on their time of origin. You must assign inpatient codes to your healthcare services if the relevant patients experience complications after their surgery.

You have to give principal diagnoses for such complications due to their time of origin. Furthermore, healthcare organizations must also implement inpatient coding if those complications warrant an extra duration of stay for their patients.

This means that outpatient coding can only be implemented in a unique case of medical complications. You can assign medical codes based on its guidelines if your treatments and procedures have an uncertain diagnosis. In this case, you can assign additional inpatient codes.

    6. Principal Diagnosis

There is no concept of principal diagnosis in outpatient coding. You cannot diagnose such patients on their first visit as they have availed of the medical services represented with outpatient codes.

On the other hand, you can give principal diagnoses to your inpatient operations as they utilize resources over a long period of time. You can also utilize this extended period to determine whether your reimbursement claims are appropriately fulfilled.

Similarities Between Inpatient and Outpatient Coding

Similarities between Inpatient and Outpatient Coding

The implementations of inpatient and outpatient coding have some common factors as well, even though they are distinct processes. They are similar in terms of their compliance, resource allocation, coding technique, and many other factors.

    1. Compliance

Healthcare organizations must fully comply with the code of ethics set by AHIMA. It is a universal combination of all primary and secondary guidelines for common medical services. You must tune your inpatient and outpatient operations according to that code of ethics.

    2. Resource Allocation

Inpatient and outpatient coding are also similar in terms of their resource allocation. Healthcare organizations usually manage and utilize their resources the same way for both processes.

The industry guidelines established by the American Hospital Association Coding Clinic bind them to ensure this practice. You must follow those guidelines until new ones are introduced that are able to supersede them.

These guidelines facilitate you to similarly code and report your healthcare treatments and procedures through inpatient and outpatient coding.

    3. Coding Technique 

You can also execute a similar technique to assign inpatient and outpatient codes to your medical procedures. It initially involves a comprehensive review of the documentation that contains healthcare records of your patients.

This review enables you to assign accurate and complete codes to your inpatient and outpatient services. You must pause medical coding If you are unable to find the documents that contain details about code assignment.

Its practices must only continue after you manage to find those details. In this way, you can easily update your medical records and issue queries to your medical practitioners.

    4. Information Retrieval

The method of retrieving information in outpatient and inpatient coding is also similar. They report information about your patients in the same way so that the diagnoses of their healthcare procedures can be accurately determined.

Both of them systematically assign medical codes with the usage of complex documentation. You can describe the medical conditions of your patients along with appropriate responses to them in the form of treatments.

    5. Types of Codes

You can use the same types of codes to implement both processes in medical billing. Inpatient and outpatient coding require alphanumeric or numeric types of codes that can be applied to most healthcare services.

Alphanumeric codes include alphabets and numerals, and numeric codes only contain numerals. You can also use any of them to distinguish between your outpatient and inpatient coding processes.

The Bottom Line

This blog sheds light on all the ins and outs of inpatient and outpatient coding in medical billing. We comprehensively covered the main differences and similarities between both processes and exhibited their role in the billing operations of healthcare organizations.

Our medical billing experts are qualified enough to accurately manage your inpatient and outpatient coding services. Join us today and elevate the quality of the medical bills generated by your healthcare organization.

Frequently Asked Questions (FAQs)

    1. What is the difference between outpatient and inpatient coding?

The difference between outpatient and inpatient coding lies in their diagnoses, as inpatient coding assigns codes for uncertain diagnoses as well. In contrast, outpatient coding requires a confirmation for all diagnoses before assigning codes.

    2. What are the coding codes for inpatients?

Inpatients can have different coding codes like 99221-99223, which corresponds to the observation care in hospitals. Hospital inpatients are identified with the 99231-99233 code, whereas discharge services can be linked with 99234-99236.

    3. What is outpatient coding?

Outpatient coding is a process in which patients can be given a diagnosis after just one hospital visit. It is different to inpatient coding in this aspect, which can report diagnoses even for a prolonged duration of stay.

    4. What is the medical billing code for outpatients?

The medical billing code for outpatients is 99201-99205. This code corresponds to the clinical examinations, patient histories, and decision-making of healthcare organizations.

    5. What is the purpose of inpatient coding?

Inpatient coding is a process in which healthcare organizations can report the diagnoses of their patients for a prolonged duration of stay. The diagnoses can include appropriate treatments for the signs and symptoms experienced by those patients.


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