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Inpatient Coding Vs Outpatient Coding

The medical billing and coding practice and a work undertaking is divided into two main parts: inpatient coding and outpatient coding.

For an ambitious medical coder, it’s important to understand the differences between these two coding areas and set a preference from an early stage. This will help them focus their training and education accordingly and spend more time learning about the domain that they are interested in.

So, coming to the vital question, what exactly are inpatient and outpatient coding and how are the two coding fields different from each other?

What is Inpatient Coding?

Inpatient coding is a kind of medical coding used for reporting procedures that are performed on inpatients.

Who are the inpatients?

Inpatients are those people who have been formally admitted to the hospital under a doctor’s order. Remember that it must be noted that for a patient to be classified as an inpatient, the patient must spend more than 24 hours at the hospital. A patient admitted to a hospital for 24 hours or less are not classified as inpatients.

Also, during their stay at the hospital, the patient will be charged for all the services and facilities they use and will be billed accordingly. Since such stays are long, they result in making of patient records that are quite widespread and complex. This makes inpatient coding complex and detail intensive.

What is Outpatient Coding?

Outpatient coding focuses on the direct treatment offered in a single visit, which is usually a few hours.  A basic rule of thumb is that outpatient care has a duration of 24 hours or less. 

Who are the outpatients?

Outpatients are the people who visit a hospital for treatment but are not admitted. These patients may stay at the hospital for few hours or even overnight. Since outpatient visits are short-term, outpatient coding is relatively less complex than inpatient coding.

Difference between the coding schemes for the two medical coding domains

  • Inpatient coding utilizes ICD-10-CM and ICD-10-PCS codes to transcribe the details of a patient’s visit and stay, while outpatient coding on the other hand utilizes ICD-10-CM and HCPCS Level II codes to report healthcare services.
  • Reimbursements for both types of services are requested under the Medicare program. Inpatient claims are processed under Medicare Part A while outpatient claims are paid under Medicare Part B plan.

Do keep in mind that no matter which type of coding field a coder may choose to specialize in, they both have their individual importance in the healthcare medical reimbursement cycle, also both require the same level of commitment and perseverance from medical coders.

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