Standardization enables everyone to be on the same page with coding. When
the coding team and healthcare professionals go by the same set of coding
standards it makes the coding process run more efficient. If everyone just
coded what they wanted, the coding process would never be consistent.
Healthcare facilities and insurance companies could charge patients whatever
they wanted for services.
The difference between inpatient and outpatient coding is that inpatient
coding is usually set up to cover multiple days of providing healthcare services.
Outpatient coding on the other hand is a shorter process, and usually involves
one day of service. Also, inpatient coding has more diagnostic testing and
imaging involved to arrive at a diagnosis for the patient’s treatment.
Outpatient coding usually revolves around procedures and are more
straightforward. Standardization improves efficacy with coding by eliminating
the challenges that interpretations can create. The standardizations lead to a
better patient outcome. Standardization improves the patient out come by
levelling the path for interoperability, reporting, and workflow improvement.
Having the standards and guidelines to choose the appropriate code will help
with documenting procedural history and allow for proper claim submission.
This applies for both inpatient and outpatient coding. Using ICD-10 PCS uses a
method of breaking down the coding process with individualizing each
component. CPT coding lends to a broader description of the procedure. Both
have standard and guidelines but are concluded differently. The
standardization process can improve the efficiency of coding by promoting the
level of productivity. It can eliminate the chances of inefficiencies in the
context of coding. By focusing on standardization, it is possible to remove any
kind of ambiguity, which can increase the quality by offering better quality
control. When users leverage standardization while coding, they can
accomplish tasks in a more efficient manner. The level of efficiency is boosted
because there exist fewer quality control challenges and issues. It also
enhances the level of consistency (Piedade et al., 2020). In the healthcare
context, the standardization of codes is considered highly critical as it can
directly influence the efficiency in the processes. There exists a considerable
difference between the standardization of inpatient and outpatient coding.
In inpatient coding, the objective is to report a patient’s diagnosis as well as
services based on the duration of the stay. The standardization is done by
using ICD-10-CM diagnosis codes for the purpose of billing. For reimbursement
purpose, ICD-10-PCS is used as the procedural coding system. Standardization
ensures that the suitable codes area followed and accurate coding protocols
are followed when a patient is admitted in a healthcare facility (Basic medical
coding - ICS canada, 2021). However, in the context of outpatient coding, the
process is different because it involves a patient who is being treated but is not
admitted to the facility for a specific duration of stay. The outpatient coding
that is used is based upon the ICD-10-CM diagnosis code for billing purposes.
For reporting accurate procurements, a CPT or HCPCS is used. The role of
documentation is of paramount importance in the case of outpatient coding
(CPT E/M Office revisions | AMA - American medical association, 2021). The
effective use of standardization with both inpatient and outpatient coding is
extremely critical as it can impact the accuracy and consistency in the coding
processes.
References
Basic medical coding - ICS canada. (2021). Retrieved January 21, 2022, from
https://www.icslearn.ca/~/media/files/pdf/samplelessons/582-basic-medical-
coding.pdf?la=en
CPT E/M Office revisions | AMA - American medical association. (2021).
Retrieved January 21, 2022, from https://www.ama-
assn.org/system/files/2019-06/cpt-revised-mdm-grid.pdf
Piedade, E. de sousa, & Brown, J. (2020, November 13). Why process
standardization improves quality, productivity, and morale: Process street:
Checklist, Workflow and SOP software. Process Street. Retrieved January 21,
2022, from https://www.process.st/process-
standardization/#:~:text=Standardization%20promotes%20productivity%20by
%20eliminating,correctly%20the%20first%20time%20around.%20
