Standardization in coding has increased overall efficiency by having a similar
format to use across many different platforms. This has given a rise in the
accuracy of coding and a reduction in erroneous codes and documentation
misunderstandings. Standardization efforts in coding also help improve the
productivity and timeliness of the coding process. Having a structured system
to follow, makes it easier to code documents in a timely manner. Guidelines
set by standardization help other organizations follow the same coding
procedures and thus allow for documentation to be more easily transferred
between organizations. Such as if a patient needs to be moved to a more
specialized facility.
Inpatient coding differs from outpatient coding in the way of what exactly is
being coded. Outpatient codes refer to those in which a patient is not being
admitted for a durational stay, for example, if someone were to visit a hospital
for a COVID test. They are receiving a diagnosis for their visit. Inpatient refers
to coding the visit of a patient and diagnoses they receive, along with billing
the length of the stay. How does standardization improve efficiency with
coding?
Standardization promotes productivity by eliminating inefficiency. This is the
result of eliminating ambiguity and providing quality control: tasks are
completed in a more efficient manner, and there are fewer quality control
issues from tasks that were not completed correctly the first time around.
According to the author, Kaufmann, (2019) “the advantages of standardizing
healthcare terms outweigh the major efforts to combat the issue around
unstructured data and interoperability. There are several national initiatives
that share the goal of standardizing vocabularies within EHRs to facilitate the
transfer of data, information, and knowledge among systems with the goal of
interoperability. The meaningful use is one of the main drivers for
interoperability with a foundation based upon priorities to improve quality,
safety, efficiency, population, and public health, and reduce health disparities.
Finding a way to overcome the variability in which clinical data is portrayed, is
extremely important in interoperability and big data. We have all this clinical
data within EHRs, databases, and data warehouses that can be used for
research and population health, but we are unable to easily extrapolate this
data due to the lack of standardized terminologies and unstructured data.”
How is this different with inpatient versus outpatient coding?
Outpatient coding refers to a detailed diagnosis report in which the patient is
generally treated in one visit, whereas an inpatient coding system is used to
report a patient's diagnosis and services based on his duration of stay. The
outpatient coding is based on the ICD-10-CM diagnostic codes for billing and
appropriate reimbursement but uses a CPT or HCPCS coding system to report
procedures. Documentation plays a crucial role in the CPT and HCPCS codes for
services.
several chronic conditions (i.e., diabetes, thyroid, DVT, etc.) for which I see a
variety of medical providers. b Back in the “olden days” when I was in my 20s
and 30s, the EHR was non-existent. b One physician could not see my health
records from a different treating specialist I was seeing. b Often, that meant
that I needed to be better at understanding medical conditions to be able to
update the variety of doctors I was seeing. b Now, not only can I access my
medical records, schedule appointments, print bloodwork orders for upcoming
appointments and other aspects of my healthcare through the patient portal,
but I can follow up with my primary care physician telephonically or through
Zoom and she has instant access to uploaded reports from the other specialists
I see. b Everyone is now literally “on the same page” as the old catch phrase
denotes. b In fact, two days ago this exact scenario was a godsend. b I had a
recent problem with a possible DVT in my left calf and needed testing to see
what progress, if any, I had made with a recent treatment plan. b The vein
specialist I saw explained things to me, but when I tried to relay those same
explanations to the PCP, I was not as eloquent or clear about those results. b My
PCP was able to look up those results on my EHR and we were able to make a
change in treatment plan accordingly. b It saved me an hour of round-trip travel
out of my day, afforded the physician’s office to handle the meeting by phone,
and further follow COVID protocols by not having me put at risk by other
patients in the office setting.
EHR has become mainstream and for good reasons. b It allows for more
accurate and timely reporting (and easy reading – no bad handwritten notes to
have to decipher.) b Having a standardized and uniform way of reporting
medical procedures and health records also allows for a more efficient and
accurate way of keeping medical records. b The ability for a group of physicians
to access the patients complete medical records also allows a safety feature, in
that providers can easily see what medications have been prescribed for the
patient and helps the providers make sure that contraindicating medications
are not doled out to the patient, possibly putting them in harm's way
physically.
From a processing perspective, having a uniform system to code medical
diagnoses and procedures not only brings an efficiency and higher accuracy
rate, but it also decreases the rejection of medical claims submissions and
increases the capacity for maximum reimbursement. b It also gives a guideline
for treatment plans that are followed nationwide, which in some
circumstances can assure a patient is receiving the best treatment plans in
improving their health problems. b This also helps with the scientific community
– as we have seen with the development of COVID and its variants – Public
Health officials and agencies can track the way a disease progresses. b Much like
Omicron that we are currently dealing with, the latest news is that this tracking
done my NIH, WHO, and other organizations, has given us the information that
although Omicron is a lot more contagious than the original COVID virus, it is
also peaking faster and the future outlook of containing this variant is
promising. b It allows scientists to get a sense of what patterns the disease is
following and how they can get ahead of the curve by updating vaccines as
needed.
Inpatient medical coding uses ICD-10-CM and ICD-10-PCS codes. These result
in insurance coverage, payments, and reimbursements based on Medicare
Severity-Diagnosis Related Groups (MS-DRGs). b “Inpatient” refers to a patient
who has been admitted to the hospital for extended stay treatments or
services (generally longer than 24 hours), such as hospice, acute and/or long-
term hospital visits, skilled nursing facilities, and home health services. b
Inpatient payments and reimbursements are covered under Part A of
Medicare. (Key Differences Between Inpatient Coding and Outpatient Coding,
2018)
In the alternative, outpatient medical coding requires ICD-10-CM and
CPT®/HCPCS Level II codes to report health services and supplies. Outpatient
status and its subsequent coding is used for single visit treatments (even if
those treatments – such as physical therapy are ongoing), and the usual rule is
that outpatient coding covers doctor visits or care that are less than 24 hours
in duration. b An exception to that would be outpatient surgeries or care that is
equal to or less than 24 hours. b Outpatient payments and reimbursements are
covered under Part B of Medicare. (Key Differences Between Inpatient Coding
and Outpatient Coding, 2018)
While researching this topic, I found a neat little chart that shows the
differences between Inpatient and Outpatient coding. b I include it below for
your perusal.
(Key Differences Between Inpatient Coding and Outpatient Coding, 2018)
References
Key Differences Between Inpatient Coding and Outpatient Coding. (2018, June
1). Retrieved from Med Converge: https://medconverge.com/key-differences-
between-inpatient-coding-and-outpatient-coding/
Standardizing Healthcare Terms: Challenges, Benefits, and Future
https://blogs.perficient.com/2019/07/09/standardizing-healthcare-terms-
challenges-benefits-future/
https://www.medicalbillersandcoders.com/blog/outpatient-coding-and-
inpatient-coding/
