In the medical field there are many situations in which there are multiple terms for a single item
or action, so it is important to have standardization to keep things clear and organized. This is
especially so, now that most operations are done digitally with computers that cannot use
intuition or context clues to determine what is meant when the text isn't clear or in the right
place. The problem only expands when dealing with multiple different systems all trying to
communicate with each other, such as in the case with an HIE.
Inpatient coding and outpatient coding are like a point but require a slightly different skillset to be
effective. An example of a difference would be that because outpatient encounters may not have
a definitive diagnosis, they must be coded differently than an inpatient stay. There are also
separate guidelines to follow depending on whether you are doing inpatient or outpatient coding,
like how HIPAA mandates the use of CPT/HCPCS codes instead of ICD-10-PCS codes for outpatient
procedural reporting (Jurek et al., 2017).
Standardization helps prevent confusion among different medical terminologies and codes. This
can improve efficiency because it prevents misinterpretations among staff and ensures that
documents are dictated correctly and that claims are billed properly for payment. Having
standardization can cause an increase in productivity as well because it will reduce the number of
errors made. This causes claims to be sent out faster which will make the billing process quicker
overall This is different with inpatient and outpatient coding because inpatient coding uses ICD1
pcs and outpatient uses cpt codes. Outpatient charts usually do not have a definite diagnosis
versus inpatient coding. Standardization improves efficiency with coding by ensuring that data is
captured accurately and consistently. Also, to ensure that healthcare claims are processed
properly for Medicare and Medicaid and other health programs. The data that is coded can have
far-reaching effects beyond provision of care. They are used for a variety of reporting
requirements, such as registries, indexing of disease and operations, prospective payment systems,
fee schedule billing, health plan insurance coverage, medical necessity justification, quality
measurements, vital statistics, public health, and much more.
Outpatient refers to a patient who checks into the ER and is being treated but is not admitted to
the hospital for an extended stay. The patient is usually released from the hospital the same day
within 24 hours. When a patient is formally admitted to a hospital upon the physician’s orders
who then take care of your extended stay at the hospital stay, he/she is considered an inpatient.
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 their extended stay.
It is important when coding to know the difference from impatient coding to outpatient coding.
Outpatient refers to a patient who is being treated but not admitted under the care of a hospital
or extended stay and is released within 24 hours. Even if a patient stays for over 24 hours, they
can still be considered an outpatient. The outpatient coding is based on the ICD-10-CM diagnostic
codes for billing and appropriate reimbursement, but uses CPT and HCPCS coding system to report
procedures.
Reference:
Jurek, J. H., Mosay, S., & Neris, D. (2017). Conquer Medical Coding 2018 A Critical Thinking
Approach with Coding Simulations (3rd ed.) [E-book]. F A Davis.
Dotson, P. (2013, December). CPT® codes: What are they, why are they necessary, and how are
they developed? Advances in wound care. Retrieved January 21, 2022, from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3865623/
New focus on process and measure: Raising data quality with a standard coding workflow and
benchmarks. Journal of AHIMA. (n.d.). Retrieved January 21, 2022, from
https://library.ahima.org/doc?oid=78703#.Yen_pi9h1QI
