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 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.
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
