Standardization improves efficiency by creating rules and regulations to be guides/tools in
accuracy and efficiency. Without these standards, there would be no cohesiveness amongst
dictation and those dictating. With coding there are times when like terms may be an issue
and entered incorrectly. Or providers dictated procedures and treatment incorrectly causing
error in not only patient records, but the treatment plan and billing as well.
Inpatient charts are usually coded using ICD-1-PCS and outpatient utilize CPT codes.
Inpatient charts are usually a little lengthier stay and outpatient tend to be urgent care or
office visits to your PCP's office. The number of orders, test, diagnostic tools also prove
differential between outpatient and inpatient charts.
Standardization promotes productivity by eliminating inefficiency. This is the result of
eliminating ambiguity and providing quality control, the 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. Implementation of code standardization
programs that increasingly ensure that a doctor’s entry in one EHR will make sense to
providers, researchers and policymakers regardless of where and how they access it.
Outpatient coding refers to a detailed diagnosis report in which the patient is generally
treated in one visit, Outpatient refers to a patient who is being treated but not admitted
under the care of the hospital for an extended stay and is released from the hospital within
24 hours. Even if a patient stays for over 24 hours, he/she can be considered an outpatient.
The outpatient coding is based on the ICD-9/10-CM diagnostic codes for billing and
appropriate reimbursement whereas an inpatient coding system is used to report a patient's
diagnosis and services based on his extended stay. The inpatient coding system is solely
based on the assignment of ICD-9/10-CM diagnostic and procedural codes for billing and
appropriate reimbursement. It’s the standard coding system used by physicians and other
healthcare providers for classification and coding of all diagnoses. The Inpatient Prospective
Payment System (IPPS) is the reimbursement methodology used by healthcare providers and
government programs to provide reimbursement for hospital inpatient services based on
the patient’s diagnosis and treatment provides during his/her hospitalization.
Standardization improves efficiency with coding by fixing areas where there are
inefficiencies. Errors that are normally seen are reduced due to standardization. Guidelines
are put in place for easy transferring of data between organizations. Organization is helpful
with standardization as it keeps everything for proper management. c c c c
Inpatient and outpatient coding differ by both being coded differently. Inpatient coding
deals with ICD-10-PCS and ICD-10-CM should be pro in ICD-10-PCS and ICD-10-CM. Inpatient
deals with being diagnosed, billing, and some sort of duration of stay. Outpatient coding
deals with ICD-10-CM and HCPCS Level II. It deals with patients who aren't staying for an
extended time.
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.
The use of standardization improves efficiency when coding by promoting productivity and
eliminating inefficiency. This process is made possible by providing quality control and
eliminating ambiguity. Also, when using standardization tasks are completed in a more
efficient manner along with fewer quality control issues associated with tasks that were not
correctly done the first time they were attempted.
Some benefits of coding standardization include interoperability ensuring the use of
different software systems. Patient reporting is another benefit because it allows providers
to look across a variety of different data sets. Coding standardization also improves workflow
by using synonyms that are automatically converted into a code. This saves time and makes
is easier and quicker to find the correct code. Enabling patients to access information that
the provider has documented is another benefit.
Outpatient coding is different than inpatient because outpatient refers to a detailed
diagnosis report where the patient can usually be treated within one visit. However,
inpatient coding is used to report a patient's diagnosis based on the length of time the
patient stays.
Standardization is the means of implementing guidelines in medical coding. These guidelines
are used to delegate the appropriate codes to document patient diagnoses as well as
submission of procedure codes. In an outpatient setting they refer to the first-listed
diagnosis, which is the equivalent of the primary diagnosis in an inpatient setting. Primary
diagnosis needs to meet medical necessity for the procedure. It would be impossible to keep
up with the codes appropriate for billing if everyone was allowed to code according to their
own preferences. One major difference between inpatient and outpatient coding is the
coding of the reason for the visit is used in outpatient coding, symptoms are coded when a
condition is being ruled out, and the final interpretation is used as diagnoses. For example, if
a patient has a sleep study snoring may be the reason for the visit, hypersomnia a symptom
and OSA can be the final diagnosis based on a positive sleep study. If the study were negative
the snoring and hypersomnia would be the codes used. Standardization allows diagnoses to be
coded to the highest level of specification, thereby leads to optimal reimbursement.
One of the ways to achieve data consistency and effective communication is through
standardization. Classification standards and terminologies help ensure accurate, secure,
and successful interoperability and reliable communication of medical information.
Basically, it allows everyone to speak the same “language” and improve data quality.
Accurately coding medical records for claims submissions is important to avoid claim
rejections and to obtain the maximum reimbursement amount. Using standardized coding
such as ICD-10, CPT, and HCPCS eliminates ambiguity and improves efficiency by ensuring
codes are accurate and consistent. Standardization also makes it easier to track trends or
patterns.
Inpatient coding utilizes standardized coding with ICD-10-CM and ICD-10-PCS codes. These
codes are for services and treatments that occur over an extended period while a patient is
admitted to a medical facility (i.e.: hospital, nursing home, rehab facility). c Outpatient coding
is typically for one visit of direct care and utilizes standardized codes ICD-10-CM, CPT, and
HCPCS Level II for services and supplies.
Standards help with consistency, quality, and trending. The standards and guidelines for
coding guide coders from all types of medical facilities on coding patient encounters,
diagnoses, signs and symptoms and more. Standards are a way to ensure each patient
encounter is coded to the highest level of specificity and is coded in the same manner no
matter who the coder is. If coders abide by the guidelines and standards, efficiency should
remain consistent, even as codes continue to be revised or added.
Outpatient and inpatient coding standards differ slightly but are overall the same process.
Outpatient encounters can address just signs and symptoms, with no specific diagnosis or
cause and inpatient encounters can code inconclusive diagnoses, but outpatient encounters
cannot. Also, outpatient encounters codes can account for test results and lab reports,
however, this is not the case for inpatient encounters. Although there are differences
between inpatient and outpatient encounters, there are clearly defined guidelines and
standards for both ensuring consistency when coding (Jurek & Mosay, 2017). c
Using standardizing formats related to coding will improve the efficiency by making sure
everyone involved is on the same page. All information that is standardized through various
formats can be read and understood no matter what system is being used. This will allow
better patient care, better understanding between healthcare team members, and lead to
more accurate coding resulting less errors which will generate better reimbursement for the
healthcare facilities. Reading chapter eight and ten of our text demonstrates this by
elaborating on RxNorm and LOINC. RxNorm is an online tool that uses standardized
vocabulary relating to pharmaceutical drugs (Giannangelo, 2019). RxNorm provides a way
for various systems that use different names or versions of drugs to communicate with each
other using similar nomenclature (Giannangelo, 2019). LOINC (Logical Observation
Identifiers, Names, and Codes) standardizes specific health related identifiers for, "health
measurements, observations, and documents", to be used universally for exchange of
information across electronic health information systems using structured medical
vocabulary (Giannangelo, 2019). LOINC is readily available online and is free to download.
The only requirement is an appropriate license for use. (Giannangelo, 2019)
The rules for inpatient and outpatient coding are similar except for three rules. With
outpatient coding, the first-listed diagnosis/condition, or symptoms and signs when there is
no diagnosis is what should be coded instead of the principal diagnosis that is used in
inpatient setting (Jurek & Mosay, 2017). This is because the principal diagnosis is used "after
study" and it could take multiple visits before a diagnosis is made in the outpatient setting
(Jurek & Mosay, 2017). An inconclusive diagnosis such as a rule out or suspicion should only
be used with inpatient coding and only a definitive diagnosis or symptoms/signs when there
is not a diagnosis are used with outpatient coding (Jurek & Mosay, 2017). In the outpatient
setting, a coder can apply codes from test results that have been interpreted by a physician
(Jurek & Mosay, 2017).
When you establish a pattern in coding it would be more recognizable. And the standards of
coding become easier the earlier you start. The patient is treated in one visit for outpatient.
And inpatient is when the patient is diagnosis and services has been reported on the stay at
the hospital.
Way back when, when I was working in California for Sutter Health, the EHR design and
usage was one of the priorities the organization was working on. I initially thought putting
everyone’s most intimate details – health records – online was a recipe for disaster. Since
EHR is now everywhere, I have certainly had a complete reversal of that opinion.
From a personal standpoint, I can say that electronic heath records have been an essential
component of my health care. I have several chronic conditions (i.e., diabetes, thyroid, DVT,
etc.) for which I see a variety of medical providers. Back in the “olden days” when I was in
my 20s and 30s, the EHR was non-existent. One physician could not see my health records
from a different treating specialist I was seeing. c 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.
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. Everyone is
now literally “on the same page” as the old catch phrase denotes. In fact, two days ago this
exact scenario was a godsend. c 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. 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. c My PCP was able
to look up those results on my EHR and we were able to make a change in treatment plan
accordingly. c 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. It allows for more accurate and timely
reporting (and easy reading – no bad handwritten notes to have to decipher.) 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. 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. 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. c 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. 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 outlook of containing this variant is promising.
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). “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.
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. c An exception to that would be outpatient surgeries or care that is
equal to or less than 24 hours. c 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. c 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 MedConverge: https://medconverge.com/key-differences-between-inpatient-coding-
and-outpatient-coding/
Giannangelo, K. (2019). Healthcare code sets, clinical terminologies, and Classification
Systems. Chicago, IL: AHIMA, American Health Information Management Association.
Jurek, J., & Mosay, S. (2017). Conquer medical coding 2018: A critical thinking approach with
coding simulations. F. A. Davis Company.
Jurek. J. & Mosay. S. (2017). Conquer Medical Coding 2018: A Critical Thinking Approach with
Coding Simulations. F. A. Davis Company. https://ebookcentral-proquest-
com.ezproxy.snhu.edu/lib/snhu-ebooks/detail.action?docID=5266018
Giannangelo, K., (2019). Healthcare Code Sets, Clinical Terminologies, and Classification
Systems, Fourth Edition. c American Health Information Management Association (AHIMA).
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/
