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 is 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 in order for proper management. b b b b
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.
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. b 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. b Classification standards and terminologies help ensure
accurate, secure, and successful interoperability and reliable communication
of medical information. b Basically, it allows everyone to speak the same
“language” and improve data quality. b Accurately coding medical records for
claims submissions is important to avoid claim rejections and to obtain the
maximum reimbursement amount. b Using standardized coding such as ICD-10,
CPT, and HCPCS eliminates ambiguity and improves efficiency by ensuring
codes are accurate and consistent. b Standardization also makes it easier to
track trends or patterns.
Inpatient coding utilizes standardized coding with ICD-10-CM and ICD-10-PCS
codes. b These codes are for services and treatments that occur over an
extended period of time while a patient is admitted to a medical facility (i.e.:
hospital, nursing home, rehab facility). b 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.
Reference
Giannangelo, K., (2019). b Healthcare Code Sets, Clinical Terminologies, and
Classification Systems, Fourth Edition. b American Health Information
Management Association (AHIMA).
