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Inpatient Coding Vs Outpatient Coding: Medical Coding Explained

October 15, 2015

Inpatient_vs_outpatient_coding-1As of October 1, 2015, all health care settings must adhere to ICD-10-CM guidelines for the correct medical coding techniques. With more than 2 million total codes and the addition of 68,000 codes in ICD-10, some careful considerations need to be taken. One of the most important aspects of coding involves key considerations for the coding differences between inpatient and outpatient events. To minimize lost costs in health care, coders need to understand the following aspects of inpatient and outpatient coding.

Inpatient Coding Placeholders

One of the greatest changes between ICD-9 and ICD-10 is the addition of two other placeholders for characters in medical coding. The seventh space is used for the determination, if required by the tabular and alphabetic indexes, of possible defining conditions when uncertain diagnoses otherwise exist. However, the use of the seventh position may be more likely in inpatient settings were a definitive diagnosis has been made with the need for an additional specification of the disease.

Coding For Uncertain Diagnoses in Inpatient Settings

For inpatient admissions to short-term, long-term, acute care, and psychiatric hospitals, uncertain diagnoses at the time of discharge should be coded as if they would have otherwise existed. Coders should not include abnormal findings unless the health care provider identifies clinical significance of the symptoms, such as explained in the next section. However, some hospitals may have additional policies for the coding of uncertain conditions, and coders should maintain compliance with their facilities’ policies as well. The goal of coding suspected, probable, likely, or possible conditions is to identify them as a possible principle diagnosis for admission on future hospitalizations.

Coding For Signs and Symptoms in Inpatient and Outpatient Settings

If signs and symptoms are a given part of a primary diagnosis, they should NOT be coded in inpatient settings. However, additional signs and symptoms may be coded when present if a definitive diagnosis is not included. For example, inpatient coding requires the coding of suspected conditions and abnormal signs and symptoms if the provider has not made a diagnosis.

Since many outpatient procedures lack a definitive diagnosis, signs and symptoms are acceptable for coding purposes. However, coders should check for any new results and information from the provider about a definitive diagnosis prior to entering the codes for such signs and symptoms.

Accurate Medical Coding improves Billing and Collections

Coding For Uncertain Diagnoses in Outpatient Settings

Unlike inpatient coding of uncertain diseases and conditions, outpatient coding of uncertain disease do not warrant any sort of code. Coders should not attempt to insert a code on the basis of their judgment of results. However, coders may code up to the absolute degree of certainty. For example, abnormal test results and unusual signs and symptoms may be coded.

Complications From Inpatient Admission Coding Concerns

If a patient requires additional length of stay in a hospital due to a complication, the complication should be listed as the principle diagnosis. However, if the complication lacks specificity to a diagnosis, an additional code may need to be assigned.

Complications From Outpatient Surgery

If a patient is admitted to the hospital due to complications during or after outpatient surgery or other outpatient procedures, the complication should be listed as the principle diagnosis for inpatient admission. However, if inpatient admission after surgery is not a complication, the first-listed reason for the outpatient surgery should be listed. Additionally, if the reason for admission is unrelated to the first-listed reason for surgery, the unrelated condition should be listed as the primary diagnosis in an inpatient setting.

The biggest difference between inpatient and outpatient medical coding remains the criteria and instructions for uncertain conditions. However, coders should always check the guidelines for additional instructions within the tabular and alphabetic indexes. By understanding these key differences between inpatient and outpatient coding techniques, overhead costs in health care settings can be reduced. A proper understanding will help coders perform more efficiently and accurately in their roles, which is the overall goal of medical coding in the first place.


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