Medical coding is divided into two parts: inpatient coding and outpatient coding. It is important for every medical biller and coder to understand the differences between these two. In this blog we will talk about the significant differences between these two terms and learn about the most common errors in inpatient coding.
So, let’s start!
What Is Inpatient Coding?
Inpatient coding is the category of medical coding used for documenting the procedures performed on inpatients.
Now, what are inpatients? You may ask!
Inpatients are those people who have been admitted to the hospital under the doctor’s order. For a patient to be classified as inpatient, they must be admitted to the hospital for at least 24 hours.
Also, during the stay at the hospital, the patient will be charged for all the services and facilities they use, and the bill will be generated accordingly. Because of long stays the patient records and documentation are complex which makes inpatient coding complex and detail intensive.
What Is Outpatient Coding?
Outpatient coding refers to the treatment offered in a single visit. But who are outpatients? Outpatients are the patients who visit a hospital for treatment but are not admitted. These patients may stay in the hospital for a few hours or even overnight but not more than 24 hours.
Since outpatient visits are short-term, the coding is relatively less complex than that of inpatient coding.
Now let’s understand the potential coding errors that cause denials in inpatient coding.
Key Differences Between Inpatient & Outpatient Coding
Codes
Inpatient coding refers to the codes used at the time of documenting the patient’s diagnosis and procedures performed on inpatients. Both ICD 10 CM and ICD 10 PCS coding manuals are used.
On the other hand, Outpatient coding uses ICD-10 CM diagnostic codes and CPT or HCPCS codes that are applied specifically to services and supplies provided in the outpatient setting. Documentation plays a major role in assigning CPT and HCPCS codes.
Length of Stay
Inpatient coding is much more complicated than outpatient coding. Inpatient coding documents the extensive range of services provided to the patient over a long period of time or for their period of hospitalization. Inpatient coding comes with a present on admission (POA) reporting requirement. POA refers to the conditions present at the time the order for inpatient admission occurs.
The main objective of POA indicator is to differentiate the conditions present at the time of admission from the complications or conditions developing during the patient’s stay in the facility.
Signs & Symptoms
Signs and symptoms documented as part of the primary diagnosis should never be coded in the inpatient setting. When definitive diagnosis is not included in the physician’s documentation, the coder will have to code additional signs and symptoms of any potential condition.
A lot of outpatient procedures do not have definitive diagnosis. In the outpatient setting, coders should never assign a diagnosis code unless it has been confirmed by diagnostic testing.
Uncertain diagnoses are indicated by the following terms;
- Probable
- Suspected
- Questionable
- “Rule out”
- Differential
In the outpatient setting, coders must report the patient visit to the highest degree of certainty based on the signs, symptoms or abnormal test results that may occur during the time of patient visit.
Top Reasons of Inpatient Coding Errors
Inaccurate/ Incomplete Coding
When healthcare providers fail to document essential details of a patient’s diagnosis, treatment, or procedures, medical coders might not be able to assign accurate medical codes. This results in denials due to unspecified codes, lack of medical necessity, and an array of other reasons.
Inconsistent Diagnosis
If medical Coders assign a diagnosis code that doesn’t match the procedure of treatment performed, the claim will definitely be denied. Again, lack of medical necessity becomes the issue.
Inconsistent Modifiers
Medical coders may sometime accidentally omit any modifier or use the wrong one. This is a sure shot denial in case of medical billing.
Invalid Codes
Outdated or invalid medical codes in the documentation process will lead to denial or a delayed claim.
Registration Errors & Omissions
Inaccurate demographic and insurance information leads to denial due to lack of coverage because the patient has another insurance that is primary. These inpatient coding errors are quite common when patients change their insurance providers.
Unbundling
Medical coders separately bill components of a service for which there is a comprehensive medical code.
Upcoding or Downcoding
The coders must assign codes that signify the actual service provided. Assigning a higher-level code to gain high reimbursement or assigning a lower code to avoid reducing patient’s financial responsibility will tend to legal and financial consequences.
Strategies to Reduce Inpatient Coding Errors
Regular Audit Claims
New medical codes for FY 2024 encourage increased specificity and granularity. Regular audits make sure that the documentation and medical coding reflect these changes. It can also help you identify other discrepancies and use them for educational purposes.
Don’t Forget Omissions
Ignoring even the smallest diagnosis code will have a negative impact on your practice. It also affects risk adjustment and the ability to close care gaps. Making sure that the coders and nurses work together to capture hierarchical condition category codes to engage patients proactively.
Enforce Clear Coding Guidelines
Determine how you will handle complex coding scenarios for certain payers. Case studies are a great way to do so. Also determine how you are going to enforce overall coding compliance and revenue integrity.
Keep Physicians in the Loop
Physicians do not need to understand medical billing extensively, but they need to understand how clinical documentation impacts medical code assignment. New medical codes tend to be more specific and have different descriptions, so physicians might need to tailor their documentation accordingly.
Leverage Technology
Use the latest coding software and tools that help with maintaining coding accuracy and augment staff capabilities. Make sure that the tools are updated with the latest coding changes and revisions.
Promote Open Communication
Create ways to share feedback and initiate dialogue between physicians, coders and billers. Sometimes all it needs to solve a problem is to gather everyone in a room and talk.
Conclusion
You must have understood the significant difference between outpatient and inpatient coding. Though the difference holds huge importance, being well-versed with all the necessities of inpatient and outpatient coding cannot be expected from a medical professional. This is where medical billing companies like Unify Healthcare services come in to help.
Unify healthcare services is a well-reputed medical billing company that holds its space in the top medical billing companies. We have a team of trained staff who are always updated about the latest trends and changes in the healthcare sector. We take care of all your documentation process including inpatient and outpatient billing so that you can focus solely on providing the best patient care.
Unify healthcare services makes sure that you are not burdened with anything except patient care. We make sure that all your claims are accurate so that you get reimbursed for every single treatment provided to the patient.
Unify healthcare services does not only provide medical billing services, but we provide mental peace for you.
