What is the difference between Outpatient Coding and Inpatient Coding?

It can be confusing to know some of the terms that are normally used in hospitals when you work in the medical field. Two of the terms that may cause confusion are outpatient coding and inpatient coding. When you say outpatient coding, this is to be used for a patient that has been treated in the hospital but does not need to be admitted.

When you say inpatient coding, this is the term used for patients that would need to be admitted to the hospital. The coding system that will be used for outpatient coding is CPT or HCPCS, while the coding system that will be used for inpatient coding is going to be ICD-10-PCS. When you say outpatient coding, the patient will not get his diagnosis on the same day. For inpatient coding, the diagnosis will be the key factor that will determine if the person is going to be admitted or not.

Hospital coding and billing is a complicated system, which is only expounded by a busy hospital environment. Coding serves several purposes, including retrieving and reporting information on the primary diagnosis and procedure. However, coding entails more than the systematic organization of codes. The patient’s medical record is the groundwork for coding.

Outpatient refers to a patient who is treated but not admitted to the hospital for more than just an overnight stay. Outpatient coding is a whole separate set of codes, and you cannot use inpatient codes with outpatient codes. Even when the patient remains in the hospital for 24 hours, it can still be considered outpatient. Inpatient refers to a patient who is officially admitted to the hospital upon the physician’s assessment. The patient will then most likely be recommended for an extended stay. The inpatient coding system is used to report a patient’s diagnosis and services based on their time in the hospital. It also uses specific diagnostic codes for billing and the appropriate reimbursement. Reimbursement methodology is courtesy of Medicare.