As you prepare to dive headfirst into the world of medical billing and coding you undoubtedly have a lot of questions that have gone unanswered for some time. For example, what is the difference between inpatient and outpatient coding? More importantly, is there actually a difference to be worried about? The answer is yes, yes there absolutely is, and you’ll find out more about it as you learn medical procedure codes, but today we’re going to at least scratch the surface.
Uncertain Diagnosis in Inpatient Settings
If a patient is admitted to a short-term, long-term, acute care, or psychiatric hospitals with an uncertain diagnosis at discharge, then the diagnosis should be coded as if they would have existed anyway. Coders do not include abnormal findings except in the event the health care provider signifies it is important in some way. Now, with that being said, there are some hospitals that will have entirely different policies when it comes to the coding of uncertain conditions, and all coders do need to make sure that they are in full compliance with the rules of their facility.
Signs and Symptoms in both Inpatient and Outpatient Settings
There are different procedures for coding signs and symptoms in inpatient settings as opposed to outpatient settings which are as follows:
Inpatient – If the signs and symptoms are presented by the physician as a primary diagnosis then they do not need to be coded in inpatient files. If, however, the symptoms seem to be part of a definitive diagnosis, they can be coded.
Outpatient – The problem with outpatient procedures is that so many of them lack an actual diagnosis. With that being the case, it is more acceptable for them to use signs and symptoms for coding purposes. Coders, however, should be constantly on the lookout for new information from the care provider so that they are able to eventually enter a definitive diagnosis.
Inpatient Coding Concerns – Complications
Additional Stays – In the event, a patient needs an additional stay in the hospital as a result of complications, then the principal diagnosis should be the complication. If, however, the complication is non-specific, additional codes will probably be made necessary at that point.
Admitted Due to Complications – Here we are bringing up an instance where a patient is admitted due to complications following outpatient surgery or other procedures which are outpatient related. In this case, the complications need to be listed as the principal diagnosis unless the reason for admission is not a complication from surgery. In this case, the first listed reason for the initial surgery would become the principle.
What are the Biggest Differences?
When it comes right down to it, the biggest reasons for the differences in coding would be the criteria for uncertain conditions. In other words, when you don’t know what the condition is, there are probably going to be two different sets of criteria for addressing it. Now, with that being said, is important that you, as the coder, make sure that you’re adhering to the regulations set forth by the environment you’re working in whether it is a hospital or a private practice. Medical coding needs to be standardized across the facility, and there is little doubt that when done properly, it is responsible for saving lives.
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