Comparing Outpatient & Inpatient Coding

There are many different opportunities that are available in the Health Information Management field.  Some of these opportunities include medical coding. Specialties include inpatient, outpatient, emergency room, and physician evaluation and management coding.

The main difference between coding outpatient and inpatient is the procedure codes.  Current Procedural Terminology (CPT) codes are used for outpatient coding and the International Classification of Diseases Ninth Revision Clinical Modification (ICD-9-CM) is used for inpatient coding. 

CPT codes are published by the American Medical Association and The World Health Organization (WHO) is responsible for ICD codes. 

Keep in mind that ICD-9 diagnoses codes are used for both outpatient and inpatient coding.  Confused?

Inpatient Codes:

• ICD-9-CM (Diagnoses codes & Procedure codes)
• DRG (Diagnoses Related Groups)

Outpatient Codes:

• ICD-9-CM (Diagnoses codes)
• CPT (Procedure codes)
• HCPCS (use for Medicare & Medicaid)

Generally, it is said that outpatient coding is easier and typically considered entry level coding. A patient's average length of stay is of course longer if they are an inpatient admit so coding these charts will usually have a higher reimbursement value and will likely be more complex, compared to a patient being seen for an outpatient same day surgery.

It is essential that you master the coding guidelines in order to accurately code.  Compliance is of utmost importance, especially with the establishment of Medicare Recovery Audit Contractors which has recouped almost a billion dollars in overpayments to healthcare providers across the country.

The purpose of this blog is provide a supplemental resource to help master inpatient and outpatient coding. Please note that sources from CMS and the CDC will be utilized as this is the most authoritative and creditable references.

The following are links you should bookmark:

https://www.cms.gov/icd9providerdiagnosticcodes/

http://www.cdc.gov/nchs/icd.htm

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Best wishes in becoming expert medical coders.