INPATIENT vs OUTPATIENT CODING What is the difference?

WHAT IS INPATIENT CODING? Inpatient coding is codes that describe WHY the patient has been admitted. ICD-10- PCS has 2 ADDITIONAL placeholders for characters in the code. The 7th character is for ADDITIONAL INFORMATION on a diagnosis, or “X” is used for future expansion of that code. When a patient is admitted there needs to be a PRIMARY DIAGNOSIS. If there is an uncertain diagnosis at the time of DISCHARGE, it should be coded as if that issue would have otherwise existed. Inpatient coding requires the coding of suspected conditions and abnormal signs and symptoms if there is NO diagnosis. (Inpatient Coding vs Outpatient Coding: Medical Coding Explained, Harold Gibson, Oct 15,2015)

WHAT IS OUTPATIENT CODING? Outpatient Coding is medical codes used telling about WHY the patient is being seen and when a patient is NOT admitted. These codes are USED in physicians office, Emergency Room (ER), Outpatient surgery/Ambulatory centers. Outpatient coding DOES NOT require a primary diagnosis. It is acceptable to code signs and symptoms. Uncertain diagnoses DO NOT warrant any sort of codes. ICD-10-CM codes are used in the outpatient setting (Inpatient Coding vs Outpatient Coding: Medical Coding Explained, Harold Gibson, Oct 15,2015)

CODING GUIDELINES - INPATIENT The number to remember is 7. The digits used is 0-9 The 24 letters used are A-H, J-N, P-Z Letters O and I are not used so they are not confused with the digits 0 and 1 Values for new devices can be ADDED. Alphabetic Index HELPS you to locate the correct PCS tables The PCS tables should ALWAYS be consulted to find the valid code. It is not REQUIRED to use the Index first to help locate the correct code. The code can be chosen directly from the PCS table. The PCS table codes are created all from the SAME row, not different ones. “And” means “and/or” It is your responsibility to determine in the medical record what is EQUAL to the definitions on the PCS table.

CODING GUIDELINES - OUTPATIENT It is essential to use BOTH the Alphabetical Index and the Tabular List. ICD-10-CM codes are composed of 3,4,5,6 or 7 characters. The codes A00.0 – T88.9, Z00-Z99.8 must be used for diagnoses, symptoms, conditions, problems, complaints for the visit and/or encounter. Codes for SIGNS & SYMPTOMS can be used if there is no confirmed diagnosis. ICD-10-CM codes are to be REPORTED only once for each encounter.

STEPS TO FOLLOW – INPATIENT Body Part (4th) Approach (5th) Device (6th) Qualifier (7th) O Upper Intestinal Tract D Lower Intestinal Tract X External 0 Drainage Device U Feeding Device Y Other Device Z No Qualifier U Omentum V Mesentery W Peritoneum INPATIENT Step 1: Find the SECTION for procedure Step 2: Find the BODY SYSTEM Step 3: Find the OPERATION Step 4: Find the BODY PART Step 5: Find the APPROACH Step 6: Find the DEVICE Step 7: Find the QUALIFIER

STEPS TO FOLLOW – OUTPATIENT Identify all the MAIN TERMS in the medical record/report. Locate the main term in the ALPHABETIC INDEX. Check for any SUB TERMS indented under the main terms. Follow any instructions (SEE ALSO) in the index. In the TABULAR LIST verify the code you selected. Read and follow any INSTRUCTIONAL terms in the list. Assign codes to their HIGHEST level of specificity. Once all component elements are FULLY identified, the code is complete.

THANK YOU!! I hope this presentation gave you some more insight to Inpatient vs outpatient coding.