Understanding The Differences Between Outpatient and Inpatient

When it comes to outpatient and inpatient coding, they might seem similar but they are quite different. Even though both the terms refer to the period when the patient stays in the hospital, both of them have different features. It is crucial to know the difference between the two in the medical world since they play a major role in outpatient and inpatient coding. Further, it adds to the overall knowledge of helping patients whenever required and managing healthcare cost-effectively and smartly.

What Is Inpatient?

The Difference Between Inpatient and Outpatient Care

Inpatient refers to the duration of the stay of the patient in the hospital. It could be for one single night or several nights altogether. The duration of their stay solely depends upon their illness, diagnosis and the recovery they would require. The doctor gets to decide upon the duration of stay for the patient depending upon their recovery time for their particular illness. Patients that tend to receive inpatient care are always under constant surveillance from all the medical professionals which includes physicians, nurses and doctors. During a patient’s stay at the hospital these are the following things that they can expect;

  1. The patient is under constant supervision by the medical team. They are prompt at delivering the medicine at the right time and providing the needed care the patient would require.
  2. After the diagnosis of the patient is done by the doctor and they are admitted to the hospital – they will be admitted depending on their diagnosed condition. For instance, if a patient is suffering from heart-related issues, they will be admitted under the cardiology services. However, if it is just general surgery, they will be admitted under general surgery services.
  3. One of the advantages of inpatient care is the fact that after the patient has been admitted into the hospital the doctors then can decide upon a treatment route which can include routine surgeries, tests and many other things.
  4. People who have experienced a sudden illness or have been in a serious accident will receive inpatient care.

Every patient admitted under inpatient care has to wait for their doctors to confirm whether or not they require further care from them. The patient will only get discharged from the hospital after they are in a stable condition. However, the doctor will prescribe follow-up appointments along with any other medicines that the patient might have to take. When it comes to the medical billing and coding process the medical coders and billers have to make sure that the details are put in correctly so that there is no problem with the insurance whatsoever.

What Is Outpatient?

Outpatients do not get admitted to the hospital like inpatients. Outpatient services are built in a manner that accommodates the procedures and treatments which can be easily done within one single day without requiring to stay at the hospital. Outpatient treatment can include an appointment with your doctor, walk-in clinics, and surgery centers dedicated to outpatients only. Many hospitals tend to have a dedicated care facility for outpatients alone. When it comes to outpatient medical coding some key differences need to be followed by medical billing outsourcing companies.

The following scenarios require outpatient care;

  1. Cataract surgery
  2. Joint replacement surgery
  3. Treatment for knee pain
  4. Installation of a temporary catheter for patients with bladder issues
  5. Injection into the sacral or lumbar spine
  6. Draining abscess out of a skin wound
  7. Treating superficial wounds
  8. receiving treatment for chronic illnesses through radiation, chemotherapy or dialysis
  9. Medical screenings such as colonoscopy, endoscopy or mammogram
  10. Minimal invasive surgery

Differences between outpatient and inpatient coding

There are some key differences between outpatient and inpatient coding. To know more keep on reading this article.

1. Codes

The use of outpatient coding includes the use of ICD 10 CM diagnostic codes along with HCPCS or CPT codes which are specific to certain supplies and services that are provided by the outpatient care. The role of documentation is crucial when it comes to the assigning of HCPCS and CPT codes

The use of inpatient coding includes the use of codes wherein a patient’s procedures and diagnosis are performed is jotted down accordingly. Both the ICD 10 PCS and ICD 10 CM code manuals are crucial when it comes to inpatient coding. In the U.S ICD 10 PCS is widely used for inpatients alone who are within the hospital setting.

2. Symptoms and diagnosis

The symptoms that a patient shows are the basis on which the diagnosis is reported which is not a part of the inpatient setting. But if a medical professional’s documentation lacks a proper diagnosis, then the medical coders can add in the required medical codes of additional symptoms and signs along with the suspected condition of the patient.

3. Duration of stay

The process of outpatient coding is not as complex as its counterpart, inpatient coding. When it comes to inpatient codes take into consideration the entire services that have been provided to the patient over a certain period or during their stay at the hospital. POA which also stands for present on admission is also an important part of inpatient coding. POA refers to the conditions that have been present during the time of admission of the patient.

How does coding for outpatients differ from inpatient coding?

How does coding for outpatient differ from inpatient coding?

The process of outpatient medical coding is not as complex as inpatient medical coding. One of the key differences that they both have is when it comes to reimbursement procedures. While the services of the outpatient get covered under Medicare part B, Medicare part A or the hospital’s insurance plan covers the services of the inpatient. The coding procedure followed by inpatient services is according to MS-DRGs (Medicare Severity Diagnosis Related Groups). 

The coding procedure for both inpatient and outpatient requires proficiency and expertise in the field of medical coding. To get the maximum benefits for your company the best decision that you could make for your medical organization is to outsource medical billing services, and this is where Synergy HCLS can help you out!