Question

which codes are used for both outpatient and inpatient settings?

medical coding and billing

Answer 1

Medical coding and billing ks indeed to be a complex system that is considering the complexity of the hospital environment.It should be in well organized and systematic staring from the billings process to the reimbursement process.It is challenge that patient billing is done and successful reimbursement is claimed a at a timely manner.Medical coding serves a number of purposes including retrieving and reporting information on the basis of diagnosis and procedure.

Medical coder will review the medical record and assign certified codes to their diagnoses.Medical coding involves assigning numeric/ alphanumeric codes to all healthcare data elements of both outpatient and inpatient.The most important step for medical coding and billing process is to identify whether patient is an outpatient or an inpatient.

Outpatient coding and Billing:

• Outpatient refers to a who is being treated but not admitted under the care of the hospital for an extended stay and discharged with in 24hrs from the hospital.If a patient stay for 24hrs,patients can be considered as an outpatient.
• Outpatient coding is based on ICD-9/ICD-10-CM diagnostic code for billing and appropriate reimbursement, but use Healthcare common procedure coding system( HCPCS) to report procedures.
• Documentation play a major role in the Current procedure terminology (CPT) and healthcare common procedure coding system codes for services.
• The healthcare common procedure coding system (HCPCS) is a collection of codes that represents procedures,supplies,products and services which may provided for medicare individuals enrolled in the private health insurances program.
• Outpatient prospective payment system (OPPS) is a prospect payment that provide reimbursement for outpatient services from the hospital.
• This system was implemented under this system is known as Ambulatory Payment classification.

Inpatient coding and Billing:

• Inpatients refers to patient that who is admitted to the hospital upon the order of the physician and then admit the patient into ward for an extended stay.
• It is used to report a patient diagnosis and services based on patient's extended stay.It also use ICD-9/ICD-10-CM diagnosis codes for billing and reimbursement but uses ICD-10-PCS as the coding system.
• Inpatient prospective payment system (IPPS)is the reimbursement methodology used by medicare to provide reimbursement for inpatient hospital services.