Hcr230

Inpatient and Outpatient Hospital Services

Misha Livingston

HCR/230

Samantha Bame

Inpatient and outpatient hospital services differ in one big way. Inpatient facilities have the setup for patients to stay there overnight. Long-term care facilities, hospitals, and skilled nursing facilities are inpatient facilities. Home health agencies, hospice staff, and ambulatory surgical centers provide outpatient services. These facilities (where applicable) do not have the equipment for overnight stays. Inpatient and outpatient facilities have different coding processes. Inpatient services diagnostic coding goes by the rules of the Uniform Hospital Discharge Data Set (UHDDS). In order for reimbursement to be made by private payers, Medicare, and Medicaid, hospitals and other such facilities must follow the UHDDS’s rules. Inpatient medical coders perform the coding for inpatient facilities once the patient is discharged. Volumes 1 and 2 of ICD-9-CM are what are used for coding inpatient diagnoses. For coding procedures performed during the stay, Volume 3 is used. The principal diagnosis is always listed first, according to hospital inpatient rules. The principal diagnosis is the central reason for admission. One example: Inpatient principal diagnosis post-surgery: Acute appendicitis (540); Inpatient admitting diagnosis: Severe abdominal pain (789.00). If a patient is admitted for laboratory or other workups to determine the patient’s medical problem, the admitting diagnosis can be suspected or unconfirmed conditions as selected by the coder. Additionally, all other conditions that affect the stay of the patient can be listed by the coder (Valerius, Bayes, Newby and Seggern, 2008).When coding for diagnoses in outpatient facilities, the primary diagnosis is the first code that is listed; that is, and the central reason the patient is seeing the physician or provider.

Reference

Valerius, J., Bayes, N., Newby, C., & Seggern, J. (2008).

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