Hospital Coders: Do You Prefer Inpatient or Outpatient Coding?

As the largest and most recognized education and credentialing entity for medical coders and billers, the AAPC sets the standard for training and certification. Did you know they offer separate certifications for medical coders looking to work in hospitals? Indeed, they have certifications for both inpatient and outpatient coding. If you are a medical coder working in a hospital environment, which do you prefer?

 

It has been said that inpatient and outpatient medical coding are two sides of the same coin. That is probably an accurate assessment. At the same time, the two types of coding are different enough that the AAPC feels justified in offering two separate certifications.

 

Perhaps looking at some of the differences between inpatient and outpatient coding would make it easier to understand separate certifications. Here are some things to consider:

 

 

Both inpatient and outpatient coding rely heavily on the ICD-10 code set. However, different portions of that set are emphasized with each type of coding. Inpatient coders rely more on ICD-10-CM and ICD-10-PCS codes. They also need to consider present on admission (POA) indicators.

 

Outpatient coders also make heavy use of ICD-10-CM for diagnoses. But they also rely on CPT/HCPCS Level II for coding procedures and services. They are more focused on the reason for a particular visit and each of the services provided.

 

 

As you might expect, inpatient medical coding is more complex due to the fact that patients remain hospitalized for some length of time. There are more procedures and resources to code. Diagnoses tend to be more detailed and there may even be multiple diagnoses to deal with.

 

Encounters in an outpatient environment tend to be shorter and more specific. This typically means that outpatient coding is less complex. There are fewer nuances and more straightforward facts that make coding easier.

 

 

Inpatient and outpatient coders often differ in daily application of their knowledge. For example, coding an outpatient encounter often involves a confirmed diagnosis. Inpatient coders can assign codes even when diagnoses are not yet confirmed.

 

Inpatient coders are dealing with a more lengthy stay. Therefore, they need to capture the entire experience from start to finish. Outpatient coders deal with individual encounters that are comparatively shorter.

 

Interestingly, both in- and outpatient coders require equally detailed information from clinicians. They need to be equally accurate in their coding. And yet different payment systems can be utilized by the two types of coders – even in the same hospital environment.

 

Understanding some of the differences between inpatient and outpatient coding should further clarify why the AAPC offers separate certifications for both. Even though the two jobs represent opposite sides of the same coin, they require mastering different skills.

 

The AAPC is quick to remind future medical coders that both in- and outpatient coding is moving rapidly forward as the healthcare system in this country evolves. They recognize that the ongoing trend of clinicians working for hospital-owned groups rather than private practices is placing more emphasis on hospital coding. As such, both inpatient and outpatient coding jobs are opening across the country.

 

While it is not a legal requirement in most states to be certified, the AAPC strongly recommends it. Being properly certified demonstrates a coder has mastered the necessary skills. Certification increases a candidate's job prospects along with career advancement and pay potential.

 

Here is the bottom line: inpatient and outpatient medical coding are similar but not identical. They are different enough that the AAPC believes separate certifications are in the best interests of coders.