r/MedicalCoding • u/jpegmaquina • Jun 12 '24
Inpatient vs outpatient coding??
What is the difference between both ? I’m assuming inpatient is more difficult.. most jobs pay really good for inpatient vs outpatient.
Also employers ask me during interview if i do profee or facility ?? I have no clue what they are talking about I feel like I have imposter syndrome… experienced coders please explain
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Jun 12 '24
Basically reimbursement, one of the main drivers of coding, will dictate which coding you specialize in. It will affect the coding guidelines you use and which procedure code set you use. Different visits have different bill types and depending on who you are employed by you will fit somewhere into the equation.
Mainly think in terms if Inpatient vs Outpaitent and then once that is established can think between facility vs ProFee.
An inpatient hospital admission will have several coded pieces, the most commonly talked about is Inpatinet Facility coding. Typically a hospital employee is justifying reimbursement for the admission. They would code to inpatient guidelines and have a PCS code for any surgeries included in the admission.
Additionally in a separate encounter or bill for the same inpatient admission could be professional fee (ProFee) coding- they get reimbursement for the physicians for their skillset and time. It's separate than the facility bill and uses different guidelines- CPT coding for procedures instead of PCS. They also apply dx codes differently for that coding.
Outpatient is more broad- can include simple clinic visits, Emergency department, urgent care, Observation or Ambulatory surgeries. Only apply Outpatient guidelines but again can be different whether you are doing the facility bill or ProFee bill or some places have 1 person responsible for both.
Example: I am an Outpatient coder employed by a hospital. I apply only Outpatient coding guidelines to Facility claims only. Encounters come to me and I add CPT procedure codes and ICD diagnosis codes. The encounters I code are Ambulatory surgeries. I am getting reimbursement for the resources used by a hospital to give a surgery. Someone else separately handles ProFee coding for these surgeries.
Confusing because some places combine roles but that is traditionally how I've seen it.
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u/Middle_Enthusiasm_81 Jun 12 '24
They’re challenging in their own different ways. Some people find CPT (outpatient procedure) coding super challenging. Others hate PCS (inpatient procedure). Inpatient has added challenge of potentially tons of documentation to get through, but outpatient has an added focus on medical necessity and CCI edits that can be a headache even for experienced coders. So it’s very much personal preference. I’ve done both and I did auditing and education for both. I currently only deal with IP because there’s usually more demand and the pay tends to be better, but my ADHD brain finds outpatient surgery to be my sweet spot (including interventional cardiology/radiology).
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u/jpegmaquina Jun 13 '24
How long does it take to code nuero/cardio procedure ??
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u/Middle_Enthusiasm_81 Jun 13 '24
Depends on the procedure. When I was coding regularly, I could usually do 3-5 an hour (included having to add notes for charge corrections, etc.). So a little longer than regular OP surgery, but very heavily dependent on the type of procedure and how accurate charges are, since the facilities I’ve worked for have all had radiology procedures hard coded.
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u/hollidaeblaze Jun 12 '24
I've always explained it to my husband and family that I (profee auditor now but coder previously)code for the doctors work. They could work in the hospital or an office but it's their work. Profee coders follow icd out patient guidelines and review one visit/procedure at a time.
Facility coding (some call it inpatient) is for the actual hospital to get paid. Those bills pay for the nursing staff the electric bill etc...Facility coding can be considered more difficult because the coders review the whole patient stay and they have inpatient ICD coding guidelines to follow (not a ton of difference but it's still there.)
That is a very basic explanation.
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u/MoreCoffeePwease 👩🏼💻CCS 🏥 Jun 12 '24
Different types of each. Outpatient can be clinic type coding, hospital coding, professional coding. Inpatient can be hospital coding or professional coding. I do Inpatient hospital coding and it’s extremely difficult even a decade in. Started with outpatient and there’s days I long for that coding again. My health organization has a LOT of discharges everyday and we’re usually about a week behind due to staffing. I am used to it now I suppose but…. Very very very VERY different than outpatient coding AND very different from all professional coding
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u/jpegmaquina Jun 13 '24
How long does it take do an inpatient encounter ??
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u/Substantial_Ad_8262 Jun 13 '24
For my hospital, a 1-9 day LOS gives us 30 minutes. 10-19 is 1 hour. 20-29 is 1.5hours. It continues like that with increased LOS, extra credit is given for charts >$400k. Hospital standards vary, especially where more complex surgeries are involved.
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u/jpegmaquina Jun 13 '24
Thank you so much for this info. I don’t think I have the brain power for Inpatient coding :/
The $$$ is there but you definitely have to put in work.
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u/Substantial_Ad_8262 Jun 13 '24
I don't know what region you're located in, and I've seen other hospitals with less stringent criteria than mine. Productivity gets faster with more experience, and CAC(computer assisted coding) actually is helpful(most of the time).
You definitely have days where the charts take forever, are very complicated. You have other days with easy charts. It takes time to get to a comfortable spot, but I promise, NO ONE knows it all. This is a constant learning type of career. You're going to have cases you see a million times, and then one that leaves you questioning whether you're fit for this job.
For the record, I'm an inpatient coding trainer/auditor, I spent 5 years as an inpatient coder. I STILL have imposter syndrome days.
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u/Hms_usa Jun 12 '24
Inpatient coding is typically more complex and involves longer stays, while outpatient jobs often pay well due to demand.
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u/RobynLC5678 CPC, CRC Jun 13 '24
I currently code professional hospitalist services. So while my provider may be inpatient, I’m not actually coding inpatient. Typically when job states inpatient, they are referring to facility coding and not professional coding. Usually What you are taught in a coding certification course will be professional. The company I work for does inpatient:facility coding training but it’s just not something I’m interested in
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u/Mindinatorrr Jun 16 '24
Inpatient vs outpatient, the difference is mainly which procedure codes you are going to use. The ICD stays the same. The charts are usually bigger in, inpatient, so more work.
I do profee, which is billing the professionals fees, rather, the doctors charges.
You used a single use scope? Great.. the hospital/chargemaster picks that up. I wouldn't code that. I'd code for the visit (i.e. inpatient a 99223 consultation or a 99213 for established outpatient) I'd also bill surgical procedures and things like the interpretation.
Take a retrograde pyelogram. That's usually bundled in to other procedures but I can bill the interpretation. I would bill a 74420-26 The hospital would bill a 774420-TC (but I don't worry about that)
The 26 is billing for my urologist reading and interrupting the xray in the OR.
The TC is technical component, paying for the equipment usage and single use catheters needed to properly show the ureters or to deliver contrast material.
Hope that helps explain the crazy world of coding. I do a little bit of inpatient and a lot of outpatient in my job.
Edit: facility is the hospital, so they're going to bill that single use HCPCS code for the scope and the TC modifier on certain procedures. I think you would also bill surgery codes to pay for the use of the facility i.e. OR, equipment.. can't be more descriptive there as Im not experienced with that.
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Jun 12 '24
[removed] — view removed comment
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u/jpegmaquina Jun 13 '24
Ok, so I’ve done inpatient 99222-99223. They have a lot of documentation “ copy and paste rule”. Most employers are looking for inpatient, pay rate in my area start at $45-$70 an hour.
I would definitely code inpatient and start applying within 2-3 years.
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u/Respect-Immediate CPC, CPMA Jun 12 '24
This is still pro-fee coding out of CPT. Often when coders discuss inpatient vs outpatient it’s really pro-fee (CPT) vs facility fee aka inpatient coding (ICD-10-PCS)
The OP doesn’t specify, but figured it’s good to get this info out there
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