What is the difference between hospital coding and physician coding?

Asked By: Dawna Chizhevsky | Last Updated: 17th February, 2020
Category: medical health surgery
4.5/5 (762 Views . 39 Votes)
Inpatient medical coding is reported using ICD-10-CM and ICD-10-PCS codes, which results in payments based on Medicare Severity-Diagnosis Related Groups (MS-DRGs). Outpatient medical coding requires ICD-10-CM and CPT®/HCPCS Level II codes to report health services and supplies.

Click to see full answer


Thereof, what is Facility medical coding?

Facility coding reflects the volume and intensity of resources utilized by the facility to provide patient care, whereas professional codes are determined based on the complexity and intensity of provider performed work and include the cognitive effort expended by the provider.

Secondly, what is the difference between professional and facility coding? While professional codes primarily capture the complexity and intensity of physician care provided during a visit, facility codes detail the volume and intensity of hospital or health system resources used to deliver patient care, such as the use of medical equipment, medication, and nursing staff.

Beside this, what is the difference between inpatient coding and outpatient coding?

Outpatient coding refers to a detailed diagnosis report in which the patient is generally treated in one visit, whereas an inpatient coding system is used to report a patient's diagnosis and services based on his extended stay.

Is inpatient or outpatient coding easier?

Outpatients are the people who visit a hospital for treatment but are not admitted. These patients may stay at the hospital for few hours or even overnight. Since outpatient visits are short-term, outpatient coding is relatively less complex than inpatient coding.

35 Related Question Answers Found

What is a Level 5 ED visit?

Hospitals charge for ER services by level, depending on the amount of equipment and supplies needed, with Level 1 requiring the fewest (e.g., a nosebleed) and Level 5 representing an emergency (trauma, heart attack).

What is Profee?

Pro-Fee generally refers to coders who work with coding the PROFESSIONAL (or PROVIDER) side of the charges, as opposed to the facility side of the charges - at least that has been my experience.

What is emergency department coding?

Emergency Medicine presents a unique set of challenges for coding. This fast paced high-volume specialty encompasses elements of primary care E&M services up to trauma services. Their coding is done remotely, usually by billing companies or hospital medical records staff.

What is a Level 1 emergency room visit?

Level 1 - Highest level ER, indicating the ability to give definitive, rapid care for all critical emergency situations; usually associated with a teaching hospital. Resources within the hospital (diagnostic and intensive care units) can continue to care for these patients.

What is a facility coder?


Hospital Facility Coding Background
Coding to address specific hospital areas including inpatient coding, emergency departments, ambulatory care, radiology (including interventional radiology), ambulatory surgery centers/same day surgery centers.

What is facility outpatient coding?

Facility Coding
The Coding Network is a premier provider of accurate coding for all types of hospital outpatient departments and clinics, ambulatory surgical centers, emergency departments, cardiac catheterization labs, and both diagnostic-and-interventional radiology departments.

What are outpatient codes?

Outpatient coding focuses on the direct treatment offered in a single visit, which is usually a few hours. A basic rule of thumb is that outpatient care has a duration of 24 hours or less.

What is professional fee coding?

The Professional Fee Coding Skills Assessment is designed to measure competency in physician, mid-level providers, and other professional services coding. Individuals use this assessment to demonstrate their level of knowledge.

What does a coder do at a hospital?

Medical coders read a patient's medical chart and analyze it, determining the patient's diagnoses and any procedures performed. They then categorize those diagnoses and procedures according to a national classification system, assigning a specific numeric or alphanumeric code to each diagnosis or procedure.

What are coding guidelines used for?


Coding guidelines are used daily. Due to the complexity of the coding process the guidelines help codersand managers make decisions. They also used to make ethical resolutions within the workplace (Standards of Ethical Coding, 2008).

Can you code possible diagnosis for outpatient?

The outpatient reporting rules state: "Do not code diagnoses documented as "probable," "suspected," "questionable," "rule out," or "working diagnosis" or other similar terms indicating uncertainty.

Is inpatient coding hard?

For some, inpatient coding may prove to be more challenging than physician coding. Besides assigning diagnosis codes to conditions, you must determine the principal diagnosis (PDx) to assign the correct diagnosis-related group (DRG) to the inpatient stay.

How do you know if it is inpatient or outpatient?

The day before you're discharged is your last inpatient day. You're an outpatient if you're getting emergency department services, observation services, outpatient surgery, lab tests, X-rays, or any other hospital services, and the doctor hasn't written an order to admit you to a hospital as an inpatient.

Can you code possible diagnosis?

If the diagnosis documented at the time of discharge is qualified as “probable,” “suspected,” “likely,” “questionable,” “possible,” or “still to be ruled out,” or other similar terms indicating uncertainty, code the condition as if it existed or was established.

How much do inpatient coders make?


National Average
Salary Range (Percentile)
25th 75th
Annual Salary $61,000 $75,000
Monthly Salary $5,083 $6,250
Weekly Salary $1,173 $1,442

What coding system is used for hospital inpatient procedures?

ICD-10-PCS procedure codes are designed only for hospital reporting of inpatient services. Current Procedural Terminology (CPT) codes will continue to be used for physician and outpatient services.

Are DRG codes used for outpatient?

Ambulatory payment classifications (APCs) are a classification system for outpatient services. DRGs have 497 groups, and APCs have 346 groups. APCs use only ICD-9-CM diagnoses and CPT-4 procedures. Payments for both are based on a weight for each DRG/APC and a rate for the facility.