Medical Coding Inpatient vs. Outpatient Coding
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Q: I’m having a difficult time distinguishing between how coding is done for each side (Inpatient vs Outpatient). Are we coding everything, (e.g. Signs & Symptoms) in outpatient and just the definitive diagnosis on the inpatient, or do I have them confused?

A: So, yes, it’s a little bit confusing. I wanted to address two issues with this question. One, do we code for signs and symptoms plus the definitive diagnosis? And two, can outpatient coders code rule out diagnosis?

Let’s take a look at the first one – Coding Signs and Symptoms. This applies to inpatient and outpatient, so that’s the first answer to the question there. If you have a definitive diagnosis, and what that means is yup they definitely have it. Maybe the physician, like in my case, I had rightsided weakness. I was getting some tingling in my arm, the side of my face was feeling numb, so I went to my doctor’s office right away and they started to do a workup over the course of a week. I went to different specialists and they were trying to rule out multiple sclerosis, MS.

As it turned out, after everything was said and done, I had a complicated migraine. My neck needed to be adjusted or whatever and after a few chiropractic treatments, I was fine. But it was pretty scary because when you work, I was an occupational therapist, and I worked with stroke patients and you start seeing those symptoms, you get really scared. So, they did a rule out. I did all these tests and labs and MRIs to rule out multiple sclerosis. My signs and symptoms were the numbness and the weakness and all those other things. So, the definitive diagnosis, had I been diagnose with it would have been multiple sclerosis. In the end, my definitive diagnosis was complicated migraines. OK? So, that’s what definitive means.

Now, when you’re dealing with signs or symptoms as whether or not you code both, the signs and the symptoms and the definitive diagnosis, depends on whether that sign or symptom is considered integral to that disease. If you always have one with the other, then you don’t code the sign or symptom, OK?

Here’s an example: Patient comes in with wheezing and they’re diagnosed with asthma. Well, wheezing always goes along with asthma, but you would not code the wheezing, you would just code the asthma. There are many other examples out there, but that’s a pretty good one.

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