Outpatient vs Facility Coding Differences – Key Terms

In outpatient settings, the condition primarily responsible for services rendered at a specific encounter. In inpatient settings, the condition established after study to be chiefly responsible for the hospital admission. A Medicare outpatient status where a patient receives monitoring services; outpatient coding rules apply. Diagnosis-Related Group; the inpatient hospital payment classification system based on principal diagnosis, procedures, and patient characteristics. Ambulatory Payment Classification; Medicare's outpatient hospital payment system. Uniform Billing claim form used by hospitals for both inpatient and outpatient facility claims. Professional claim form used by physicians and non-facility providers for outpatient services. Uniform Hospital Discharge Data Set; federal definitions governing inpatient data elements including diagnosis reporting. Same-day surgery where the patient is discharged the same day; coded as outpatient. Indicator required on inpatient hospital claims; NOT required for outpatient encounters.