Forum - Questions & Answers

Nov 1st, 2011 - khripplinger

facility vs. non-facility vs. outpatient vs. inpatient

I am a newly certified CPC-A searching for a job an I'm confused by some of the language used in job postings. I'm seeing posting for "Facility Coding" or for
"Professional Coders" When I was taking my coding classes the references used were for either outpatient or inpatient coding with the use of modfier to indicated
if you were coding the technical component (TC) or the professional component.
I thought that the CPC-A was outpatient coding. Then there's CPC-H, which I thought was inpatient coding but now I'm told that is for "Facility Coding" I'm really confused. Can anyone explain to me which credential is for inpatient vs. outpatient
vs. facility vs. non-facility. I jsut want to be sure that any job I apply for I'm quailfied for and don't look like a dunce. Thanks

Nov 3rd, 2011 - Codapedia Editor 1,399 

re: facility vs. non-facility vs. outpatient vs. inpatient

A physician will provide services in both the outpatient or office setting and in an inpatient setting. (Or home, nursing home, etc.) The professional component or physician charge is billed to Part B. Reimbursement is based on the fee schedule associated with the CPT® code. That is professional coding. Both AAPC and AHIMA offer credentials for the professional, Part B side of coding. AAPC started on the physician side, but credentials for both (I believe.)

The facility is coded based on a day rate with a private insurer or based on Diagnosis Related Groups (DRGs) for Medicare, and bills to Part A. AHIMA has traditionally been more involved with facility coders, but now has credentials for the physician side as well. In order to work in the facility, you need intensive diagnosis coding skills. On the physician side, we need to be proficient in diagnosis coding, but reimbursement is based on CPT® code.

I hope this helps.

Maybe some of my more knowledgeable coding friends will chime in here.



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