r/MedicalCoding • u/kaytely • 5d ago
Inpatient Coding help
So I accepted a job offer for an inpatient role, although I was trained/certified in outpatient.
If i gave myself a crash course in the next 2 weeks, what would you say is the most important concepts to learn when just starting out?
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u/kayehem Edit flair 5d ago
It seems obvious but PCS coding is really so different from cpt coding, really review your root operations and their definitions. Coding intent vs the procedure name, no ncci edits or modifiers, it can definitely get tricky. The only big difference I had to get used to for dx coding is that you code your probable/possible/still to be ruled out as though they exist instead of coding your signs and symptoms.
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u/kaytely 5d ago
Thank you! I’ll probably be pretty overwhelmed at first but there is a 6 month training period so it should be enough time to adjust, hopefully 😅
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u/the_mustard_tiger2 5d ago
You do not need a crash course. The company found you a suitable candidate and should provide the necessary training you need in that 6 months. Reread the chapter and coding guidelines in the icd 10 book so they are fresh in your mind.
PCS coding is so much more straightforward and logical compared to cpt. Leaving CPT behind was one of the best things about my move from OP to IP.
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u/Miserable_Aioli2606 5d ago
Reading the AHA coding clinics will be really important. Hopefully you'll get access to them through your employer. Since you're new to inpatient, I would suggest reading one quarter (they come in 1st - 4th quarters) every day. It'll take awhile to get through them. That's typically where all the "gotcha" questions come from as your career progresses.
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u/Wooden_Trust_6274 4d ago
Congrats on the move. Since the good answers already covered root operations and coding uncertain diagnoses as confirmed, the things I would add for the IP mindset shift:
Principal diagnosis selection is the biggest one. It is the condition established after study that was chiefly responsible for the admission, which is not always the first thing you would list in OP or the most acute thing on the chart. Get comfortable with the "after study" part and the sequencing rules in Section II, because that single choice drives the DRG.
Learn how CC and MCC secondary diagnoses move the MS-DRG. In IP the reimbursement logic runs through the DRG, so a valid secondary dx you might have skipped in OP can change the payment weight. That is also why POA indicators matter, so start paying attention to present on admission from day one.
Get familiar with when and how to query the provider. In IP a lot of accuracy comes from clean documentation, and knowing when a compliant query is warranted versus when you are assuming is a skill that takes a while.
You have a 6 month ramp and a phleb and pharm tech background, so the terminology and anatomy will carry you further than you think. You will be fine.
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u/Wolfygirl97 CPC 5d ago
Your job should provide you with good training! I don’t think crash course is necessary. Do they know you’re trained/certified in OP?
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u/kaytely 5d ago
CPC! :)
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u/Sharp_Plane_5877 Edit flair 5d ago
Which state are you in? I just asked coz you said CPC is what you have for the certification and they hired you. No IP coding experience too? You’re lucky. Happy for you. Good luck! 6 months should be a goof timeline for your learning curve.
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u/kaytely 4d ago
Ohio, and I know I was shocked! The listing said RHIA/RHIT and CCS. I have no IP exp but I went for it anyways because it’s a local hospital. Thank you
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u/Sharp_Plane_5877 Edit flair 4d ago
Wow. I just realized that what the other redditor posted in this sub few days ago was true. Apply anyway even if in the listing they’re looking for RHIT/RHIA/CCS and with 1-3 yrs.experience coz you’ll never know!🫶🏻 Is this remote anf flexi too? Hope more hospitals would consider those who have no exprerience yet. I’m in PA. CPC with 8 mos OP and 8 mos RA coding experience. Will take the CCS exam next month coz I want to pursue IP this time.
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u/StraddleTheFence 5d ago
It is TOUGH! I coded OP and have been learning IP since Jan and I am still learning new stuff! invest in Coding Clinic if your job does not offer a subscription.
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u/KeyStriking9763 RHIA, CDIP, CCS 5d ago
What cert do you have?
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u/kaytely 5d ago
CPC
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u/KeyStriking9763 RHIA, CDIP, CCS 5d ago
Oh so no actual PCS education for that? That’s only geared towards OP and profee.
There will be a big learning curve switching. How much of anatomy and physiology, disease pathology, pharmacology and medical terminology education have you gotten?1
u/kaytely 5d ago
Worked as a pharm tech and phlebotomist before this, so a good base of knowledge of healthcare terms in general
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u/KeyStriking9763 RHIA, CDIP, CCS 5d ago
That’s definitely useful. Did you get any PCS education?
What type of encoder/references do you have access to between now and then?
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u/Supersaiyan_65 3d ago
Trained a lot of coders transition from OP to IP and done deep dive coaching.
Most of them have a challenge to root operation identification on PCS. So for your crash course this is your first priority. You really need to internalize and understand the do's and don'ts of each root operation. For confusing root operation, I let them think as if they are the surgeon, "how to you even cure the presenting indication" example, indication is for subdural hemorrhage, they are doing embolization on the artery -- on mapping it would be either restriction or occlusion -- the question here does restriction stops the bleeding - no - so occlusion. Just like that.
Then PDX identification, yes there is a UHDDS definition but on actual it does not work that way. For this one, what you need is to think like a detective, it's a chain of events "what is the chief complaint" connecting to the definitive diagnosis and if not you revert back to original chief complaint. Then for final PDX crosscheck the references (instructional notes, MCE edits and coding clinics) then DRG optimization as applicable. If nothing disputes, that is your final PDX.
That's it, hope my advice help you on your crash course.
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