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CODING: The reason why coding must be done before submission of inpatient billing
Inpatient billings for the hospital portion requires clinical coding or the IHC (inpatient hospital claim) will be rejected.
If you submit a paper claim, you set a provisional diagnosis and provisional procedure on the HC21 (national claim form) but you don’t need a DRG, then you have to do the formal final coding before submitting your mandatory Hospital Casemix Protocol data which includes all diagnoses, procedures and DRG.
In the case of the inpatient hospital claim electronic, the electronic message contains the clinical coding data including DRG, and the fund will reject the claim if the clinical coding data is not in the message.
It does not affect medical billings but because the medical and hospital are on the same account (unless the patient is an outpatient) and these claim types are submitted at the same time, most sites finalise the clinical coding before submitting both hospital and medical.
If you submit a paper claim, you set a provisional diagnosis and provisional procedure on the HC21 (national claim form) but you don’t need a DRG, then you have to do the formal final coding before submitting your mandatory Hospital Casemix Protocol data which includes all diagnoses, procedures and DRG.
In the case of the inpatient hospital claim electronic, the electronic message contains the clinical coding data including DRG, and the fund will reject the claim if the clinical coding data is not in the message.
It does not affect medical billings but because the medical and hospital are on the same account (unless the patient is an outpatient) and these claim types are submitted at the same time, most sites finalise the clinical coding before submitting both hospital and medical.
