AHA Coding Clinic® for HCPCS - 2010 Quarter 4; FOR your INFORMATION
Change in Critical Care Codes
For CY 2011, the introductory guidelines for Critical Care Services CPT codes have been revised to specifically state that, for hospital reporting purposes, critical care codes do not include the specified ancillary services (e.g. cardiac output measurements, chest x-rays, blood gases, ECGs, ventilatory management, etc.) and that facilities may report those services separately. Beginning in CY 2011, hospitals that report in accordance with the CPT guidelines will begin reporting all of the ancillary services and their associated charges separately when they are provided in conjunction with critical care. The Centers for Medicare & Medicaid Services (CMS) has...
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Article Overview
This article reviews CMS guidance for CY 2011 related to hospital reporting of critical care services under CPT and the associated outpatient payment approach under the OPPS final rule. It focuses on how hospitals should understand the relationship between critical care reporting and ancillary services, along with the use of claims processing edits and HCPCS modifier 59 in the hospital setting. The piece is relevant to hospital coders, revenue cycle staff, and compliance teams tracking Medicare outpatient billing changes.
Why This Topic Matters
It helps readers understand a Medicare payment policy change that affects how critical care encounters and related services are reported and processed for hospital claims.
What You Will Learn
- How CMS addressed critical care reporting for CY 2011
- How hospital outpatient payment policy interacts with critical care claims
- Why ancillary services are discussed in connection with critical care reporting
- What role claims processing edits and modifier 59 have in the hospital context
Who Should Read This
- Hospital coders
- Outpatient revenue cycle staff
- Billing specialists
- Compliance teams
- Medicare reimbursement professionals
Modifiers Discussed
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