AHA Coding Clinic® for HCPCS - 2002 Issue 3

CMS proposes modification of criteria for direct admits to observation

The implementation of the provision for separate payment of observation services under APC 0339 has generated several questions regarding a patient’s direct admission into observation by his/her physician without prior critical care or evaluation and management (E/M) services in a hospital clinic or emergency department the day before or the day of admission to observation. The Centers for Medicare and Medicaid Services (CMS) have responded to these questions via an open forum. One question specifically sought clarification of the “Frequently Asked Question (FAQ)”, Question #97, posted on CMS’s web site regarding the reporting of a low-level...

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