AHA Coding Clinic® for HCPCS - 2003 Issue 4; FOR your INFORMATION

CMS provides an informational update on billing and payment requirements for observation services

In a recent program memorandum, Transmittal A-03-051, CMS states that the instruction provided in Transmittal A-02-129, that instructed hospitals to report modifier -25 with HCPCS code G0263 (Direct admission of patient with diagnosis of congestive heart failure, chest pain or asthma for observation services that meet all criteria for HCPCS code G0244) in order to receive payment for code G0244 (Observation care provided by a facility to a patient with CHF, chest pain, or asthma, minimum eight hours, maximum forth-eight hours), was incorrect. CMS goes on to say that hospitals are not required to report modifier -25 with code...

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