AHA Coding Clinic® for HCPCS - 2001 Issue 4

New medical observation APC reporting rules

The November 30, 2001 OPPS final rule approved the creation of a new APC for medical observation services. Medicare will continue to package observation services into surgical procedures and most clinic and emergency visits. APC 0339, Observation, has been created to make a separate payment for observation services for three medical conditions: chest pain, asthma and congestive heart failure (CHF) when certain criteria are met. For all other conditions, payment for observation services is packaged into the APC in which those services were provided. The example provided in the final rule is that of a patient with syncope who...

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