AHA Coding Clinic® for HCPCS - 2002 Quarter 3
OCE recognizes admitting diagnosis for observation services
A recent program memorandum (PM), Transmittal A-02-075, released by the Centers for Medicare & Medicaid Services, now requires the Shared Systems Maintainers (SSMs) to pass the admitting diagnosis field to the outpatient prospective payment system (OPPS) outpatient code editor (OCE). The effective date for this change is April 1, 2002. However, the change will not be implemented by the SSMs until January 1, 2003. Presently, to determine whether observation services meet the requirements for separate OPPS payment, all the diagnosis fields on an outpatient claim are required to be available to the OPPS OCE. Each diagnosis field on the...
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Article Overview
This article covers a CMS program memorandum update to the outpatient prospective payment system workflow and the outpatient code editor used in claim processing. It is relevant to hospital outpatient coders, revenue cycle staff, and compliance teams who need to understand changes in how diagnosis data are transmitted and evaluated for observation-related payment determinations. The article also notes the timing of the policy effective date and the later system implementation date.
Why This Topic Matters
Understanding this change helps outpatient billing and coding staff follow Medicare claim-processing updates that affect observation service payment review and diagnosis-field transmission.
What You Will Learn
- What CMS changed in the outpatient claim processing workflow
- How the update relates to observation service claim evaluation
- Why the timing of the effective date and implementation date matters for providers
- Which Medicare outpatient systems are involved in the change
Who Should Read This
- Hospital outpatient coders
- Revenue cycle staff
- Outpatient billing personnel
- Compliance teams
- Medicare claims processing staff
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