AHA Coding Clinic® for HCPCS - 2002 Issue 3

Proposed hospital coding for evaluation/management services

Since the implementation of the hospital outpatient prospective payment system in August 2000, facilities have been using CPT evaluation and management (E/M) codes to report clinic and ED visits. CMS allowed each facility to develop an internal set of guidelines to report services represented by these codes. The only requirements were that the services be documented, be medically necessary and that the mapping should reasonably reflect the intensity of the hospital’s resources consumed. Hospitals have struggled to create their own systems and looked forward to CMS developing a standard methodology for reporting evaluation and management (E/M) services in...

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