AHA Coding Clinic® for HCPCS - 2011 Quarter 1; FOR your INFORMATION
Reporting Critical Care Services Under the Opps
In previous years including calendar year 2010, the Centers for Medicare and Medicaid Services (CMS) instructed hospitals to report critical care CPT codes in accordance with CPT guidance, unless instructed otherwise by CMS. In particular, hospitals were instructed by CMS that any of the services indicated by the CPT Editorial Panel to be included in the reporting of CPT code 99291 were not to be billed separately. This advice was recently revised by the AMA CPT Editorial Panel and therefore, as of January 1, 2011, hospitals are to report all of the ancillary services and their associated charges separately...
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Article Overview
This brief article is for hospital coders, billing staff, and revenue cycle teams tracking OPPS reporting guidance. It summarizes a change in the way critical care-related hospital charges are reported, highlights the role of CMS and the AMA CPT Editorial Panel, and notes the use of a modifier when services occur in separate encounters on the same day.
Why This Topic Matters
Updates to hospital reporting guidance can affect charge capture, claim accuracy, and compliance for critical care encounters. Readers need to know when the guidance changed and what general categories of services are implicated.
What You Will Learn
- How reporting guidance for hospital critical care services changed over time
- Which organizations are referenced in the reporting update
- What general type of hospital reporting issue the article addresses
- When the revised guidance became effective
Who Should Read This
- Hospital coders
- Outpatient billing staff
- Revenue cycle professionals
- Compliance teams
Codes Discussed
Modifiers Discussed
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