AHA Coding Clinic® for HCPCS - 2001 Quarter 1; EVALUATION and MANAGEMENT
Sharing ideas from facility to facility
Evaluation and Management (E/M) facility coding is a new requirement for hospitals since the implementation of the Outpatient Prospective Payment System (OPPS). In the past, hospitals were allowed to report one code ( 99201 ) to indicate a clinic or emergency visit of any type. Now, there are 31 E/M codes used to classify these patients into Ambulatory Payment Classification (APC) groups. With the understanding that existing E/M codes may not accurately reflect the nonphysician resources, the final regulation allows each facility to develop a system for mapping the provided services or combination of services furnished to the different...
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Article Overview
This article explains the shift to hospital facility Evaluation and Management (E/M) coding under the Outpatient Prospective Payment System (OPPS) and discusses why facilities needed mapping systems to classify visits. It covers the general approaches hospitals could use to build an internal methodology, the involvement of federal and professional organizations, and the broader effort to improve consistency in facility coding. It is relevant to hospital coders, HIM staff, emergency department leaders, and others involved in outpatient facility billing and coding processes.
Why This Topic Matters
Hospitals had to adapt to a new OPPS-related facility E/M framework, and the quality of their internal mapping approach could affect coding consistency and compliance. The article highlights the operational and educational challenges facilities faced while building systems that aligned with their resources and documentation practices.
What You Will Learn
- Why facility-level E/M coding became important for hospitals under OPPS
- What kinds of internal mapping approaches facilities were encouraged to develop
- Which organizations were involved in discussing standardization efforts
- Why communication and shared experience matter for consistent facility coding
Who Should Read This
- Hospital coders
- Health information management professionals
- Emergency department staff
- Facility billing teams
- Outpatient compliance staff
Codes Discussed
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