tci Medicare Compliance & Reimbursement - 2012 Issue 20

Reader Question: Medicare Doesn't Expect Hospital and ER Doc Codes to Match

Question: Does Medicare require that the E/M CPT® codes submitted for payment by the hospital and the emergency physician be identical or "match"?Answer: No, the hospital and physician CPT® codes do not have to match. CMS has stated that Medicare does not expect a "high degree of correlation" of the E/M CPT® code levels submitted by hospitals versus those submitted by physicians. The AMA developed CPT® codes to capture physician cognitive and procedural services, and the codes were never intended to capture the utilization of hospital resources. Medicare recognizes that hospital and physician coding may have significant differences...

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