AHA Coding Clinic® for HCPCS - 2009 Issue 1
AHA Central Office on HCPCS response to E/M coding inquiries
The Central Office on HCPCS continues to receive requests for assistance in the assignment of appropriate evaluation and management (E/M) codes for hospital clinic and emergency department (ED) visits. While the Central Office on HCPCS appreciates your concerns regarding the coding and reporting of E/M services for hospital clinic and ED visits, and because at present there are no national visit guidelines, we cannot provide guidance for the reporting of these services. The Centers for Medicare & Medicaid Services (CMS) has consistently instructed hospitals to continue reporting visits based on their own internal hospital guidelines. In CY 2008, OPPS...
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Article Overview
This article explains the scope of hospital clinic and emergency department evaluation and management coding guidance from the AHA Central Office on HCPCS, including CMS principles for internal hospital visit guidelines, reporting expectations, and updates affecting hospital-based visit coding. It is relevant to hospital coders, compliance staff, and revenue cycle professionals who need background on hospital-developed E/M guidelines and related coding inquiries.
Why This Topic Matters
Hospitals continue to receive questions about assigning and reporting E/M services for clinic and ED encounters, and the article summarizes the CMS framework hospitals are expected to follow. It also helps readers understand the broader compliance and audit context for facility-level visit coding.
Article Sections
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Introduction and CMS background
The opening discusses hospital requests for help with clinic and emergency department visit coding and summarizes CMS expectations for hospital-developed visit guidelines. It frames the article as a response to recurring E/M reporting questions.
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Guideline principles
This section outlines the CMS principles hospitals are expected to consider when developing internal visit coding guidelines. It focuses on the general attributes those guidelines should have and the operational context in which they are used.
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Update on hospital clinic and emergency department visit coding
This section summarizes later guidance affecting hospital clinic and ED visit reporting and notes a change in how patient status is viewed under the hospital outpatient setting. It also mentions continued reliance on hospital internal guidelines.
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Sample coding questions and responses
The final portion introduces sample hospital coding inquiries intended to illustrate common E/M documentation concerns. It presents practical question-and-response style material related to facility coding scenarios.
What You Will Learn
- How CMS-related hospital visit guideline guidance is described in the article
- What general principles are associated with hospital internal E/M visit guidelines
- How the article frames hospital clinic and emergency department coding updates
- What types of hospital coding questions are used as examples in the discussion
Who Should Read This
- Hospital coders
- Coding managers
- Compliance staff
- Revenue cycle professionals
- Facility auditors
Codes Discussed
Modifiers Discussed
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