AHA Coding Clinic® for HCPCS - 2002 Issue 3

OCE recognizes admitting diagnosis for observation services

A recent program memorandum (PM), Transmittal A-02-075, released by the Centers for Medicare & Medicaid Services, now requires the Shared Systems Maintainers (SSMs) to pass the admitting diagnosis field to the outpatient prospective payment system (OPPS) outpatient code editor (OCE). The effective date for this change is April 1, 2002. However, the change will not be implemented by the SSMs until January 1, 2003. Presently, to determine whether observation services meet the requirements for separate OPPS payment, all the diagnosis fields on an outpatient claim are required to be available to the OPPS OCE. Each diagnosis field on the...

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