AHA Coding Clinic® for HCPCS - 2008 Issue 4
Update on hospital clinic and emergency department visit coding
This article was developed to provide a summary of the highlights related to the coding of hospital clinic and emergency department visits, as published in the CY 2009 Outpatient Prospective Payment System (OPPS) final rule that went on display October 30, 2008. Clinic visit coding Hospitals are to continue using CPT evaluation and management (E/M) outpatient visit codes, including the differentiation between new and established patients. CMS finalized their proposal to change the definitions of new and established patients. Beginning in CY 2009, the meanings of “new “ and “established” patients pertain to whether or not the...
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Article Overview
This article summarizes CMS guidance affecting hospital clinic, emergency department, and critical care visit reporting under the CY 2009 OPPS final rule. It is relevant to hospital coders, outpatient billing staff, compliance teams, and revenue cycle professionals who need a high-level understanding of the visit-coding topics addressed in the rule, related CMS clarifications, and the broader reporting framework discussed in the article.
Why This Topic Matters
Hospital outpatient visit coding affects how clinic, emergency department, and critical care services are reported under OPPS. Understanding the CMS guidance discussed here helps organizations align internal guidelines and reporting practices with current federal policy discussions.
Article Sections
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Clinic visit coding
Discusses hospital clinic visit reporting under CPT E/M outpatient visit codes and related CMS policy updates for CY 2009. Covers the general outpatient setting and the framework for hospital patient status under the rule.
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Emergency department visit coding
Summarizes CMS guidance for hospital emergency department visit reporting for CY 2009. Addresses the broader Type A and Type B ED reporting context.
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Critical care coding
Reviews CMS guidance related to hospital critical care reporting and related outpatient visit considerations. Includes discussion of the CPT and HCPCS framework referenced by the article.
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Visit reporting guidelines
Covers CMS statements on hospital internal visit guidelines, national guideline status, and related oversight expectations. Also addresses broader OPPS reporting concepts and references to CMS communications.
What You Will Learn
- How the article frames CMS guidance for hospital outpatient visit reporting
- What areas of hospital clinic, emergency department, and critical care coding are discussed
- How the article situates hospital internal guidelines within the CY 2009 OPPS context
- What CMS-related communications and policy references are mentioned in connection with visit reporting
Who Should Read This
- Hospital outpatient coders
- Emergency department billing staff
- Revenue cycle and compliance teams
- Health information management professionals
- Medicare billing specialists
Codes Discussed
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