AHA Coding Clinic® for HCPCS - 2021 Quarter 4; In this Issue
Facility reporting and the Central Office on HCPCS
The Central Office on HCPCS occasionally receives requests for clarification regarding advice published in Coding Clinic for HCPCS that seems to conflict with advice provided by a variety of different entities. As coding is not an exact science, we realize that at times there may be gray areas where the documentation and corresponding code assignment may render different opinions. However, the advice provided by the Central Office on HCPCS is in accordance with the guidelines for procedures reported by hospital outpatient departments, i.e., facility reporting. While physician and facility coding may be based upon the same procedure, there...
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Article Overview
This article discusses how the Central Office on HCPCS develops guidance for hospital outpatient facility reporting and how questions are reviewed before publication in Coding Clinic for HCPCS. It covers the relationship among CPT, HCPCS Level II, facility reporting, and Medicare coding guidance, with emphasis on why facility coding may differ from physician coding, how modifiers are treated in that setting, and how NCCI-related concerns are handled. It is relevant to hospital outpatient coders, coding educators, and others who need to understand the scope and process behind published HCPCS advice.
Why This Topic Matters
Understanding how facility coding guidance is created helps coding professionals interpret published advice appropriately and apply it to hospital outpatient claims without assuming physician coding rules always transfer to the facility setting.
What You Will Learn
- How the Central Office on HCPCS reviews and publishes facility coding guidance
- Why facility reporting may differ from physician reporting
- How modifiers are handled differently in facility coding
- How Medicare coding guidance and edit policies relate to published advice
- What types of questions are considered for Coding Clinic for HCPCS publication
Who Should Read This
- Hospital outpatient coders
- Facility coding professionals
- Coding educators
- Revenue cycle staff
- Coding compliance staff
Modifiers Discussed
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