AHA Coding Clinic® for HCPCS - 2013 Quarter 4
Hospital outpatient clinic and emergency department visits under the OPPS
Hospitals are currently functioning under a longstanding policy established April 7, 2000, by the Centers for Medicare & Medicaid Services (CMS) which states that because a national set of hospital-specific codes and guidelines do not currently exist for the reporting of clinic and emergency department (ED) visits hospitals were instructed to develop internal guidelines for reporting the appropriate visit level of service. In the calendar year (CY) 2014 update, Medicare modified its hospital outpatient clinic visit policy. Information regarding this modified policy can be found in the CY 2014 OPPS/ASC final rule that was published in the Federal Register...
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Article Overview
This article explains Medicare’s OPPS policy for hospital outpatient clinic and emergency department visit reporting and summarizes the CY 2014 update described in the CMS final rule. It is useful for hospital outpatient coding staff, billing teams, compliance personnel, and revenue cycle professionals who need a high-level understanding of which visit categories were affected, which remained unchanged, and how the guidance is organized. The article also outlines the visit-level code structure referenced for clinic and ED services and places the changes in the context of CMS hospital outpatient reporting policy.
Why This Topic Matters
Hospital outpatient visit reporting affects claim preparation, compliance, and the consistency of service-level assignment under the OPPS. Understanding the policy shift and the continued separation between clinic and emergency department reporting helps organizations align internal guidelines with Medicare requirements.
Article Sections
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OPPS hospital outpatient visit reporting policy
Discusses the longstanding CMS policy framework for hospital outpatient clinic and emergency department visit reporting and the role of hospital-developed internal guidelines.
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CY 2014 OPPS update
Summarizes the Medicare update described in the CY 2014 OPPS/ASC final rule and the general scope of the reporting changes.
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Hospital outpatient clinic visits under the new reporting approach
Covers the clinic visit portion of the policy update and the broader reporting approach applied under OPPS for the affected visit category.
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Emergency department visit reporting under OPPS
Describes the status of emergency department visit reporting for the year addressed in the article and the continuation of the existing reporting structure.
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Visit type coding table
Provides a side-by-side reference table for the visit categories discussed in the article and the related codes shown for the reporting periods referenced.
What You Will Learn
- The CMS policy context for hospital outpatient clinic and emergency department visit reporting
- How the CY 2014 OPPS update affected hospital outpatient clinic visit reporting
- Which outpatient visit categories remained under the existing reporting structure for the period discussed
- How the article organizes visit-level coding references for clinic and emergency department services
Who Should Read This
- Hospital outpatient coders
- Emergency department billing staff
- Revenue cycle teams
- Compliance professionals
- Health information management professionals
Codes Discussed
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