decisionhealth Newsletters, Coder Pink Sheets - 2008 Issue 8 (August)
CMS clarifies policy on critical care, ED visits
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Article Overview
This article covers a Medicare/CMS policy clarification on the relationship between emergency department evaluation and management services and critical care billing on the same date of service. It is relevant to physicians, hospital-based coders, and billing staff who work with critical care, ED, and inpatient or office/outpatient E/M claims. The discussion also addresses CMS documentation expectations for time spent with family or surrogate decision-makers and notes that the broader critical care guidance in the Medicare Claims Processing Manual was updated through transmittals.
Why This Topic Matters
The article helps readers understand a Medicare policy change that can affect whether certain services are payable together, along with the documentation and billing context around critical care claims. It is important for reducing claim denials and aligning billing practices with CMS guidance.
What You Will Learn
- How CMS clarified the relationship between emergency department services and critical care on the same date
- What the article says about Medicare payment policy for certain E/M services before critical care
- What types of documentation CMS expects when family or surrogate discussions are used in critical care time
- Which CMS transmittals and manual updates are referenced as the source of the clarification
Who Should Read This
- Physicians
- Medical coders
- Billing staff
- Revenue cycle staff
- Hospital compliance teams
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