tci Medicare Compliance & Reimbursement - 2012 Issue 20
Reader Question: Medicare Doesn't Expect Hospital and ER Doc Codes to Match
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Article Overview
This short article addresses a common Medicare billing question about whether hospital-submitted and physician-submitted evaluation and management coding must match. It is aimed at coders, billing staff, and compliance readers who need a high-level understanding of how CMS views facility and professional coding as separate systems. The discussion focuses on general Medicare policy and the distinction between hospital and physician code reporting.
Why This Topic Matters
Understanding that hospital and physician reporting are separate can help reduce confusion when reviewing claims from the same visit and support more accurate coordination between facility and professional billing teams.
What You Will Learn
- How Medicare views the relationship between hospital and physician E/M coding
- Why facility and professional billing are treated as distinct systems
- The general policy context behind hospital and emergency physician coding differences
- How CMS and the AMA are referenced in the discussion of E/M reporting
Who Should Read This
- Medical coders
- Hospital billing staff
- Professional billing staff
- Compliance staff
- Revenue cycle professionals
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