Outpatient Facility Coding Alert - 2010 Issue 5
E/M CODING: CMS 'Very, Very Close' to Issuing More Guidance on Consult Code Replacement Codes
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Article Overview
This article is a CMS policy update for coders, billers, compliance staff, and provider enrollment teams working with evaluation and management reporting and ordering/referring edits. It focuses on CMS comments about forthcoming guidance for hospital visit reporting when documentation does not support the lowest initial level, plus a separate update on the availability and use of the national practitioner ordering-and-referring list and related enrollment file processing.
Why This Topic Matters
The article matters because it addresses two operational issues that can affect claim submission, denial management, and provider enrollment workflows: how CMS is handling pending clarification for hospital E/M reporting and how the national ordering/referring file is used in claims edits. Organizations that bill inpatient and ordered/referred services need this information to monitor CMS updates and coordinate with local contractor guidance and enrollment records.
Article Sections
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CMS guidance on hospital E/M reporting after consult code changes
Discusses CMS comments from an Open Door Forum about upcoming clarification for hospital visit reporting and the broader effort to create more specific instructions. The section also summarizes the type of questions raised by providers and contractors.
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Look for NPI List on CMS Site
Covers CMS’s update on the national ordering-and-referring practitioner list, where it is posted, and how it ties to enrollment and claim processing. The section also notes the upcoming phase of ordering-and-referring edits and the role of PECOS in enrollment file matching.
What You Will Learn
- What CMS said about pending guidance for hospital E/M reporting after consult code changes
- How the CMS ordering-and-referring practitioner list is made available
- How ordering-and-referring edits interact with enrollment records and claims processing
- Who should review the practitioner file and whom to contact if a name is missing
Who Should Read This
- Medical coders
- Billing staff
- Compliance professionals
- Provider enrollment staff
- Revenue cycle teams
- Physicians and nonphysician practitioners
Codes Discussed
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