tci Outpatient Facility Coding Alert - 2012 Issue 5

Reader Question: Medicare Doesn't Expect Hospital and ER Doc Codes to Match

Question: Does Medicare require that the E/M CPT® codes submitted for payment by the hospital and the emergency physician be identical or "match"? Michigan Subscriber Answer: No, the hospital and physician CPT® codes do not have to match. CMS has stated that Medicare does not expect a "high degree of correlation" of the E/M CPT® code levels submitted by hospitals versus those submitted by physicians. The AMA developed CPT® codes to capture physician cognitive and procedural services, and were never intended to capture the utilization of hospital resources. Medicare recognizes that hospital and physician coding may have significant, even though...

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