How have APCs affected hospital outpatient coding?
Prior to Aug. 1, 2000, hospitals were reimbursed by Medicare for outpatient services on a “cost-basis”. CPT codes were not required on the UB-92 claim forms and hospitals received reimbursement based on their reported “costs” for drugs, supplies, E&M services (such as ED visits), etc. Under OPPS, it is essential to document and capture all services provided by the hospital, since the efficiency and resource utilization of the hospital will determine whether the hospital incurs a “profit or loss” on each Medicare outpatient encounter. Thus, it is imperative that hospital staff accurately and completely document any and all services provided to Medicare beneficiaries in the outpatient areas. Physicians can greatly assist their hospitals by being as diligent as possible in their documentation efforts. For example, physician documentation of such services as insertion of a CVP line (CPT 36556 and 36557) will assist the hospital coders in assignment of these codes—with ultimate payment by M
Related Questions
- If a hospitalist evaluates a patient in the hospital do we follow inpatient or outpatient coding guidelines? Can we submit this data to the health plan?
- How has the outpatient Prospective Payment System (PPS) affected coding and billing for hospital Emergency Departments?
- Are there hospital outpatient services which are NOT paid under APCs?
