Health Information Management

Pay-Per-View: Use internal guidelines to ensure consistent E/M coding

APCs Insider, August 13, 2010

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by Lolita M. Jones, RHIA, CCS

A visit is defined as direct personal contact between a registered hospital outpatient and a physician (or other person who is authorized by state licensure law and, where applicable, by hospital staff bylaws to order or provide services for the patient) for purposes of diagnosis or treatment of the patient.

In the April 7, 2000, OPPS final rule (65 Federal Register 18434), CMS instructed hospitals to report facility resources for clinic and ED visits using CPT E/M codes and to develop internal hospital guidelines to determine the level of visit to report for each patient. Some hospitals refer to these internal guidelines as “mapping logic” or “E/M criteria.”

Continue reading “Use internal guidelines to ensure consistent E/M coding” on the HCPro website. Subscribers to Briefings on APCs have free access to this article in the August issue.

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