Transcription of Billing and Coding Guidelines - Centers for Medicare and ...
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Billing and Coding Guidelines - Centers for Medicare and ...
Billing and Coding Guidelines Contractor Name Wisconsin Physicians Service Insurance Corporation Contractor Number 05101, 05201, 05301, 05401, 05102, 05202, 05302, 05402, 52280 Title Billing and Coding Guidelines for Acute Inpatient Services versus Observation (Outpatient) Services (HOSP-001) Original Determination Effective Date 03/17/2012 Original Determination Ending Date Revision Effective Date Excerpt from CMS internet only Manual (IOM): Publication 100-2, Chapter 6, A. Outpatient Observation Services Defined Observation care is a well-defined set of specific, clinically appropriate services, which include ongoing short term treatment, assessment, and reassessment before a decision can be made regarding whether patients will require further treatment as hospital inpatients or if they are able to be discharged from the hospital.
Services that are covered under Part A, such as a medically appropriate inpatient admission, or services that are part of another Part B service, such as postoperative monitoring during a standard recovery period, (e.g., 4-6 hours), which should be billed as recovery room services.
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