This course will explain observation services under the Outpatient Prospective Payment System (OPPS ). It will define observation services and discuss codes that are used to report these services. Requirements for admission, including documentation requirements, are covered. Additionally, information on common claims edits is included. This lesson may feature information on the use of medical and procedural codes, including CPT codes as they relate to the subject matter presented.
“This program has been approved for 0.5000 continuing education unit(s) for use in fulfilling the continuing education requirements of the American Health Information Management Association (AHIMA). Granting prior approval from AHIMA does not constitute endorsement of the program content or its program sponsor.”
This activity is approved for 0.5000 contact hours.
Section 1: Introduction
About This Course
Definition of Observation Services
Section 2: Coding and Payment
Observation and APC Codes
Requirements for Separate Ambulatory Payment Classification Payment
Section 3: Direct Admission
Direct Admission to Observation Care
Reporting Direct Admission to Observation Care
Section 4: Edits
Outpatient Code Editor Edits
Section 5: Conclusion
Expert Reviewer: Veronica Ziac, MBA
Deborah is responsible for Elsevier's online solution of education and tools to improve employee performance for Revenue Cycle, Coding, CDI, and Compliance professionals. Deborah has earned BS degrees in Management/Human Resources and Social Psychology. She is a Registered Health Information Management Administrator (RHIA) and is a Certified Coding Specialist, Physician-Based (CCS-P). Prior to joining Elsevier, Deborah held positions such as Revenue Cycle Analyst for Mayo Clinic; Compliance Officer; educator; coding manager; and senior consultant. Deborah actively participates on projects important to the healthcare industry. As an active member of AHIMA, she has participated in the Quality Initiatives & Secondary Data Practice Council, was Chair of the Coding Policy and Strategy Committee and Board member for the Society of Clinical Coding. She has authored journal articles, been a presenter of audio-conferences and a speaker at national and state conventions. Deb was a member of the AHA Editorial Advisory Board for ICD-9-CM Coding Clinic and AHA Editorial Advisory Board for HCPCS.Disclosure: Deborah Neville, RHIA, CCS-P has no Relevant Financial or Non-Financial Relationship with ineligible companies to disclose.
Veronica Ziac, MBA has over twenty years of healthcare administration experience. Her areas of expertise include revenue cycle, information systems, population health and physician practice management. Most recently, she was the Director of Revenue Cycle Integrity at Cobleskill Regional Hospital. Prior to that, Veronica was the Chief Operating Officer for a large multispecialty hospital-based physician practice based in New York. Veronica has an MBA in Healthcare Administration from Union College and a bachelor’s degree from the University at Albany. She is a member of HFMA and MGMA and has been Certified in Healthcare Compliance (CHC) by the Healthcare Compliance Association.Disclosure: Veronica Ziac, MBA has no Relevant Financial or Non-Financial Relationship with ineligible companies to disclose.
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