Acute Inpatient Diagnosis in the Office Setting
Defines billing and documentation expectations for reporting acute inpatient diagnoses in professional/office settings (POS 11) for Blue KC-contracted providers; applies to commercial and Medicare Advantage lines of business.
No material clinical or coverage changes in this revision.
Acute Inpatient Diagnosis Reporting Rules
Acute Inpatient Diagnosis Reporting Rules
Billing and documentation criteria for acute inpatient diagnoses when service occurs in an office setting:
Applies to Blue Cross Blue Shield of Kansas City contracted providers; implements OIG recommendations regarding over-coding of acute conditions in professional settings.
Resolved conditions should not be billed as active acute inpatient diagnoses.
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