Clinician Office Visit
  • 16 May 2023
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Clinician Office Visit

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Article Summary


An encounter in which the patient received in-person care from a clinical provider, including non-physicians, in an office or clinic setting; operationally defined by the presence of one or more of the following: (1) a qualifying HCPCS code on a professional claim or bill service line item, or on an EMR encounter service line item; (2) a qualifying HCPCS or revenue center code on an institutional claim or bill service line item associated with a claim or bill with a qualifying type of bill code; or (3) an EMR encounter record flagged as a clinician office visit (i.e., Is Encounter Type Clinician Office Visit = 1). Qualifying records are considered to be part of the same encounter if they share the same patient, service date, and service provider, billing provider, or provider group.


Q: Are telehealth encounters considered clinician office visits?
A: No, our definition of a clinician office visit is that the encounter is in-person in an office or clinic setting.

Q: Do encounters where the patient is seen in an office setting but on a hospital campus considered clinician office visits, or are those considered another type of hospital outpatient encounter?
A: Otherwise qualifying encounters that take place on a hospital campus (e.g., for which an institutional claim was generated with a type of bill code = 131) are still considered clinician office visits. Clinicians often have on-campus offices, and the nature of these on-campus office visits is typically no different from those taking place in off-campus office locations.

Q: What are the qualifying HCPCS, revenue center, and type of bill code values used to identify clinician office visit encounters?
A: The qualifying values are contained in the following value sets (which can be accessed in Ursa Studio in the Metadata Manager / Value Sets screen):

NamespaceValue TypeValue Set Name

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