Section title: Requests for Interpretation
RFI #
1090
Definition of Episode of Care
Description

Section 1.5 of the guide defines a patient event as "the service or group of services associated with a single episode of care." What is considered an "episode of care"?

For example, can an episode of care include an admission and a referral which are combined in the 278?

RFI Response

The 278 guide does not contain the definition for episode of care, however the following link provides an industry definition.

http://medical-dictionary.thefreedictionary.com/episode+of+care

Yes, an episode of care can include an admission and a referral. For additional examples, please reference the following sections of the 005010X217 278 guide:

1.5, 1.11.1 and 1.12.3.

DOCUMENT ID
005010X217