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MedPAC Recommends CMS Change to ED Coding

Posted by David Fong on Apr 25, 2019 8:00:00 AM

A key Medicare advisory panel, the Medicare Payment Advisory Commission (MedPAC), has formally called on the CMSconsistent ED coding3 to revisit creating a national guideline for coding emergency department visits.


At its recent April 4th and 5th meeting, MedPAC members discussed the ED coding problems affecting the system. With a current lack of consistency in the ways such coding guidelines are applied, hospitals develop their own guidelines without using a consistent set source of parameters. In particular, the commission cited significant problems with the Outpatient Prospective Payment System.


As a result of the meeting, MedPAC officially asked HHS to develop nationwide and consistent ED coding guidelines by the year 2022. "The potential benefits of national guidelines include that payments could accurately reflect hospital resources used to provide ED care, hospitals would have a clear set of rules for coding ED visits and CMS would have a firm foundation for assessing and auditing hospital coding practices," commission staff member Dan Zabinski said during the meeting.


The CMS could have a firm foundation for assessing and auditing coding behavior if it has a national guideline for ED visits, the panel said.


As reported in Modern Healthcare, in 2005, level five ED visits made up about 10% of all ED visits to hospitals, according to a MedPAC analysis of cost statistics from the CMS. But in 2017, the number of level five visits increased to 30%, MedPAC found. The panel also looked at data from the National Hospital Ambulatory Medical Care Survey from 2011 to 2016 showing an increased use in screening services such as CT scans and EKGs for ED visits but no change in lab tests and procedures. MedPAC's analysis said that there is no clear explanation for the change in coding that has taken place in recent years.EDPMA 219


At Aviacode, our 700+ AAPC or AHIMA certified coders are experienced in more than 60 medical specialties, including emergency medicine. Aviacode will be at next week's Emergency Medical Practice Management Association (EDPMA)'s Solutions Summit booth #4 to discuss how our medical coding and audit services have been successfully helping ED clients nationwide.

Topics: ED Coding, EDPMA