News: MedPAC recommends national coding guidelines for ED visits by 2022

CDI Strategies - Volume 13, Issue 16

Following their April 4 meeting, members of the Medicare Payment Advisory Commission (MedPAC) asked the U.S. Department of Health and Human Services (HHS) to create national coding guidelines for emergency department (ED) visits by 2022, according to JustCoding.

ED visit coding has shifted to higher evaluation and management (E/M) visit levels over the last decade, according to MedPAC. Specifically, hospitals are billing level 5 visits at a higher concentration, which likely means that Medicare payments are too high for many patients.

To address this issue, at a March meeting, commission staff suggested that HHS revisit the idea of developing national guidelines for ED visit coding. According to MedPAC, establishing guidelines would give hospitals clearer rules for coding ED visits and provide CMS with a firm foundation for assessing and auditing coding behavior.

MedPAC staff also recommended that HHS implement the following policies to encourage ED staff to report resources more appropriately:

  • Expanding the quality measurement of avoidable ED use to provider types who frequently administer non-urgent care
  • Improving care coordination between EDs and primary care physicians
  • Initiating a beneficiary education campaign to improve the understanding of appropriate ED and urgent care center use related to non-urgent care

At a meeting on April 4, commission staff unanimously voted to approve these recommendations to HHS.

Editor’s note: This article originally appeared in JustCoding. To read about the American Medical Association’s planned E/M documentation and coding changes, click here.

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