AHA Coding Clinic® for HCPCS - 2019 Quarter 2
MedPAC recommendation to create facility coding guidelines for emergency department visits
The Medicare Payment Advisory Commission (MedPAC) recently voted to draft a recommendation for Congress to direct the Health and Human Services Secretary to develop and implement a set of national guidelines for coding hospital (facility) emergency department visits by 2022. MedPAC is an independent commission that advices Congress on issues pertaining to the Medicare program. Among its tasks is to analyze access to care and quality of care issues as they pertain to Medicare. In its analysis of Emergency Department (ED) visits, MedPAC has reported an increase in patient’s seeking non-urgent care at ED’s and that the...
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Article Overview
This article covers a MedPAC recommendation related to standardizing hospital facility emergency department visit coding, along with the background of CMS policy development and prior industry efforts to create consistent guidance. It is relevant to hospital coders, compliance staff, revenue cycle teams, and health information management professionals who track facility E/M reporting policy and auditing expectations. The discussion focuses on the evolution of federal guidance, the role of stakeholder panels, and the general principles CMS has provided for internal facility coding methodologies.
Why This Topic Matters
Standardized facility ED coding guidance can affect hospital reporting consistency, compliance review, audit readiness, and payment accuracy across emergency department services.
Article Sections
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MedPAC recommendation and policy context
Introduces the recent MedPAC recommendation and explains the broader policy issue involving hospital facility emergency department visit coding.
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Background on ED facility coding and CMS oversight
Summarizes the historical development of hospital outpatient prospective payment policy and CMS involvement in facility-based ED reporting.
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Stakeholder panel efforts and CMS follow-up
Describes the creation of a multi-stakeholder panel, its recommendations, and CMS’s subsequent consideration of standardized guidance.
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CMS principles for internal facility guidelines
Lists the general framework CMS provided for hospitals developing their own internal facility coding guidelines.
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Current status and possible implications
Concludes with the article’s discussion of why the MedPAC recommendation may affect future standardization of emergency department visit reporting.
What You Will Learn
- How MedPAC is approaching hospital facility emergency department coding policy
- Why CMS and stakeholder efforts have focused on standardizing facility E/M guidance
- What broad considerations CMS has outlined for hospital internal coding methodologies
- How the article frames the compliance and audit relevance of ED visit reporting
Who Should Read This
- Hospital coders
- Health information management professionals
- Compliance officers
- Revenue cycle staff
- Emergency department billing teams
- Healthcare policy readers
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