Increased Spotlight on Emergency Department Facility Coding by CMS, HHS and DOJ

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Although the professional component of coding for evaluation and management services ("E&M Services") has been scrutinized over the years, until recently, little attention has been given to coding practices for the facility component of these services—including emergency department facility services. In a September 24, 2012, letter written by Kathleen Sebelius, Secretary, U.S. Department of Health and Human Services (HHS); and Eric Holder, Jr., Attorney General, U.S. Department of Justice, to hospital leadership throughout the United States, HHS and the Justice Department expressed their concern that hospitals may be inappropriately coding E&M Services. Specifically, the letter notes that "CMS is initiating more extensive medical reviews to ensure that providers are coding evaluation and management services accurately." In acknowledging the absence of clarity with respect to facility coding, the American Hospital Association in its September 24, 2012, response letter to HHS and the Department of Justice stated: "The AHA has long called for national guidelines for hospital ED and clinic visits, and we stand ready to work with CMS in the development and vetting of such guidelines."

To date, HHS has declined to promulgate more formal guidelines relating to emergency department facility coding, and instead seems content with relying upon the guidance that has been provided over time to the industry. Nevertheless, it is apparent that HHS and the Department of Justice are continuing to monitor this area, and will allocate additional resources to ensure compliance. Recently, on May 3, 2013, CMS and the Office of the National Coordinator for Health Information Technology convened a full-day on-site meeting at national CMS headquarters to discuss "the increase in code levels billed for some Medicare services, and appropriate coding in an increasingly-electronic environment." In light of the recent attention on emergency department facility component coding practices, an area that so far has largely been overlooked by the regulators, any facility that has not reviewed its coding practices for the facility component of E&M Services may want to consider doing so at this time.

For Further Information

If you have any questions about this Alert, please contact Gregory A. Brodek, any member of the Health Law Practice Group or the attorney in the firm with whom you are regularly in contact.