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Medicare Compliance & Reimbursement

HOSPITALS:

Huge Increase In High-Level ED Visits Brings On Hospital Billing Scrutiney

Published on Sat Jun 10, 2006

Ed visits may see upcoding emergency soon.

Emergency Department physicians and hospitals may be upcoding evaluation & management visits in the ED, according to one study.

The number of high-level E/M services in the ED increased sharply from 2002 to 2004, a nationwide study of Medicare ED claims by American Hospital Directory found. For example, 24 percent of visits were billed at 99284 in 2004, up from just 20 percent in 2002.
 
The shift may be due to hospital-specific factors, but also to a change in coding practices. The study is available at www.ahd.com/EMstudy060530.pdf.

Separately, a new study by the Institute of Medicine found that sick patients in ambulances are sent away from EDs to EDs at other hospitals. EDs turn patients away because they're are overcrowded and lacking in basic supplies and facilities. "The safety net... has huge holes," co-author A. Brent Eastman told the San Francisco Chronicle.
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