Health Information Management

Pay-per-view: Significant changes proposed for E/M coding

APCs Insider, September 20, 2013

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E/M coding and reimbursement for hospital outpatients could change dramatically if CMS finalizes its proposal to replace current E/M CPT® codes with three G-codes.

This proposal seems to be a big step to try to standardize the use of a set of codes can vary from facility to facility based on internally developed facility-specific guidelines, says Shannon E. ­McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CCDS, director of coding and HIM at HCPro.

Technical E/M services have always been an area of concern. It is difficult to measure and consistently report facility E/M codes to fairly account for resources used without encouraging overutilization, she says.

"This standardization would take out the guesswork of 'Did we overreport or underreport the technical E/M service level?' " McCall says. "But, as with any change, if it affects the overall payment the facility receives, it may not be received with thunderous applause, especially if that means less revenue for some cases. Hopefully the calculation of the one payment per type of HCPCS service code billed is one that is going to be somewhat budget neutral and not one where the reimbursement overall suffers."


Continue reading Significant changes proposed for E/M coding on HCPro’s website. Subscribers to Briefings on APCs have free access to this article in the September issue.

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