MedPAC to Recommend CMS Revisit Emergency Department Coding

According to King (2019, March 7), “In 2005, level five ED visits made up about 10% of all ED visits to hospitals, according to a MedPAC analysis of cost statistics from the CMS. But in 2017, the number of level five visits increased to 30%.” Currently, CMS has no national guideline for reporting ED visits; therefore, auditing ED Medicare claims is challenging. Hospitals are permitted to establish internal policies and procedures based on American Hospital Association, the American College of Emergency Physicians or other guidelines for coding. MedPAC is also expected to propose claims for Medicare patients ultimately receiving non-emergency care in emergency room settings should be coded and billed similar to an outpatient clinic visit.