How has the outpatient Prospective Payment System (PPS) affected coding and billing for hospital Emergency Departments?
A. Prior to August 1, 2000, EDs charged for their services by billing a level of service (determined by criteria designated by each facility) along with the supplies, medications and ancillary services performed during a patient visit. The Centers for Medicare and Medicaid Services (CMS) designed the new Ambulatory Patient Classification (APC) system around the physician method of coding and billing. Hospitals are instructed to utilize Evaluation and Management (E/M) Levels 99281-99285 and 99291 to bill for the intensity of services administered to patients in the ED. CMS instructed each hospital outpatient area to develop its own unique criteria, called “E/M Level criteria or Nursing Assessment Criteria,” for determining these levels of service. The criteria must reflect increasing intensity and be accurately and consistently applied in coding. Although most hospitals have put their best efforts into developing custom E/M Level criteria, the truth is that most EDs are operating with f
Related Questions
- How does a childrens hospital exiting the prospective payment system (PPS) participate in the CHGME Payment Program without a three-year waiting period?
- What are the APCs applicable to Emergency Dept. visits and in 2010 what will the "average" US hospital receive in payment for these ED APCs?
- How have APCs affected hospital outpatient coding?
