A panel established by two healthcare trade associations announced Friday that it has submitted to the CMS proposed revisions in evaluation and management codes used by hospitals to bill Medicare and Medicaid.
The 16-member Hospital Evaluation and Management Coding Panel, which started work on the revisions in January, comprises clinical, administrative and health information management professionals and was established by the American Health Information Management Association and the American Hospital Association, both based in Chicago.
The three-tiered code scheme would create a national standard for hospital E&M codes for clinical, critical care and emergency department service, which are now set individually by hospitals. The current mishmash was created as the Healthcare Finance Authority, now CMS, switched to an ambulatory payment classification for payment of hospital-based ambulatory care in 2000 and adapted the physician-based E & M system for hospital use, according to Dan Rode, vice president of policy and government relations at AHIMA.
"It was a place holder until they came up with something better," says Rode, whose association represents 45,000 healthcare information management workers. "The current system has just no foundation, because one facility's E&M codes may not be comparable with another's."
Although CMS sent observers to the committee meetings, no private-sector payer organizations were represented on the committee, Rode says. Nevertheless, one of the goals of the committee was to come up with a coding scheme that could function for CMS and for the private sector.
"We don't like to put our members, many of whom are coders, into a situation where you have to code it one way for one payer and another way for another payer," Rode says.
Neither CMS nor any private payer is obligated to adopt the panel's recommended coding scheme, Rode says, but "we'd hope that as CMS does whatever they're going to do with this, other payers do the same."
Rode says the model code system was given a real world workout before it was handed over to CMS.
"The team put in well over 30 hours of time meeting together and many of them worked with the facilities they represent and other experts to test the models."
It should be revenue-neutral and require neither a great deal of adjustment of a hospital's information technology nor a lot of additional staff training to implement, he says.