ED Coding and Reimbursement Alert

The table below summarizes the facility reporting of ED and outpatient clinic visits for 2014:

Look For Nice Increases in ED Facility Payments in 2014

2014 APC Payments for ED Facility Services set to increase significantly. The table below demonstrates the meaningful increase in ED facility payments for 2014. On a comparative basis ED facility payments will increase a minimum of 8 percent and as much as 32 percent on a code by code basis, states Michael A. Granovsky, MD, FACEP, CPC, President of LogixHealth, an ED coding and billing company in Bedford, MA.

Watch for Bundling of Other Services into APC PaymentsGranovsky notes these additional points from the OPPS Rule:

• The composite observation APC is confirmed with a substantial increase from the prior year $1,199 for 2014 compared to a 2013 rate of $798. Be aware that medication administration services such as hydration, injections, and infusions will be continued to be paid and will not be bundled with observation. Also, most other services such as diagnostic testing are not being packaged as initially proposed.
• Importantly, the general packaging of IV medication administration was not finalized with add- on hours of IV hydration, infusion or IV push medications continuing to be reported and reimbursed as they are in 2013.
• CMS is not packaging diagnostic radiology with ED visit services as previously proposed.

5 packages to review: CMS did, however, advance their overall concept of packaging more services with the following five services (a decrease from the original seven proposed services) finalized as packaged for 2014 and adding to the list of OPPS packaged items and services in 42 CFR 419.2(b), Granovsky says.

(1) Drugs, biologicals, and radiopharmaceuticals used in a diagnostic test or procedure;

(2) Drugs and biologicals when used as supplies in a surgical procedure;

(3) Certain clinical diagnostic laboratory tests;

(4) Procedures described by add-on codes; and

(5) Device removal procedures.