Study Finds Improper Medicare Coding of Hospital Emergency Services

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In a study of Medicare claims for hospital emergency departments nationwide, American Hospital Directory ( has found unexpected variances in Medicare coding for evaluation and management services. Improper coding can result in inaccurate Medicare payment for services.

Some hospitals are improperly coding Medicare claims for emergency services, according to a study released today by American Hospital Directory. The report, which looks at Medicare claims and payments for hospital emergency services nationwide from 2002 through 2004, explains that accurate Medicare coding is essential to ensure appropriate payment for evaluation and maintenance services.

Medicare implemented the Outpatient Prospective Payment System in 2000. However, the data examined by Paul Shoemaker, president and CEO of American Hospital Directory, and Leatrice Ford, founder and CEO of ConsultCare Partners, showed an increase in the number of visits coded as high-level emergency visits from 2002 to 2004. While the level of care given to emergency-room patients may differ because of hospital-specific factors including the complexity of services and size, the shift also may also reflect changes in hospitals' Medicare coding practices, the study reports.

The study provides benchmarking data to aid hospital administrators in determining whether its Medicare coding for medical emergency care is within expected ranges or in need of internal review. The study categorizes hospitals by the number of claims per year and provides the methodology for determining whether a hospital's average reimbursement is higher or lower than expected.

Any variances, the authors warn, should be investigated to determine their causes. "Under-coding can result in lower levels of reimbursement, while over-coding can be a compliance problem requiring immediate intervention and correction," the study states.

Government and industry officials are pushing for hospital pricing transparency, lending more urgency to the need for accurate Medicare coding. The online destination for free hospital cost information, American Hospital Directory (, is built on data from Medicare claims and other public and private sources.

To obtain a copy of the study, entitled "Variations and Trends in the Coding of Evaluation and Management (E&M) Services by Hospital Emergency Departments," visit

About American Hospital Directory

The American Hospital Directory ( provides online data about more than 6,000 hospitals in the United States. The extensive database of information is built from both public and private sources including Medicare claims data (MedPAR and OPPS), hospital cost reports, and other files obtained from the federal Centers for Medicare and Medicaid Services (CMS). AHD was founded in 1996 and today serves 10,000 visitors per day.


Barbara Eilert

(502) 396-2637

Email: beilert @


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