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June/July 2018

Editor's Note: Coders Take the Rap for ED Price Hikes
By Lee DeOrio
For The Record
Vol. 30 No. 6 P. 3

It seems like the only time coders receive notice in the mainstream media is when someone's looking to blame them for a portion of the health care industry's failings.

For example, John Hargraves, a researcher at the Health Care Cost Institute, coauthored a report which shows that in 2016, the average amount spent nationally by insurers and patients for emergency department (ED) visits was $247 per insured person, an increase of $122 since 2009.

Hargraves told the Houston Chronicle the jump appears to be the result of a dramatic shift in how emergency visits are being coded, with many more designated at the highest levels of severity: "Since the population of insured people in emergency rooms is not changing, the only logical explanation is a change in how things are being coded."

According to the report, over an eight-year period, the price of the highest coded visit rose to $1,108, from $627 in 2009.

To shift the onus of this development onto the shoulders of coders and coding managers is ludicrous and shortsighted. It fails to take into account several other factors at play.

First, all medical facilities are experiencing rising costs.

Second, it's called an ED for a reason. Under what circumstances would you not expect to see higher levels of service and charges?

Third, there's all kinds of exotic software to electronically identify chart documentation that supports valid charges, significantly decreasing the chances that anything is going to be missed.

Fourth, while there's probably some level of upcoding occurring, it's unreasonable to believe that a significant number of coders have suddenly decided to start jacking up their code levels.

Fifth, and perhaps most relevant, providers and patients alike have become more cost-conscious. More EDs have adjusted to the fact that too many patients use the service as a matter of convenience, a practice that wastes both physicians' time and facility assets. Consequently, EDs are more likely to triage thoroughly and refer nonemergent patients to a next-day clinic or an in-house, late-hours urgent care.

Patients who have to pay out of pocket or have copays and deductibles are fast becoming aware of the cost of zooming through one of the many conveniently located, open-late urgent care centers rather than using an expensive and slower emergency center. Therefore, it makes perfect sense that the severity levels coded in EDs are in fact on the upswing.

It's also important to note that there don't appear to be any major code or coding rule changes that would have prompted severity levels to become artificially inflated.

So lay off the coders.