ED Coding & Reimbursement Alert - 2024 Issue 1
Expert Opinion: Find Out How Emergency Departments Might Fare With MPFS in 2024
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Article Overview
This article reviews 2024 updates affecting emergency department split/shared evaluation and management services under Medicare and CPT. It covers the alignment between CMS and the AMA on the substantive portion concept, the role of physician and nonphysician practitioner documentation, and broad implications for coding and billing workflow in facility settings. It is aimed at emergency department coders, physicians, and compliance staff who need to understand how the 2024 MPFS final rule and CPT guideline updates shape reporting and documentation expectations.
Why This Topic Matters
The article helps readers understand a major 2024 policy alignment that affects who may bill split/shared services in emergency department settings and what kind of supporting documentation may be needed. That matters for accurate reporting, compliance, and operational consistency.
Article Sections
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AMA Clarifies Split/Shared Definition
Introduces the 2024 CPT update and describes the general framework for defining split/shared visits in facility-based evaluation and management services. It also summarizes the relationship between the physician and qualified healthcare professional roles.
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EDs Should Benefit From Guideline Updates
Explains the broader impact of the 2024 CMS policy change for emergency departments and notes the alignment with CPT guidance. The section focuses on how the update resolves long-standing uncertainty in shared service reporting.
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Follow These Rules on ‘Substantive Portion’
Covers documentation and attestation considerations tied to the substantive portion concept in shared emergency department services. It also discusses how physician review, approval, and participation may be reflected in the medical record.
What You Will Learn
- How 2024 split/shared visit guidance is being aligned across Medicare and CPT
- What the substantive portion concept means in broad reporting terms
- How emergency department documentation and attestation practices are affected
- How physician and nonphysician practitioner collaboration is addressed in facility-based E/M services
Who Should Read This
- Emergency department physicians
- Medical coders
- Billing staff
- Compliance professionals
- Nonphysician practitioners
- Practice managers
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