Could Supreme Court Chevron ruling bring chaos to medical coding and billing? Possibly.

By Brian Murphy

 

The traditional authority granted to institutions has been steadily eroded in recent years, and in the wake of the landmark Chevron ruling it’s been dealt another blow. Could medical coding be next?

 

I draw your attention to this thoughtful article by HIM expert Rose Dunn, on the blog of Libman Education. “What the Strike Down of Chevron May Mean to HIM Professionals.”

 

In June the Supreme Court overturned the Chevron doctrine, which had allowed courts to defer to federal agencies’ interpretations of ambiguous laws. This decision shifts power back to the judiciary, potentially limiting agencies’ regulatory capabilities, especially in areas like environmental policy and public health.

 

I knew about Chevron but admittedly hadn’t considered its impact on the field I work in, until I read Dunn’s piece.

 

The impacts could be considerable. Says Dunn: “Let’s consider what the Chevron decision might mean for coding and billing guidelines that will be on the table for payers to litigate the validity of, and how the guidelines may be modified in each court. Could we end up with guidelines that are not just payer-specific, but also state-specific?”

 

She adds, even more chillingly: “Payers may use the demise of the Chevron rule to apply their own billing requirements that you may need to defend against using. Imagine having to configure the organization’s or practice’s billing and edit systems for each payer’s application of the standard billing rules.”

 

Today four Cooperating Parties oversee and approve the Official Guidelines for Coding and Reporting—the American Hospital Association (AHA), the American Health Information Management Association (AHIMA), the National Center for Health Statistics (NCHS), and CMS. These same parties in conjunction with specialty input also have ultimate oversight of AHA Coding Clinic.

 

We have traditionally deferred to the Cooperating Parties, and even the quasi-regulatory authority each entity has independently (AHA with Coding Clinic, ACDIS/AHIMA with query guidelines). 

 

While HIPAA is a law, not a regulation, and mandates the use of code sets, Coding Clinic guidance is not law. Nor is query practice. They could be challenged (and I wonder if CPT guidance, though privately owned by the AMA, will too).

 

Some I imagine would rejoice to see these regulatory bodies knocked down a peg or bypassed altogether. I wouldn’t be among them. 

 

I’m not saying life is perfect. We all know Coding Clinic has put out coding advice incongruent with medicine, or contradictory to its own past guidance.

 

But a world where courts settle coding disputes seems to me untenable. As Rose points out, imagine a large healthcare organization with hospitals across half the country having to account for legal precedents set in every state. 

 

It’s possible I’ve gotten too far out over my skis on this one, so let me know what you think, and if I’m making a mountain out of a molehill. Would love to hear what you think—especially from the legal community serving the HIM/coding space.

 

Contact Brian at brian.murphy@norwood.com.