Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, USA.
Acad Emerg Med. 2011 Nov;18(11):1161-6. doi: 10.1111/j.1553-2712.2011.01203.x.
All services provided by physicians to patients during an emergency department (ED) visit, including procedures and "cognitive work," are described by common procedural terminology (CPT) codes that are translated by coders into total professional (physician) charges for the visit. These charges do not include the technical (facility) charges. The objectives of this study were to characterize associations between Emergency Severity Index (ESI) acuity level, ED Evaluation and Management (E&M) billing codes 99281-99285 and 99291, and total ED provider charges (sum of total procedure and E&M professional charges). Secondary objectives were to identify factors that might affect these associations and to evaluate the performance of ESI and identified variables to predict E&M code and average total professional charges.
The authors reviewed 276,824 patient records for calendar year 2007, of which 193,952 adult ED visits from three different ED types (community, university-based academic, and non-university-based academic) met inclusion criteria. Correlations between 1) ESI level and E&M billing code per visit by institution and 2) ESI and total professional charges were analyzed using Spearman rank correlation. Linear regression analysis was performed to identify variables that significantly affected these correlations.
ESI level and E&M codes were moderately correlated (Spearman r = 0.51). ESI levels corresponded proportionately to higher E&M codes. ESI 1, 2, and 3 most frequently corresponded with E&M level 5 (50, 62, and 45%, respectively), and ESI 4 and 5 most frequently corresponded with E&M level 3 (56 and 67%, respectively). Only age by decade significantly affected the association between ESI level and E&M billing code. The mean total professional charge for all patient encounters was $421 (SD ± $204) with increasing mean charges per patient by increasing ESI acuity. Race and E&M code significantly affected the relationship between ESI level and total ED professional charges per patient (adjusted r(2) = 0.66).
A moderate, nonlinear correlation exists between ESI acuity levels and ED E&M billing codes. Increasing age affects this correlation. Race and E&M code affect the correlation between ESI level and total professional charges. As such, basic triage data can be used to estimate E&M code and total professional charges. Future studies are needed to validate these findings across other institutional settings.
医生在急诊科（ED）就诊期间为患者提供的所有服务，包括程序和“认知工作”，都由通用程序术语（CPT）代码描述，这些代码由编码员转换为就诊的总专业（医生）费用。这些费用不包括技术（设施）费用。本研究的目的是描述急诊严重程度指数（ESI）严重程度级别、ED 评估和管理（E&M）计费代码 99281-99285 和 99291 与 ED 提供者总费用（总程序和 E&M 专业费用之和）之间的关联。次要目的是确定可能影响这些关联的因素，并评估 ESI 和确定的变量预测 E&M 代码和平均总专业费用的性能。
作者回顾了 2007 年的 276824 份患者记录，其中来自三种不同 ED 类型（社区、大学附属医院和非大学附属医院）的 193952 例成年 ED 就诊符合纳入标准。使用 Spearman 秩相关分析分析了 1）按机构划分的 ESI 水平和每次就诊的 E&M 计费代码之间，以及 2）ESI 和总专业费用之间的相关性。进行线性回归分析以确定显著影响这些相关性的变量。
ESI 水平和 E&M 代码中度相关（Spearman r = 0.51）。ESI 水平与 E&M 代码成正比。ESI 1、2 和 3 最常对应 E&M 级别 5（分别为 50%、62%和 45%），ESI 4 和 5 最常对应 E&M 级别 3（分别为 56%和 67%）。只有年龄的十年差异显著影响了 ESI 水平和 E&M 计费代码之间的关联。所有患者就诊的平均总专业费用为 421 美元（标准差±204 美元），随着 ESI 严重程度的增加，每位患者的平均费用也随之增加。种族和 E&M 代码显著影响了 ESI 水平和每位患者的 ED 专业总费用之间的关系（调整后的 r(2) = 0.66）。
ESI 严重程度水平与 ED E&M 计费代码之间存在中度、非线性相关性。年龄的增加会影响这种相关性。种族和 E&M 代码会影响 ESI 水平和总专业费用之间的相关性。因此，可以使用基本的分诊数据来估计 E&M 代码和总专业费用。需要进一步的研究来验证这些发现是否适用于其他机构环境。
