Department of Emergency Medicine, Children's Minnesota, Minneapolis, Minnesota, USA.
Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota, USA.
J Ultrasound Med. 2019 May;38(5):1279-1286. doi: 10.1002/jum.14808. Epub 2018 Sep 12.
The goal of this study was to evaluate trends in medical claim submissions for limited ultrasound studies performed (1) during emergency department (ED) encounters and (2) by ED providers compared to radiologists.
We conducted a retrospective, descriptive study using medical claims data from Medica Health Plans from January 1, 2011 to December 31, 2015. Current procedural terminology codes were abstracted for limited ultrasound applications performed during an ED visit and further stratified by studies performed by ED providers compared with radiologists. We excluded claims for which we could not determine provider specialty.
We identified 42,576 encounters with limited US claims, of which, 32,666 were submitted by ED providers (N = 9649) or radiologists (N = 23,017). Among ED providers, there was a significant linear increase in the annual number of claims for retroperitoneal (P < .001) and nonlinear increases for thoracic, soft tissue, cardiac, transvaginal genitourinary (GU) and transabdominal GU claims (all P < .001). Compared with radiologists, there was a linear increase in the annual proportion of claims submitted for retroperitoneal (P = .023), transabdominal GU (P = .003), and transvaginal GU (P < .001) studies by ED providers. There was a nonlinear decrease in the annual proportion of limited abdomen claims (P < .001) submitted by ED providers compared with radiologists.
Using data from a large health plan provider, we show that medical claims for many limited ultrasound studies are increasing among ED providers. Compared with radiologists, ED providers are increasingly submitting claims for retroperitoneal, soft tissue, and transabdominal GU studies.
本研究旨在评估在急诊科（ED）就诊期间和（2）由 ED 医生进行的有限超声检查的医疗索赔提交趋势，与放射科医生相比。
我们使用 Medica Health Plans 从 2011 年 1 月 1 日至 2015 年 12 月 31 日的医疗索赔数据进行了回顾性描述性研究。提取了在 ED 就诊期间进行的有限超声应用的现行程序术语代码，并进一步按 ED 医生与放射科医生进行的研究进行分层。我们排除了无法确定提供者专业的索赔。
我们确定了 42576 份有限 US 索赔的就诊记录，其中 32666 份是由 ED 医生（N=9649）或放射科医生（N=23017）提交的。在 ED 医生中，腹膜后（P<0.001）的年度索赔数量呈显著线性增加，而胸部、软组织、心脏、经阴道泌尿生殖系统（GU）和经腹 GU 索赔呈非线性增加（均 P<0.001）。与放射科医生相比，ED 医生提交的腹膜后（P=0.023）、经腹 GU（P=0.003）和经阴道 GU（P<0.001）研究的年度索赔比例呈线性增加。ED 医生提交的有限腹部索赔的年度比例呈非线性下降（P<0.001）。
使用来自大型健康计划提供者的数据，我们发现许多有限超声检查的医疗索赔在 ED 医生中呈上升趋势。与放射科医生相比，ED 医生越来越多地提交腹膜后、软组织和经腹 GU 研究的索赔。
