Emergency Severity Index Triage System Correlation with Emergency Department Evaluation and Management Billing Codes and Total Professional Charges

Abstract

Objectives: 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. Methods: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-universitybased 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.Results: 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).Conclusions: 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.

Validity of the emergency severity index in predicting patient outcomes in a major emergency department

“…Some studies have focused on the correlations between patient service costs and ESI triage level confirming the findings of the present study in this regard (11)(12)(13). Higher cost of services in female patients could be due to the fact that women are often more concerned about their condition and tend to ask physicians for more tests.…”

Identification of Emergency Department Visits in Medicare Administrative Claims: Approaches and Implications

“…To do this we first included all physician service claims used for ED services (HCPCS 99281, 99282, 99283, 99284, 99285, 99291) 19 and all hospital outpatient and inpatient claims that indicated use of ED services based on revenue center codes (0450–0459, 0981). As many claims included numerous “claim lines” for distinct healthcare services over broad ranges of time, we consider each individual claim line as a possible visit for this analysis.…”

Aligning emergency care with the triple aim: Opportunities and future directions after healthcare reform

“…ED triage itself demonstrates this difficulty as presentation conditions do not always correlate with discharge severity; predicting who will be admitted or what interventions will be necessary is imperfect. 31 Illness severity, compromised follow-up conditions, and EMTALA requirements limit how much volume can simply be diverted away from EDs. Also at stake is preserving emergency care capacity such that EDs will be staffed and capable of dealing with a variety of disasters or surge needs, which would not be feasible under current payment models with significant decreases in ED volume.…”