ED Coding and Reimbursement Alert

Services increase as clinical acuity sharpens

The number of critical care cases reported by emergency departments is on the rise - and one expert attributes the change to ED physicians' improved documentation skills.
 
The volume of critical care cases has doubled in the last two years due to various factors, including specialty designation changes, increased clinical acuity, and increased volume, says James Blakeman, vice president of Emergency Groups' Office in Arcadia, Calif. "I think emergency physicians are also getting better at identifying critical care and reporting it appropriately."
 
While critical care services for Medicare patients represent only 2.8 percent of all ED services reported, that percentage (for Medicare) should be somewhere between 6 and 8 percent, Blakeman says. For the general population, it should be at least 2.5 to 4.5 percent.
 
"By 'should,' I mean that if the physician used a fair estimate of the time he spent giving attention to the patient while the patient had the immediate potential to deteriorate into medical crisis, the clinical acuity of these cases would warrant reporting them as critical care," Blakeman says. Many critical care services go unreported because the physicians were performing other procedures, such as cardiopulmonary resuscitation, that precluded the 30-minute reporting period.
 
Also, sometimes patients who would otherwise be counted as critical care recover quickly or die in less than 30 minutes, so you can't report them as such.