ED Coding and Reimbursement Alert

10 specific diagnoses drove the overuse of ED services.

Your ED is likely to see patients with bronchitis, headaches, and nausea frequently, but one insurer thinks those patients would save the healthcare system a lot of money if they visited primary care physicians instead of emergency departments.

That’s the word from a new analysis by UnitedHealth Group, which calculated that the 18 million avoidable ED visits annually add a startling $32 billion to insurers’ costs every year. That’s because the average ED visit costs about 12 times more than a physician office visit and about 10 times the cost of an urgent care visit, UHC contends.

The 10 most common conditions that are seen in the ED but are treatable in the primary care setting, UHC says, are bronchitis, cough, dizziness, flu, headache, low back pain, nausea, sore throats, strep throat, and upper respiratory infections.

It’s unclear whether UHC intends to invoke any regulations that dissuade its beneficiaries from visiting EDs, but it’s important to keep this information on your radar screen as you work with your UHC contracts.

Importantly, the ED provides the safety net for EMTALA mandated care so document correctly, code correctly, and pursue appropriate payment for services.

Resource: To read more about UHC’s analysis, visit  www.unitedhealthgroup.com/content/dam/UHG/PDF/2019/UHG-Avoidable-ED-Visits.pdf.