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{
    "pk": 41521,
    "title": "Analysis of Emergency Department-based Intensive Care Units on Coding and Revenue",
    "subtitle": null,
    "abstract": "<p><strong>Introduction:</strong> Emergency department-based intensive care units (ED-ICU) address the increasing demand for critical care services and represent a transformative approach to the specialty’s management of critically ill patients within emergency medicine. However, data on their financial impact and operational effects remain limited.</p>\n<p><strong>Methods:</strong> We conducted a retrospective, quasi-experimental study at an urban, academic ED with approximately 90,000 annual visits. In July 2019, a nine-bed ED-ICU model, referred to as “Next Pod,” was implemented. We analyzed Current Procedural Terminology (CPT) coding data and professional revenue (charges billed and payments received) for 35 weeks before and after the intervention (November 2018–March 2020). The intervention involved repurposing a nine-bed ED area and adjusting physician and nursing staffing models. We compared critical and non-critical care CPT coding proportions and professional revenue using the Student t-test.<br>Results: During the study period, there were 38,283 ED visits pre-implementation and 36,424 visits post-implementation. Across the entire ED, critical care coding significantly increased following implementation (CPT 99291: 6.2 - 8.8% [total percentage increase of 41.94%]; 99292: 0.5 - 1.0% [total percentage increase of 100%]). Encounters where 99292 was billed multiple times increased by 128.1% (32 vs 73). Non-critical care coding (99282, 99283) decreased 23% (9.1% vs 7.0%, P&lt; .001) / 29.6% (16.2 vs 11.4, P &lt; .001), respectively. There was a non-statistically significant increase in 99284. Higher acuity codes (99285) increased by 10% (31.7% vs. 34.9%, P &lt; .001). Average ED charges per visit increased by $40 (95% CI $37.2 – $45.5) post-implementation.</p>\n<p><strong>Conclusion: </strong>The implementation of an ED-ICU was associated with significant increases in critical care and high-acuity coding, as well as enhanced professional revenue. These findings suggest that ED-ICU models can improve both fiscal performance and operational efficiency. Further research is needed to explore the contributions of resource allocation, documentation improvements, and care practices to these outcomes.</p>",
    "language": "eng",
    "license": {
        "name": "Creative Commons Attribution 4.0",
        "short_name": "CC BY 4.0",
        "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.",
        "url": "https://creativecommons.org/licenses/by/4.0"
    },
    "keywords": [
        {
            "word": "ED-ICU"
        },
        {
            "word": "EM/CCM"
        },
        {
            "word": "CCM"
        },
        {
            "word": "Emergency Department Intensive Care Units"
        },
        {
            "word": "Emergency Medicine Operations"
        },
        {
            "word": "resource utilization"
        },
        {
            "word": "Healthcare Economics"
        },
        {
            "word": "Quality Improvement Initiatives"
        },
        {
            "word": "ED Workflow Optimization"
        },
        {
            "word": "Professional Revenue Generation"
        }
    ],
    "section": "Emergency Department Operations",
    "is_remote": true,
    "remote_url": "https://escholarship.org/uc/item/0sk7w6vw",
    "frozenauthors": [
        {
            "first_name": "Michael",
            "middle_name": "H.",
            "last_name": "Sherman",
            "name_suffix": "",
            "institution": "Boston University Chobanian & Avedisian School of Medicine, Department of  Emergency Medicine, Boston, Massachusetts",
            "department": ""
        },
        {
            "first_name": "Vincent",
            "middle_name": "L.",
            "last_name": "Kan",
            "name_suffix": "",
            "institution": "University of Massachusetts Chan Medical School, Department of Emergency  Medicine, Worcester, Massachusetts",
            "department": ""
        },
        {
            "first_name": "Patric",
            "middle_name": "",
            "last_name": "Gibbons",
            "name_suffix": "",
            "institution": "University of Massachusetts Chan Medical School, Department of Emergency  Medicine, Worcester, Massachusetts; University of Massachusetts, Department of Anesthesiology & Perioperative  Medicine, Worcester, Massachusetts",
            "department": ""
        },
        {
            "first_name": "Jacob",
            "middle_name": "",
            "last_name": "Garrell",
            "name_suffix": "",
            "institution": "University of Massachusetts Chan Medical School, Department of Emergency  Medicine, Worcester, Massachusetts",
            "department": ""
        },
        {
            "first_name": "Martin",
            "middle_name": "A.",
            "last_name": "Reznek",
            "name_suffix": "",
            "institution": "University of Massachusetts Chan Medical School, Department of Emergency  Medicine, Worcester, Massachusetts",
            "department": ""
        }
    ],
    "date_submitted": "2024-12-20T05:55:55.035000Z",
    "date_accepted": "2025-04-15T20:27:08.303000Z",
    "date_published": "2025-09-27T19:25:00Z",
    "render_galley": null,
    "galleys": [
        {
            "label": "PDF",
            "type": "pdf",
            "path": "https://journalpub.escholarship.org/westjem/article/41521/galley/39994/download/"
        }
    ]
}