# Analysis of Emergency Department-based Intensive Care Units on Coding and Revenue

## TL;DR

This study examines how creating an emergency department-based ICU affects coding practices and revenue in a hospital setting.

## Contribution

The study provides new empirical evidence on the financial and operational impact of implementing an ED-ICU model.

## Key findings

- Critical care coding increased significantly after ED-ICU implementation, with notable increases in CPT codes 99291 and 99292.
- Professional revenue per visit increased by an average of $40 following the ED-ICU implementation.
- Non-critical care coding decreased, while high-acuity codes increased, suggesting a shift in patient acuity levels.

## Abstract

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.

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.

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< .001) / 29.6% (16.2 vs 11.4, P < .001), respectively. There was a non-statistically significant increase in 99284. Higher acuity codes (99285) increased by 10% (31.7% vs. 34.9%, P < .001). Average ED charges per visit increased by $40 (95% CI $37.2 – $45.5) post-implementation..

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.