There really isn't very much published about this. CMS puts out 
information related to Medicare billing; this generally shows a curve 
titling towards 99284 and 99285. Joe Losik, Sam Reid and I published a 
survey in Peds Emergency Care in 2005 that showed in general peds ED 
were billing at a lower level then the CMS data (curve skewed towards 
99282 and 99283) (see abstract below).

It is my personal experience that most PEM's that do their own coding 
under appreciate the level of service they are providing and aren't 
well familiar with the coding guidelines.

Jeffrey Linzer Sr., MD, FAAP, FACEP
Associate Medical Director for Compliance
Emergency Pediatric Group
Children's Healthcare of Atlanta at Egleston and Hughes Spalding

Losek JD, Reid SR, Linzer J. Survey of Academic Pediatric Emergency 
Departments Regarding Use of Evaluation and Management Codes. Red Em 
Care. 2005;21:578-581.

Objective: The aims of the study were to determine the frequency at 
which each emergency medicine evaluation and management (E/M) code is 
used, to identify factors associated with their use by academic 
pediatric emergency departments (PEDs), and to compare PED E/M code 
utilization rates with rates reported by Centers for Medicare and 
Medicaid Services for general emergency departments (EDs).

Method: A 24-question survey was sent to 42 academic PED medical 
directors. Questions pertained to PED demographics, physician staff, 
records/documentation, billing education, and E/M coding data for 1 
year. The general ED E/M code utilization rates were obtained from the 
published Centers for Medicare and Medicaid Services database. 
Descriptive statistics and odds ratios were used to report and compare 
the data.

Results: Twenty (48%) of the surveys were returned, and 9 (21%) 
completed the E/M coding data questions. From these 9 departments, the 
mean PED annual census was 46,065 (range, 23,531-92,910). The methods 
of PED medical record documentation were template (6), handwritten (2), 
and dictation/transcription (1). Charge documents were completed by the 
PED physician (3), professional service coders (4), and hospital coders 
(2). Coding/documentation in-services were provided to the physicians 
of 7 PEDs, and billing audits were performed in 5 PEDs.

The total number of charges for the 9 PEDs was 325,129, 78.4% of the 
census. Multiple reasons were given for the discrepancy between census 
and charges. The percentage of each of the 5 levels of service billed 
was calculated for each of the 9 PEDs. The 2 lowest levels of service 
were used 38.3% of the time, whereas the 2 highest were used 19.2% of 
the time. The range for the highest level of service varied widely from 
5.3% to 53.3%. Approximately 65% of E/M codes used by general EDs were 
for the 2 highest levels of service. The PED with the highest 
percentage of upper level charges (53.4%) was the only PED that used 
dictation/transcription for documentation.

Conclusion: Although the response rate was low, and thus the validity 
of the results was limited, the findings may serve as a benchmark for 
E/M code utilization in PEDs. The large variation in use of the E/M 
codes among the PED in our study and the lower rate of using the 
highest E/M codes by the PEDs compared with the general EDs suggest 
potential opportunities for academic PEDs to improve billing practices.

Quoting Joy Nagelberg <[log in to unmask]>:

> Do any of you have the distribution of billing codes in your 
> department or are
> you aware of any publications listing these distributions for 
> pediatric EDs?  If
> you send your own data, I would appreciate it if you would also send the
> percent of patients admitted from your ED as a general measure of acuity.
> Thank you.
> For more information, send mail to [log in to unmask] with 
> the message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:

For more information, send mail to [log in to unmask] with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is: