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Assessing the reliability of pediatric emergency medicine billing code assignment for future consideration as a proxy
Justin M Park1,2, Erica McDonald1,2, Yijinmide Buren2
1Faculty of Medicine, University of British Columbia, Vancouver, Canada.
Pediatric emergency department physicians reliably assign billing codes, showing substantial agreement with auditor assignments. This supports billing codes as a valid measure of pediatric emergency physician workload.
Area of Science:
- Emergency Medicine
- Health Services Research
Background:
- Accurate pediatric emergency department (PED) workload measurement is crucial for resource allocation and reducing physician burnout.
- Currently, no single validated variable consistently measures PED workload.
- Billing codes, reflecting medical decision-making complexity, show potential as a proxy for workload but require reliability assessment.
Purpose of the Study:
- To assess the reliability of billing codes assigned by PED physicians.
- To identify factors influencing the inter-rater reliability of billing code assignment in a PED setting.
Main Methods:
- Retrospective cross-sectional study of 150 physicians at a quaternary-level PED (January-December 2018).
- Physician-assigned billing codes were compared against a billing auditor's assignments (criterion standard).
- Inter-rater reliability was calculated; logistic regression analyzed associations between covariables and reliability.
Main Results:
- Substantial inter-rater reliability (AC2 0.72) was found between physician and auditor billing code assignments.
- Adjusted models indicated that clinical trainee involvement was significantly associated with increased inter-rater reliability.
Conclusions:
- Billing codes are reliably assigned by PED physicians, demonstrating substantial agreement with expert auditors.
- This finding is a critical step in validating billing codes as a reliable proxy for pediatric emergency physician workload.
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