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Do billing codes accurately reflect pediatric emergency physician workload? A cross-sectional study.

Erica Qureshi1,2, Kenneth McKinley3, Justin Park4,5

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Summary

Billing codes do not reliably measure physician workload in pediatric emergency departments. Further research is needed to develop a specific, valid workload measure for pediatric emergency physicians.

Keywords:
Billing codesPediatric emergency departmentWorkload

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Area of Science:

  • Emergency Medicine
  • Health Services Research

Background:

  • Accurate measurement of physician workload in pediatric emergency departments (EDs) is crucial for optimizing staffing and improving patient flow.
  • Currently, no universally accepted metric exists to quantify pediatric ED physician workload.
  • Billing codes, reflecting treatment complexity, are explored as potential workload surrogates.

Purpose of the Study:

  • To evaluate the validity of billing codes as a surrogate measure for physician workload in the pediatric emergency department.
  • To determine if billing codes correlate with objective measures of physician work and visit complexity.

Main Methods:

  • A retrospective health records review of 150 pediatric ED visits was conducted.
  • Multivariable ordinal logistic regression models assessed associations between physician-assigned billing codes and measures of physician work.
  • Sensitivity analysis included billing auditor-assigned codes.

Main Results:

  • Physician-assigned billing codes showed associations with ordering labs, medications, and specialist consultations.
  • No significant associations were found between billing codes and physician work measures after adjusting for visit complexity, age, and sex.
  • Visit acuity (PaedsCTAS 1-3) was significantly associated with increased billing codes.

Conclusions:

  • Limited evidence supports the content validity of billing codes as a surrogate for pediatric ED physician workload.
  • The findings underscore the need for developing a dedicated, valid, and reliable workload measure for pediatric emergency physicians.
  • Optimizing staffing and improving ED efficiency necessitates accurate workload assessment.