Improving Professional Billing for Critical Care Services in a Hospital Medicine Division

Professional billing is an important component of division revenue and financial sustainability, yet billing knowledge for varied clinical scenarios is often lacking. Rapid Response Team (RRT) events for patient decompensation often require hospitalists to provide critical care services. However, the applicability of critical care codes to these events was underrecognized by our division. Our specific aim was to increase appropriate hourly critical care code use for eligible RRT events from 10% to 50% by July 1, 2024, and sustain for 6 months.

Daytime, weekday RRT events on the hospital medicine service between January 2023 and June 2025 were reviewed for critical care criteria, charges placed, and documentation meeting requirements for code use. Interventions occurred between October 2023 and August 2024. The process measure was critical care code use for eligible RRT events; the outcome measure was work relative value unit (wRVU) per patient day with an eligible RRT event, and the balancing measure was critical care code use for RRT events not meeting critical care criteria. Interventions included education sessions, a billing tip sheet, streamlined access to billing codes, and regular data updates.

Critical care code use increased from 10% to 94% with special-cause variation observed, and wRVUs increased by 191% per patient day with an eligible RRT event and critical care code placed. Appropriate documentation for use of critical care codes increased from 13% to 90%.

Educational interventions, just-in-time resources, and regular feedback improved appropriate use of critical care codes, documentation, and revenue for RRT events.