SHM Converge Scientific Abstract ePoster Gallery-Improving Critical Care Billing in a Pediatric Hospital Medicine Division

Pdf Summary

The project addressed underuse of Critical Care Services (CCS) professional billing codes in a Hospital Medicine division, despite the importance of billing accuracy for capturing the complexity of care and supporting division revenue. The aim was to increase appropriate use of CCS CPT Evaluation and Management codes from 10% to 50% by July 1, 2024, and sustain that improvement for six months.<br /><br />The study was conducted at a 320-bed freestanding academic hospital from January 1, 2023, through December 31, 2024. It focused on weekday daytime Rapid Response Team events for hospitalized Hospital Medicine patients. The team used stakeholder engagement, problem analysis with a fishbone diagram, a key driver diagram, and multiple plan-do-study-act cycles. Data were collected through retrospective chart review.<br /><br />Results showed substantial improvement. Use of CCS CPT E/M codes increased from 10% to 52%, exceeding the original target. Work relative value units (wRVUs) increased by 83% per RRT event day. In addition, 87% of notes contained documentation appropriate to justify CCS code use.<br /><br />The authors concluded that relatively simple interventions—provider education, a billing tip sheet, and EMR changes—can significantly improve appropriate CCS coding and increase wRVUs, better reflecting the care delivered.

Asset Subtitle

Padmaja Pavuluri

Meta Tag

Author List Allison Markowsky, Bridget Allard, Dalton Haslam, Margarita Ramos, Padmaja Pavuluri, Paul Michel

Category Research

Concept Professional Billing

Concept Critical Care Services CPT Evaluation and Management Codes

Concept Division Revenue

Concept Quality Improvement

Concept Complexity of Care

Distinguished Non-Finalist

Presenter Organization Children's National Hospital

Presenting Author Padmaja Pavuluri

Track Quality Improvement

Keywords

Critical Care Services

CCS billing codes

Hospital Medicine

CPT Evaluation and Management

Rapid Response Team

billing accuracy

wRVUs

provider education

electronic medical record

quality improvement

Professional Billing

Critical Care Services CPT Evaluation and Management Codes

Division Revenue

Quality Improvement

Complexity of Care