Abstract:
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.
journal_name
Pediatr Emerg Carejournal_title
Pediatric emergency careauthors
Losek JD,Reid SR,Linzer Jdoi
10.1097/01.pec.0000177193.60784.c2subject
Has Abstractpub_date
2005-09-01 00:00:00pages
578-81issue
9eissn
0749-5161issn
1535-1815pii
00006565-200509000-00004journal_volume
21pub_type
杂志文章abstract::Expected clinical manifestations of intussusception include paroxysmal abdominal pain, vomiting, abdominal mass, and with time, rectal bleeding. We report a case where lethargy and vomiting are the presenting complaints. Diagnostic delay was encountered for this infant who had altered sensorium without accompanying pa...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/00006565-198706000-00015
更新日期:1987-06-01 00:00:00
abstract::The ingestion of foreign bodies remains a common occurrence in children. Most ingested foreign bodies pass spontaneously, although up to 1% will result in intestinal perforation. Specific foreign bodies such as sharp, pointed, or corrosive objects have been typically associated with perforation. The initial diagnosis ...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0b013e3180302be6
更新日期:2007-02-01 00:00:00
abstract::Subcutaneous granuloma annulare is an inflammatory lesion occurring in otherwise healthy children. We present 3 pediatric patients with different diagnostic-therapeutic paths depending on the ward they were referred to. The lesions regress spontaneously, and medical or surgical treatments are generally not necessary. ...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0000000000000591
更新日期:2017-08-01 00:00:00
abstract:INTRODUCTION:Resuscitation skills decay as early as 4 months after course acquisition. Gaps in research remain regarding ideal educational modalities, timing, and frequency of curricula required to optimize skills retention. Our objective was to evaluate the impact on retention of resuscitation skills 8 months after th...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0000000000001849
更新日期:2019-07-11 00:00:00
abstract:OBJECTIVES:The objectives of this study were to evaluate the efficacy and utilization of an observation unit (OU) for admission of pediatric patients after a toxicologic ingestion; compare the characteristics and outcomes of patients admitted to the pediatric OU, inpatient (IP) service, and intensive care unit (ICU) af...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0b013e3182717329
更新日期:2012-11-01 00:00:00
abstract:PURPOSE:Primary cardiac events are rare in children. There is little information in the literature regarding the most appropriate emergency department (ED) management of this type of pediatric patient, especially with regard to medication use. SUMMARY:This case highlights the pediatric ED evaluation and treatment of s...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0000000000000547
更新日期:2017-02-01 00:00:00
abstract:OBJECTIVE:The aim of this study was to report an acute onset of symptoms erroneously attributed to serotonin syndrome in a child who had been given both anticholinergic and serotonergic agents. CASE SUMMARY:A 9-year-old girl with chronic anxiety and gastrointestinal problems was prescribed oral sertraline 6.25 mg dail...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0000000000000515
更新日期:2015-12-01 00:00:00
abstract:OBJECTIVE:Occult pneumothoraces (OPTXs) are defined by air within the pleural space that is not visible on conventional chest radiographs (CXR). The aim of this study was to understand how frequently the Extended Focused Assessment with Sonography for Trauma (eFAST) examination identifies occult PTX in a pediatric blun...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0000000000002303
更新日期:2020-12-01 00:00:00
abstract::We present a case of a six-week-old infant who developed life-threatening complications after unintentional sodium bicarbonate intoxication. Baking soda was being used by the mother as a home remedy to "help the baby burp." A review of the literature regarding the use (or misuse) of baking soda follows. Our patient, a...
journal_title:Pediatric emergency care
pub_type: 杂志文章,评审
doi:
更新日期:1995-04-01 00:00:00
abstract:OBJECTIVES:To ascertain the incidence, determinants, and outcome of sepsis workup in febrile infants aged 0-90 days with respiratory syncytial virus (RSV) infection. DESIGN:Retrospective chart review. RESULTS:191 infants with RSV, 21.5% younger than 28 days, were identified; 101 (52.9%) were febrile and 90 were afebr...
journal_title:Pediatric emergency care
pub_type: 杂志文章,评审
doi:10.1097/01.pec.0000092576.40174.28
更新日期:2003-10-01 00:00:00
abstract::Pneumomediastinum is a relatively uncommon occurrence in pediatric patients. After mediastinal air leak, air may dissect through a variety of tissue planes within the chest, neck, and abdomen. We report the case of a 16-year-old adolescent boy who presented with spontaneous pneumomediastinum accompanied by the presenc...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0b013e31828a38ad
更新日期:2013-04-01 00:00:00
abstract::The diagnosis of septic arthritis should be considered in all children with hip pain. We review the evaluation of children who present with fever and hip pain, emphasizing features that may assist in distinguishing septic arthritis of the hip from transient synovitis. We also discuss the impact of the increased preval...
journal_title:Pediatric emergency care
pub_type: 杂志文章,评审
doi:10.1097/01.pec.0000159063.24820.73
更新日期:2005-05-01 00:00:00
abstract:OBJECTIVE:Human immunodeficiency virus (HIV) continues to be a significant public health concern for adolescents and young adults. Since 2006, the Centers for Disease Control and Prevention has recommended more aggressive routine screening for HIV for patients presenting to the emergency department (ED). Our objectives...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0b013e3182767add
更新日期:2012-12-01 00:00:00
abstract::We report a case of a patient presenting with fever, right lower leg swelling, and pain who was found to have a fluid collection between muscle planes noted on point-of-care ultrasound. Point-of-care ultrasound raised the clinician's concern for deep musculoskeletal infection, leading to prompt initiation of antibioti...
journal_title:Pediatric emergency care
pub_type: 杂志文章,评审
doi:10.1097/PEC.0000000000001711
更新日期:2019-01-01 00:00:00
abstract::Alcaligenes faecalis is a gram-negative organism that is commonly found in the environment and may also be a part of normal fecal flora in humans. Although various infections with this bacteria have been described in the pediatric population, it has not been previously identified in infections as the pathogen after a ...
journal_title:Pediatric emergency care
pub_type: 杂志文章,评审
doi:10.1097/PEC.0000000000000645
更新日期:2017-07-01 00:00:00
abstract:OBJECTIVE:To describe the clinical course and determine the minimal observation period required following isopropanol ingestion in children. METHODS:The emergency department records of children less than 6 years of age with isopropanol ingestion who presented between June 1992 and December 1998 were identified. Demogr...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/00006565-200008000-00005
更新日期:2000-08-01 00:00:00
abstract::A case of bilateral primary spontaneous pneumothorax ("buffalo chest") in a previously healthy man is described. The clinical presentation and treatment options are discussed. ...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0b013e318191db2b
更新日期:2009-01-01 00:00:00
abstract:OBJECTIVE:The aim of this study was to delineate pediatric emergency medicine provider opinions regarding the importance of, and to ascertain existing processes by which practitioners maintain, the following critical procedural skills: oral endotracheal intubation, intraosseous line placement, pharmacologic and electri...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0000000000000991
更新日期:2019-08-01 00:00:00
abstract::We describe an unusual case of a toddler diagnosed with an idiopathic seizure disorder that later was proved to be caused by deliberate administration of amitriptyline by his custodian. In spite of seizures associated with widened electrocardiographic wave (QRS) and right axis deviation on the electrocardiogram (EKG),...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/00006565-199906000-00011
更新日期:1999-06-01 00:00:00
abstract:OBJECTIVES:To determine the frequency of inappropriate transport by Emergency Medical Service (EMS). DESIGN:A retrospective study. SUBJECTS:Patients up to 36 months of age with medical complaints transported by EMS to an urban pediatric emergency department (ED). INTERVENTIONS:None. MEASUREMENTS:Arbitrary criteria ...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/00006565-199806000-00004
更新日期:1998-06-01 00:00:00
abstract:OBJECTIVE:Timely delivery of β-agonists and steroids to patients with acute recurrent wheezing is a key component of the National Heart, Lung, and Blood Institute recommended emergency department (ED) asthma care. We conducted an ED improvement initiative to standardize asthma care and improve time to treatments. METH...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0000000000001249
更新日期:2017-09-01 00:00:00
abstract::Guillain-Barré syndrome (GBS) in children can present with early symptoms of limb and back pain that progress to acute generalized paralysis. Although the clinical course of this illness may be benign with spontaneous recovery, treatment is indicated for more severe cases. We report a three-year-old patient with GBS, ...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/00006565-199808000-00007
更新日期:1998-08-01 00:00:00
abstract:OBJECTIVES:Although child abuse pediatricians are frequently asked to evaluate risk of abuse based on photographs, the effect of photographic quality on this process is presently unknown. Photographs of abused children are often taken by professionals without photographic training, and quality varies widely. This artic...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0b013e31828e848e
更新日期:2013-05-01 00:00:00
abstract::We describe two related cases of pertussis infection ("whooping cough"). This disease entity was almost completely eradicated through successful mass immunization programs. In the past decade it has demonstrated a steady rise in incidence. The epidemiology, clinical manifestations, treatment, and current vaccines for ...
journal_title:Pediatric emergency care
pub_type: 杂志文章,评审
doi:
更新日期:1993-08-01 00:00:00
abstract:OBJECTIVES:To develop a mathematical model to predict the probability of having community-acquired pneumonia and to evaluate an already developed prediction rule that has not been validated in a clinical scenario. METHODS:Children who presented with fever and had presumptive clinical diagnosis of pneumonia were evalua...
journal_title:Pediatric emergency care
pub_type: 杂志文章,多中心研究
doi:10.1097/PEC.0b013e3181e05779
更新日期:2010-06-01 00:00:00
abstract::Medical directors of pediatric emergency departments were surveyed by mail to determine the present role of their pediatric hospitals in general, and emergency departments in particular, in the evaluation and management of pediatric sexual assault and abuse. Seventy-four percent of the responses were from communities ...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/00006565-198809000-00003
更新日期:1988-09-01 00:00:00
abstract:OBJECTIVES:Radiographic survey of the entire aerodigestive tract (nares to anus) is common practice in children presenting to the emergency department following coin ingestion. The purpose of our study was to determine the optimal protocol for radiographic survey post-coin ingestion. We hypothesized that for children p...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0000000000001688
更新日期:2018-11-19 00:00:00
abstract::Meningoencephalitis and acute disseminated encephalomyelitis (ADEM) are both neurological disease processes, but there have been few cases of meningoencephalitis progressing to ADEM in the pediatric population. A case of a 4-year-old girl with an initial diagnosis of meningoencephalitis is presented here, whose initia...
journal_title:Pediatric emergency care
pub_type: 杂志文章,评审
doi:10.1097/PEC.0000000000000107
更新日期:2014-04-01 00:00:00
abstract:OBJECTIVE:The goal of this retrospective cohort study of pediatric patients exposed to flumazenil was to identify the frequency of seizures. METHODS:Included patient were those aged 12 years or younger who received flumazenil, who had evidence of clinical poisoning as defined by an altered mental status, and who were ...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0b013e3182531d0d
更新日期:2012-05-01 00:00:00
abstract::Acute disseminated encephalomyelitis is a rare central nervous system demyelinating disease that occurs most frequently in children. It usually runs a monophasic course, beginning with fever, headache, and meningeal signs and rapidly progressing to coma when appropriate diagnosis and treatment are not provided. We rep...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:
更新日期:1998-02-01 00:00:00