PURPOSE: Electronic medical record (EMR) systems have been shown to improve the quality of patient care and patient safety. Despite compelling evidence of return on investment, EMRs have not been universally accepted. The purpose of this study was to determine what effect instituting an intensive care specific EMR in an academic medical center has on capturing billable encounters (BE).
METHODS: This was a single center, retrospective study occurring in the surgical intensive care unit (ICU) of the University of Pennsylvania. A retrospective analysis of all BE was performed through the study period. Prior to the initiation of the EMR, BE were captured via manual chart abstraction by professional fee abstracters certified by the American Academy of Professional Coders (AAPC). There was no change in attending coverage or coding staff during the study period.
RESULTS: Each year was divided into quarters for analysis. The EMR was introduced in the second quarter of 2005. CPT code 99291 designates critical care services provided for between 30 and 74 minutes (after which it is billed as 99292). Prior to the institution of EMR, the average number of CPT 99291 being captured was 935.4 (range 836-1136). After initiation of EMR, the average number of CPT 99291 being captured rose to 1663.6 (range 1275-2266) (figure 1). The total number of billable events which were captured was 4,382 prior to the EMR and 4,937 after introduction of EMR. The documentation supported critical care code billing in 55% of the encounters prior to initiation of the ICU EMR and 77% afterwards. When comparing these numbers to the total BE, this change is statistically significant by Fisher exact test at p < 0.0001 [OR 2.61, CI 2.39-2.85].
CONCLUSION: The addition of EMR to an academic medical center surgical intensive care unit significantly increased the capture of billable critical care services as measured by CPT 99291.
CLINICAL IMPLICATIONS: Institution of EMR in academic ICUs may increase hospital revenue by properly capturing billable events.
DISCLOSURE: Benjamin Kohl, None.