ED Level Table

Emergency Department (ED)  Acuity Level Assignment Table

5 Point Value		10 Point Value		15 Point Value		20 Point Value		Critical Care Patient
Repeat vital signs		Triage assesment inc vital signs		Pelvic exam w/cultures		Radiology accompanied		Trauma team activate
Neuro checks		Visual accuity		Charoal administration		LP assist		Stroke team activate
Arm sling application		Orthostatic vital signs		Wound irrigation		Combative patient		Code I or II activate
Radiology unaccompanied		O2 mask application		Admit regular room		Prolonged care		TPA administration
Cervical collar application		Pulse oximetry		Post mortem care		Restraint application		Central nervous system failure
Ace wrap application		Eye patch application		IV insert difficult		Medicated IV gtts		Circulatory failure
Steri strips application		Dressing minor		IV insert 2 or more lines		AMA		Shock
p.o. meds		Pelvic exam- no cultures		Dressing major		Isolation procedures		Renal, hepatic or metabolic failure
Sublingual meds		IV insertion simple 1 line		Enema		Level I rapid infuser/blood warmer		Respiratory failure
Topical meds		IV pump set up		Eye irrigation		Rape exam		Sepsis work up
Suppositories		Psyc intervention		Frequent suctioning		Latex allergy cart use		Admit ICU
Fetal heart measurement		Ring removal		Urine screen		Admit tele or peds		Admit OR
O2 canula application		Baer hugger application		Cardiac monitoring		Conscious sedation		Transfer to other facility
Ear exam assist		Air cast application		Discharge instructions
Consents written/verbal		Chem strip/Urine Screen		Clean up patient
Urine preg test		End tidal CO2 monitoring
Ice bag application		Wound Dressing
		Cast removal
		Specimen collection						Do not charge for the following in addition to Critical Care: gastric intubation or transcutaneous pacing.  All other procedures should be charged.
		Venipuncture (new)
		Blood alcohol draw
		Guiac hema cult
Total  column 1		Total column 2		Total  column 3		Total column 4		Critical Care
		Column 1 total		Level 1 (0-35) 1100		If Procedure Selected Was patient also seen for a significant condition not related to the procedure performed? Yes                                         No Charge Level w/ mod 25     |     Do not charge for level
		Column 2 total		Level 2 (40-65) 1200
		Column 3 total		Level 3 (66-90) 1300
		Column 4 total		Level 4 ( 91-115) 1400
		Column 5 total		Level 5 (116-140) 1500
		Grand Total		Critical Care 1600
				Trauma 1700
Procedures		Procedures		Procedures		Procedures		Procedures
Level I Inc/Drain 7000		Level I Excision/biopsy 7045		Closed Treatment FX Finger/Toe/Trunk 7080		Thoracentesis/Lavage Procedures 7120		Level II Female Reproductive Proc 7170
Level II Inc/Drain 7005		Level I Skin Repair 7060		Closed Treatment FX/dislocation except finger/toe/trunk 7085		GI Intubation/asparation or lavage 7220		Vaginal Delivery 7175
Level III Inc/Drain 7010		Level II Skin Repair 7065		Level I Strapping/Cast 7110		Level II Endoscopy Upper Airway 7125
Nail Procedures 7015		Level III Skin Repair 7070		Level II Strapping/Cast 7115		Endo Intubation 7130		Spinal Tap 7180
Level I Debride/Destruct 7020		Adhesive Skin Repair 7073		Level II Eye Tests 7200		CPR 7132		Level I Nervous System Injections 7185
Level II Debride/Destruct 7025				Level I Repair Eye procedures 7205		Temp Transcutanious Pacing 7134		Level II Nervous System Injections 7190
Level III Debride/Destruct 7030		Placement Transvenous Cath 7075		Level II Repair Eye procedures 7210		Cardioversion 7136		Level I Tube Changes/Reposit 7140
Level IV Debride/Destruct 7035		Injections 7165		Nasal Caut/Packing 7215		Level I Anal/Rectal Procedure 7150
Biopsy Skin, Subcut 7040		Minor Ancillary Procedures 7160		Level I ENT Procedures 7155		DX Anoscopy 7145
Billable Supplies		Orthotic/Prosthetic
Dressing Small 6000
Dressing Med 6005		Aircast ankle  6105
Dressing Large 6010
Chest Tube 6015		Cervical collar 6115
Enema 6020		Crutches 6120
Foley Cath 6025		Rib Belt 6125
Minor Proc Tray 6030		Shoulder immob 6130
IV Solution 6035		Clavicle splint 6135
Nasal Tampon 6040		Fibgls foot splint 6140
MultiLumen CVD  6045		Finger splint 6150
Sutures/Stapler 6050		Cock-up splint 6155
Extra sutures 6055		Harness splint 6160
Dispos cautery 6060		Univ knee splint 6165
Ace wrap 6065
Arm sling 6070
Adaptic 6075
Iodoform Gauze 6080
Morgan lens 6085
Posterior nasal packing 6090
Balloon cath 6095
Casting roll 6145
Cast Boot/shoe 6100
Equalizer boot  6110