Monday, September 10, 2012

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



p.o. meds

Pelvic exam- no cultures

Dressing major

Isolation procedures

Renal, hepatic or metabolic failure

Sublingual meds

IV insertion simple 1 line


Level I rapid infuser/blood warmer

Respiratory failure

Topical meds

IV pump set up

Eye irrigation

Rape exam

Sepsis work up


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






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

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


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

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