Step 1: Standard Costs

The EDC Analyzer™ reviews all reason for visit diagnosis codes and assigns a Proportional Standard Cost Allocation (PSCA) and associated standard cost weight to each code based on the age and gender of the patient. If multiple PSCAs are assigned to a claim, the EDC Analyzer™ takes the highest PSCA found. There are five possible PSCAs corresponding to the five ED visit levels:

PSCA Values

PSCA Description
1 (lowest weight) Presenting problem is self-limited or minor
2 Presenting problem is low to moderate severity
3 Presenting problem is moderate severity
4 Presenting problem is high severity, requiring urgent evaluation
5 (highest weight) Presenting problem is high severity, posing an immediate, significant threat to physiological function

PSCA weights were derived from the standard resource valuation for the presenting problems in that ED visit level and include the costs associated with:

  1. Nursing and ancillary staff time (for a routine arrival, triage, registration, basic patient/family communications, and a routine discharge)

  2. The room

  3. Creation of a medical record

  4. Coding and billing

Step 1 Examples

Presenting Problem Diagnosis Code Age Range Gender Standard Cost Weight*
Blood pressure check Z01.30 > 2 M & F ***
Weakness R53.1 > 2 M & F ****
Seizure: pregnant O15.9 7 – 54 F ****
Fever R50.9 2 – 74 M & F ***
Fever R50.9 75+ M & F ***
Wheezing R06.2 2 – 11 M & F ***
Wheezing R06.2 12+ M & F ****