The EDC Analyzer™ reviews all line-level services on the claim to identify diagnostic tests that fall into each of the following categories:
Each category carries an extended cost weight. The EDC Analyzer™ adds together the weights for each unique category of tests found on the claim to determine the overall extended cost weight. For example, if 2 laboratory tests and 3 X-rays are billed, the EDC Analyzer™ will count the laboratory tests as one and the X-rays as one.
Extended cost weights were calculated for each category based on the level of ED resources expended (including staff time) to note orders, communicate with the patient and staff, and follow up as needed.
Below are some examples showing how the EDC Analyzer™ assigns an extended cost weight based on a diagnostic test:
|Diagnostic Category||CPT Code||Code Description||Extended Cost Weight*|
|Lab||80048||BASIC METABOLIC PANEL CALCIUM TOTAL||***|
|Lab||85025||COMPL CBC W AUTO DIFFIAL WBC||***|
|CT/MRI/Ultrasound||70450||CT HEAD/BRN C-MATRL||***|
|EKG/RT/Other Diagnostic||93005||ECG ROUTINE ECG W/LEAST 12 LDS TRCG ONLY W/O I&R||***|
|EKG/RT/Other Diagnostic||94640||INHALATION TREATMENT||***|
|Lab||80053||COMPRE METAB PANEL||***|
|Lab||83605||LACTATE (Lactic Acid)||***|
|X-Ray – Plain Film||71020||CHEST XRAY 2VW FRONTAL LATL||***|