Step 2: Extended Costs

The EDC Analyzer™ reviews all line-level services on the claim to identify diagnostic tests that fall into each of the following categories:

  1. Laboratory tests

  2. X-rays (film)

  3. CT/MRI/Ultrasound

  4. EKG/Respiratory therapy/Other diagnostic services

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:

Step 2 Examples

Diagnostic Category CPT Code Code Description Extended Cost Weight*
Lab 61070 PUNCTURE OF SHUNT TUBING OR RESERVOIR FOR ASPIRATION OR INJECTION PROCEDURE ***
Lab 62270 SPINAL PUNCTURE, LUMBAR, DIAGNOSTIC ***
CT/MRI/Ultrasound 62284 INJECTION PROCEDURE FOR MYELOGRAPHY AND/OR COMPUTED TOMOGRAPHY, LUMBAR (OTHER THAN C1-C2 AND POSTERIOR FOSSA) ***
EKG/RT/Other Diagnostic 62302 MYELOGRAPHY VIA LUMBAR INJECTION, INCLUDING RADIOLOGICAL SUPERVISION AND INTERPRETATION; CERVICAL ***
EKG/RT/Other Diagnostic 62303 MYELOGRAPHY VIA LUMBAR INJECTION, INCLUDING RADIOLOGICAL SUPERVISION AND INTERPRETATION; THORACIC ***
Lab 69100 BIOPSY EXTERNAL EAR ***
Lab 69105 BIOPSY EXTERNAL AUDITORY CANAL ***
X-Ray – Plain Film 70010 MYELOGRAPHY, POSTERIOR FOSSA, RADIOLOGICAL SUPERVISION AND INTERPRETATION ***
*Redacted