7-052

Impact of smart pump-electronic health record (EHR) interoperability with auto-documentation on®
infusion-therapy Current Procedural Terminology (CPT ) code billing claims at a community hospital
Tina M. Suess , John W. Beard , Michael Ripchinski , Matthew Eberts , Kevin Patrick , Leo J.P. Tharappel
123Penn Medicine Lancaster General Health ; ICU Medical, Inc. ; Indegene, Pvt. Ltd.
121BackgroundFig. 2 Overall billed therapies

40,00030,00020,00010,0000ED

30,000***20,000***10,0000Non-ED2016   2017Fig. 5 Comparison of 2016 and 2017 billed therapies for ED by CPT code®

Number of billed therapies

50,000Methods

EDp = 0.40

8,000

4,000
2,000

Non-ED

Number of billed therapies

8,000
6,000
2,000

***

096360

***
***

***
96361

96365

96366

96367

96368

96372

96374

96375

$262,150

96361

96365

96366

$69,112

96367

96368

CPT Code®

96376** p <0.05, *** p <0.001

2016   2017***

2,0000***

***

***

96372

96374

96375

***

**
96361

96365

96366

96367

96368

CPT® Code***96376** p <0.05, *** p <0.001$51,480

Category

Description

CPT® code

Rate

ED ($)

Non-ED ($)

Total ($)

Hydration

Initial96360$ 180.00

112,32046,080158,400

Additional

96361$ 35.00(11,130)

273,280

262,150

Initial96365$ 180.00

351,540

113,60465,300

Additional

96366$ 35.00

10,08072,38082,460

New Drug

96367$ 53.00

25,4406,630

31,800Concurrent

96368

$ —

—

—

—

SQ/IM

96372

$ 53.00—

69,112

69,112

Initial Push

96374

$ 180.00(16,200)

67,68051,480Initial Push, new drug

96375

$ 35.00

6,930

20,02026,950Additional push, same drug

96376

$ ——

—

—

478,980

668,672

1,147,652

Total$26,950

$–

96372

96374

96375

96376

Directions for further study

Table 1 ED versus non-ED: Medicare Addendum B annual dollar amount change by CPT® code

$96360

96375

4,000

$158,400

$–

96374

6,000

Injection$31,800

96372

8,000

IV Infusion$82,46096368>> This is the first study to document the positive impact of interoperability®
on CPT -coded infusion therapy billing claims.
>> The findings from this study support the value of smart pump-EHR
interoperability and extend the benefits beyond patient safety to include
improved hospital financial performance through charge capture andbilling compliance.
®
>> CPT code submission count was higher among patients who had
auto-documentation of infusion start and stop times enabled bysmart pump-EHR interoperability.
>> The annualized increase in value of the corresponding 2017 Medicare
Addendum B rates was $1,147,652.
>> When divided by study groups, the ED had a $478,980 increase, while
non-ED units had an increase of $668,672 in claims.
>> Viewed by admission status, claims increased by $610,712 for outpatientsand $536,940 for inpatients.
>> Gains demonstrated across units and by admission status suggest theseeffects may be generalizable to the broad hospital population.
>> The net hospital revenue associated with these codes is subject to a highly
complex analysis of payer mix, reimbursement contracts, etc. and isbeyond the scope of this study.
>> These community hospital results may help drive adoption of smartpump-EHR interoperability by providing critical financial considerations.
>> Further study is required to confirm and evaluate the implications ofthese results.

*** p <0.001$465,300$100,000

96367

***

10,000$400,000$200,000

96366

96376

Fig. 4 Financial impact (ED plus non-ED), 2017 Medicare Addendum B dollar amounts by CPT® Billing claim value$300,000

96365

CPT® Code96360

CPT® Code$500,000

96361

Fig. 6 Comparison of 2016 and 2017 billed therapies for non-ED by CPT code

10,000

***

***

®

12,000******** p <0.001

2016   2017

14,0004,000***96360

2016   2017******

0Fig. 3 Overall impact (ED plus non-ED) of billed therapies by CPT code
16,0002016   2017

6,000

®

Billing claims value>> Retrospective cohort study approved by the Institutional
Review Board.
>> Data were analyzed from patients admitted to Penn
Medicine Lancaster General Health who received IV®
infusions and for whom CPT -coded infusion-therapy billingclaims were submitted.
>> Data was collected for patients in the emergency
department (ED) and in non-ED units (e.g., oncology,neuroscience, cardiac telemetry, etc.).
>> A “patient event” is defined as an ED visit or a non-ED unit
admission day.
>> The intervention was defined as the use of smart pumpEHR interoperability to auto-document infusion-therapy
start and stop times.
>> The 2016 pre-auto-documentation group had
auto-documentation of start time only; the 2017
post-auto-documentation group had auto-documentationof both start and stop times.
>> The primary outcome of the study was the total count of all®
CPT codes submitted.
®
>> Secondary outcomes included the individual CPT codes
count submitted and the corresponding 2017 Medicare
Addendum B dollar amounts.
®
>> CPT reimbursement rates were converted to annualizedamounts.

3Conclusions

Number of billed therapies>> To evaluate the impact of smart pump-EHR interoperability
with auto-documentation on Current Procedural
Terminology (CPT®)-coded infusion-therapy billing claims
submissions.

Fig. 1 Overall patient events
Number of billed therapies

Purpose1Results

Number of patient events>> Smart pump-electronic health record (EHR) interoperability
has been demonstrated to reduce adverse events and1,2,3
increase documentation and billing accuracy.
>> Relatively little is known about the impact of interoperability
on infusion therapy billing claims and hospital finances.

1

Table 2 Overall billing impact for IPs and OPs
Visit typeNo. of billed therapies
in 2016

No. of billed therapies
in 2017% change in billedtherapies

P value

Annualized billing ($)

IP

14,605

16,56613.4<0.001536,940

OP

22,43025,18012.3<0.001

610,712

Total

37,03541,74612.7<0.001

1,147,652>> Trend of interoperability driven billing improvements over time.
>> Financial results of conversion from total manual documentation to autodocumentation of start and stop times.
>> Impact of interoperability on documentation of therapies not delivered bythe infusion pump.
REFERENCES
1. Ohashi K, Dalleur O, et al. Benefits and Risks of Using Smart Pumps to Reduce Medication Error Rates: A Systematic Review.
Drug Saf. 2014;37:1011-1020.
2. ECRI Guidance Article. Infusion pump integration. Health Devices. 2013:210-21.
3. Biltoft J, Finneman L. Clinical and financial effects of smart pump-electronic medical record interoperability at a hospital in aregional health system. Am J Health-Syst Pharm. 2018;75(14)1064-8.
DISCLOSURES> John Beard is an employee and a shareholder of ICU Medical Inc.
> Tina Suess, Michael Ripchinski, Matthew Eberts, and Kevin Patrick have not received personal compensation for their rolesin this study.
> Leo Tharappel is an employee of Indegene, Pvt. Ltd., which was contracted to perform statistical analysis for this study.
> LG Health provided marketing and consulting services to ICU Medical Inc.pursuant to a Professional Services andConsulting Agreement.