A Quality Improvement Initiative Significantly Improves Critical-Care Billing on a Pediatric Hospital Medicine Service
CLINICAL QUESTION: How can pediatric hospitalists improve critical-care billing and documentation for hospitalized pediatric patients?
BACKGROUND: Appropriate billing significantly impacts hospital reimbursement and can influence resources, staffing, and quality of care. Several studies have previously shown the importance of optimizing critical-care billing in adult patients and in emergency medicine settings, but to date, no studies have demonstrated how to implement and improve critical-care billing for hospitalized pediatric patients.
STUDY DESIGN: Quality improvement initiative
SETTING: A single tertiary care children’s hospital
SYNOPSIS: A quality improvement initiative was implemented to improve critical-care billing for hospitalized pediatric patients. Eligible patients were on at least 5L high flow nasal cannula or continuous albuterol. Interventions included education sessions for physicians, adding critical-care billing to the electronic health record (EHR) “Charge Capture Quick List,” EHR templates to assist in critical-care documentation, EHR secure messaging reminders, emails to specific physicians identifying missed critical-care billing opportunities, and visual reminder cards in physician workspaces. Over six months, the mean percentage of critical-care codes billed in eligible patients increased from 21% to 74%, and the mean percentage of charts containing documentation to support critical-care billing increased from 31% to 70%. Over a period of 12 months, critical-care billing in eligible patients led to a three-fold increase in relative value units and a four-fold increase in estimated total reimbursement compared with standard billing practices. This quality improvement initiative was conducted at a single, academic, children’s hospital with robust implementation support, which many institutions may not have, which may limit its generalizability.
BOTTOM LINE: Implementation of a quality improvement initiative to improve critical-care billing in hospitalized pediatric patients significantly improves critical-care billing, documentation, relative value units, and reimbursement.
CITATION: Ramazani SN, et al. Implementing critical care billing on a pediatric hospital medicine service. Hosp Pediatr. 2025;15(6):449-456. doi: 10.1542/hpeds.2024-008183.
Dr. Widmann
Dr. Widmann is a pediatric hospitalist in the division of hospital medicine at Nationwide Children’s Hospital and an assistant professor of pediatrics at The Ohio State University College of Medicine, both in Columbus, Ohio.
Dr. Dienstbach
Dr. Dienstbach is an internal medicine and pediatric hospitalist at The Ohio State University Medical Center and Nationwide Children’s Hospital and an assistant professor of internal medicine and pediatrics at The Ohio State University College of Medicine, all in Columbus, Ohio.