Emergency Department Appropriate Use

Overview

HealthInfoNet applies proven value-add logic to participants' encounter records to flag which encounters are deemed as an appropriate use of Emergency Department utilization. The following sections outline the methodology for this metric.

Emergent/Non-Emergent Use of the ED

Based on an ICD-10 value set identified by MaineCare under “Section 45 Non-Emergent Use of Emergency Department: ICD-10 codes,” effective October 1, 2015, and expanded in partnership with Community Care Partnerships of Maine, the Emergent filter identifies encounters had by patients that are deemed to be an Emergent or Non-Emergent diagnosis, and by extension, appropriate or inappropriate use of the Emergency Department.

Non-Emergent Category

To add additional detail to the Emergent/Non-Emergent Use of the ED, categorization of the non-emergent encounters is available. Valid values for these categories include: Ear Ache, Headache, Respiratory, UTI, and other. Encounters with a non-emergent category of null are considered to be appropriate use of the emergency department.

Appendix

A listing of the categorized ICD-10 codes can be found here: ICD10 Emergent Codes with Category.xlsx