Using Billing Codes to Create a Pediatric Functional Status e-Score for Children Receiving Inpatient Rehabilitation.
Jennifer P Lundine, Jared D Huling, P David Adelson and 13 others
PMID 37075966WHAT IT FOUND
Most of the top billing codes ranked by their relationship to discharge WeeFIM mobility, self-care, and cognition/communication scores were also chosen by expert clinicians.
This is a first-step score model, not a validated clinical tool.
Key findings
01The consensus process reduced 9,306 initial billing codes to 1,382 codes.
02For self-care, mobility, and cognition/communication, a vast majority of the top 250 and top 500 codes were included by consultants: self-care 78% and 78%, mobility 78% and 75%, cognition/communication 80% and 71%.
03The enteral pump code was the most strongly related code to the cognition/communication discharge WeeFIM rating and was associated with a lower rating of 12.8 (SE=1.2).
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The data came from one quaternary children's hospital in the midwestern United States, so institution-specific coding and billing practices may limit generalizability. The records span January 2000 to July 2020, and the switch from ICD-9 to ICD-10 plus changing coding practices may affect code relationships, even after mapping to medical concepts. Only children with verified discharge WeeFIM ratings from an inpatient rehabilitation admission were included, so children discharged without inpatient rehabilitation or without WeeFIM ratings are not represented. WeeFIM has a ceiling that makes it hard to distinguish among higher levels of function and among older children. The analysis did not account for age when assessing functional status. The proposed pediatric functional status electronic score is not yet built or validated; the paper says further analysis, larger samples, multicenter retrospective data, and prospective validation are next steps. The consensus meeting was remote because of the pandemic, two consultants could not attend, and 70% agreement was required for consensus.
Declared interests
The article is listed as NIH extramural research support, and the authors report no further disclosures or conflicts.
The easy way to misread this
Do not read this as a validated pediatric rehabilitation outcome score. The paper describes a first-step model and says validation on larger samples and prospective cohorts is still needed.