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In order to simplify and make more uniform  emergency department triage, the ESI acuity scale was developed. ESI has become very popular because it has been validated for interrater and inter-institution reliability and is even endorsed as a best practice by AHRQ ( the Agency for Healthcare Research and Quality).  Dr. Wiler and others published an article in the Society of Academic Emergency Medicine in 2011 showed a moderate correlation between ESI  triage scores and  evaluation  and management billing codes.   the study concluded that there is a moderate nonlinear correlation between ESI levels and emergency department evaluation and management billing codes (99281-5 and 99291). She also notes that the older the patient has the more likely this correlation.

So what are the ramifications of this?   Certainly this information could be helpful  if ESI was determined to be   correlating with measuring intensity of nursing care to determine level of staffing.   It could also be potentially used to determine the intensity of physician care as well  determine a real-time when a physician needs additional support.   The non-direct correlation  could also  possibly demonstrate how diversion from emergency departments  may not be a safe nor wise idea.

Source: Emergency Severity Index Triage System Correlation with Emergency Department Evaluation and Management Billing Codes and Total Professional Charges – Wiler – 2011 – Academic Emergency Medicine – Wiley Online Library