Table 3.
Top 25 Professional Fee Ratios by Clinical Classifications Software Category and Payer Type for ED treat and release visitsa, 2016–2020
| Commercial | Medicaid | |||||
|---|---|---|---|---|---|---|
| Rank | CCSR code | CCSR description | PFR | CCSR code | CCSR description | PFR |
| 1 | NEO066 | Malignant neuroendocrine tumors | 1.467 | END013 | Pituitary disorders | 1.789 |
| 2 | FAC012 | Other specified encounters and counseling | 1.442 | NVS002 | Encephalitis | 1.714 |
| 3 | MUS034 | Crystal arthropathies (excluding gout) | 1.438 | PNL004 | Neonatal cerebral disorders | 1.708 |
| 4 | NVS005 | Multiple sclerosis | 1.415 | NVS009 | Epilepsy; convulsions | 1.698 |
| 5 | SKN001 | Skin and subcutaneous tissue infections | 1.404 | MBD022 | Hallucinogen-related disorders | 1.687 |
| 6 | EAR005 | Postprocedural or postoperative ear and/or mastoid process complication | 1.392 | PRG027 | Complications specified during the puerperium | 1.660 |
| 7 | DIG002 | Disorders of teeth and gingiva | 1.380 | MAL002 | Digestive congenital anomalies | 1.629 |
| 8 | SKN007 | Other specified and unspecified skin disorders | 1.374 | INJ019 | Burn and corrosion, initial encounter | 1.628 |
| 9 | EAR006 | Other specified and unspecified disorders of the ear | 1.365 | PRG003 | Spontaneous abortion and complications of spontaneous abortion | 1.621 |
| 10 | SKN005 | Contact dermatitis | 1.359 | MBD023 | Inhalant-related disorders | 1.610 |
| 11 | MUS029 | Disorders of jaw | 1.358 | MUS004 | Juvenile arthritis | 1.598 |
| 12 | INF009 | Parasitic, other specified and unspecified infections | 1.358 | GEN022 | Benign ovarian cyst | 1.589 |
| 13 | DIG014 | Hemorrhoids | 1.354 | CIR039 | Other specified diseases of veins and lymphatics | 1.587 |
| 14 | EAR001 | Otitis media | 1.352 | RSP004 | Acute and chronic tonsillitis | 1.578 |
| 15 | SKN002 | Other specified inflammatory condition of skin | 1.352 | MBD008 | Disruptive, impulse-control and conduct disorders | 1.571 |
| 16 | CIR018 | Cardiac arrest and ventricular fibrillation | 1.350 | MAL005 | Congenital malformations of eye, ear, face, neck | 1.563 |
| 17 | INF004 | Fungal infections | 1.348 | MBD007 | Trauma- and stressor-related disorders | 1.563 |
| 18 | RSP007 | Other specified and unspecified upper respiratory disease | 1.340 | MAL001 | Cardiac and circulatory congenital anomalies | 1.551 |
| 19 | CIR035 | Varicose veins of lower extremity | 1.339 | PRG018 | Maternal care related to disorders of the placenta and placental implantation | 1.541 |
| 20 | MUS023 | Acquired deformities (excluding foot) | 1.332 | SKN001 | Skin and subcutaneous tissue infections | 1.539 |
| 21 | EYE001 | Cornea and external disease | 1.331 | MBD014 | Neurodevelopmental disorders | 1.534 |
| 22 | EYE005 | Retinal and vitreous conditions | 1.330 | GEN019 | Endometriosis | 1.533 |
| 23 | SKN006 | Postprocedural or postoperative skin complication | 1.329 | EAR001 | Otitis media | 1.527 |
| 24 | MAL005 | Congenital malformations of eye, ear, face, neck | 1.327 | GEN021 | Menstrual disorders | 1.527 |
| 25 | MUS033 | Gout | 1.327 | MAL003 | Genitourinary congenital anomalies | 1.523 |
Data source: 2016–2020 Merative™ MarketScan® databases.
a
Counts for admissions and visits analyzed to produce these estimates and 95% confidence intervals reported in SDC1. CCSR indicates Clinical Classification Software Refined; PFR Professional fee ratio.