Emergency Center Nursing Charges

Arrival / Monitoring
0 / Ambulatory, w/c, routine EMS or POV arrival / 10 / Initial cardiac monitoring / rhythm interpretation & recording
40 / Critical Transfer from other facility, mobile ICU or aircraft / 20 / Monitoring, simple VS or single-system
10 / Routine Transfer in by EMS from other facility / 40 / Monitoring, complex or multi-system, freq re-assessments
Initial Exam / 5 / Pulse oximetry spot check
10 / Triage – simple / re-check / 15 / Pulse oximetry monitoring, continuous
15 / Triage – complex ( multiple complaints, altered LOC, etc.) / 20 / Nurse monitoring pt in outside dept. (CT,MRI,NucMed,etc.)
15 / Assist, simple exam & visit / 10 / Seclusion / restraint monitoring, each 15 min.
20 / Assist, intermediate complexity ( gloved ) /

Point of Care Testing

30 / Extended exam w/ initiation of protocols/directives/care paths / 20 / 12-lead EKG by nurse or tech ,each
Special Needs / 10 / ABG
10 / Isolation / 10 / Bedside glucose testing
10 / Special needs patient (emotional, educational, language,etc.) / 10 / Bedside Troponin-I testing
15 / Patient with altered mentation / 10 / Dip urinalysis
General Procedures / 10 / Glasgow coma scoring
20 / SSE / Fleets enema / 15 / Legal blood alcohol / drug screen testing (not SANE )
10 / Dressing : simple / 10 / Occult clood testing - stool or gastric
15 / Dressing : large or complex / 15 / Orthostatics vital signs
5 / Eye exam / eye stain / slit lamp exam / 10 / Specimen collection - ( stool / UA / sputum / swabs)
5 / Ear irrigation / 5 / Visual acuity testing
15 / Epistaxis management / Critical Care
10 / Eye irrigation / morgan lens - per eye / 5 / O2 Administration
15 / G-tube / feeding tube replacement / 45 / Resuscitation team Response ( non-CPR, in any room )
10 / IV – simple saline lock / 45 / CPR - initial multidisciplinary response
15 / IV – complex start ( difficult puncture / EJ / scalp / foot / ped ) / 10 / CPR - each additional 15 minutes
10 / IV - fluid administration , each bag or piggyback / 120 / Trauma Alert 1 team response
15 / IV - blood product administration, each bag / 80 / Trauma Alert 2 limited team response
20 / Laceration repair assist , simple 1 - 10 min / 30 / Cardiac pacing, external
30 / Laceration repair assist, intermediate 10- 20 min / 30 / Cardiac pacing, assist with Internal pacer insertion
40 / Laceration repair assist, complex > 20 min / 30 / Cardioversion
5 / Medications – PO, rectal, topical, eye, ear, G-tube / 25 / Central line placement assist
10 / Medication - antibiotic injection / 40 / Chest Tube insertion assist
10 / Medications immunization - dT Hep Rabies ______ / 15 / Endotracheal suctioning, sterile, each time
10 / Medication - IM or SQ - all others / 25 / Gastric lavage / GI decontamination
15 / Medications - IV (pushes) / 25 / Invasive Monitoring setup ( Art. line / Swan / CVP / ICP )
20 / Medications - IV, complex or nurse-titrated drips, RSI / 25 / Intraosseous infusion
5 / Phlebotomy ( by nurse or lab ) / 25 / Intubation assist
5 / Ring removal / 20 / Lumbar Puncture assist
10 / Steri-strip wound closure / 20 / Pericardiocentesis assist
20 / Suctioning / irrigation / 20 / Peritoneal Tap Assist
10 / Surgical localized prep (shave,scrub,ethyl chloride) / 30 / Rapid infusion / fluid bolus
5 / Suture / staple removal - simple / 20 / Thoracentesis / Paracentesis assist
10 / Suture / staple removal - complex, time-consuming / 20 / Tracheostomy assist or replacement
15 / Tubes : urinary catheterization / NG / OG / 30 / Thoracotomy assist
10 / Wound cleansing or irrigation / I & D / 50 / Thrombolytic administration
5 / Wound debridement- multiply by %BSA of burn or wound / 30 / Ventilator management
5 / Xray – simple transport to radiology /

Orthopedics

10 / Xray – complex ( CT / MRI / fluoro / nuclear med ) / 15 / Crutch training and fitting
10 / Unlisted Procedure, simple - each 15 minutes (routine item) / 20 / Splinting, simple ( finger, toe, hand, ACE wrap )
20 / Unlisted Procedure, complex - each 15 minutes (technical) / 30 / Splinting, complex ( slings, all OCL splints, knee immob. )
Discharge Instructions
OB-GYN / 10 / Special needs / social services / discharge planning
30 / Precipitous newborn delivery / 10 / Simple discharge instructions (Rx,simple instruction sheet)
10 / Public health screen / GC culturing / 15 / Complex discharge instructions (detailed w/follow up)
30 / Newborn exam / APGAR scoring / Disposition
30 / Rape exam (if NOT done by SANE) / 20 / DOA / expired in department / Coroner’s case
15 / Pelvic exam assist / 30 / Involuntary Admission or Transfer
20 / Fetal heart tone assessment / 10 / AMA / elopement
CPT/HCPCS 99281 Level 1 0 - 35 points
CPT/HCPCS 99282 Level 2 36 - 55 points
CPT/HCPCS 99283 Level 3 56 - 85 points
CPT/HCPCS 99284 Level 4 86 - 115 points
CPT/HCPCS 99285 Level 5 116 - 145 points
CPT/HCPCS 99291 Critical Care > 146 points
Total Score points / 10 / Routine hospital admission
20 / Telemetry admission
30 / ICU / Operating Room admission
40 / Critical transfer to another facility (mobile ICU, ALS, flight)
20 / Routine transfer to another facility or nursing home
10 / Discharge w/ assistance
Patient Sticker Here
Rev 19- 2/3/01
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Nurse Signature