Fiscal analysis of emergency admissions for chronic back pain: a pilot study from a Maine hospital

Pain Med. 2007 May-Jun;8(4):354-8. doi: 10.1111/j.1526-4637.2007.00309.x.


Objective: Our study was designed to document fiscal data for emergency department admissions for acute exacerbation of chronic back pain.

Design: This was a 12-month retrospective, descriptive study.

Setting: The two emergency facilities operated by the Maine General Medical Center in central Maine provided the study data.

Patients: We collected fiscal data for patients with emergency admissions for acute exacerbation of chronic nonmalignant back pain (International Classification of Disease code 724.1). Data were limited to patients with the top three of five Current Procedural Terminology (CPT) codes visits (99283-99285) for emergency department, indicating problems of moderate to high complexity. Records with event codes (E codes) for trauma and/or malignant disease were excluded.

Outcome measures: We totaled charges for physician and provider services, laboratory tests, imaging studies, medications, and other billable items.

Results: Of 1,397 emergency department visits for acute exacerbation of chronic back pain logged over the 12-month study for all five CPT codes, 1,039 visits were tagged with the three highest codes; 30% were multiple visits. Mean charges per visit ranged from $399 for CPT code 99283 to $1,943 for code 99285. While only 3% of the patients (N=46) were seen three or more times, they accounted for 12.4% of the total charges.

Conclusions: Emergency department care may be a costly venue for the management of chronic back pain. Because most patients obtain only short-term relief, they are likely to continue seeking urgent care intermittently until effective long-term pain management is widely available and reimbursable on an outpatient basis.

MeSH terms

  • Costs and Cost Analysis
  • Emergency Medical Services / economics*
  • Emergency Medical Services / statistics & numerical data
  • Humans
  • Low Back Pain / epidemiology*
  • Maine / epidemiology
  • Pilot Projects
  • Retrospective Studies
  • Workforce