Outpatient Visits Are Growing More Complex: Implications for Health Costs

The cost of an outpatient visit to a physician’s office, urgent care, or emergency department, depends in part on the level of service provided. This analysis uses claims data from private, large employer-based plan to examine trends in complexity coding across outpatient practice settings from 2004 to 2021.

Over the 18-year period, claims for evaluation and management services trended towards higher complexity codes, even among specific, common diagnoses like urinary tract infections and headaches. These changes are contributing to higher outpatient health spending. In 2021, outpatient evaluation and management spending would be 4% lower in both physician offices and emergency departments than actual 2021 spending, if visits were coded at the same levels as is 2011.