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Accuracy of CPT evaluation and management coding by family physicians
M S King1, L Sharp, M S Lipsky
1Department of Family Medicine, Northwestern University Medical School, Chicago, IL, USA.
The Journal of the American Board of Family Practice
|May 17, 2001
Summary
Physician coding accuracy for Current Procedural Terminology (CPT) evaluation and management services is low, especially for new patients. Errors include undercoding for established patients and overcoding for new patients.
Area of Science:
- Medical Billing and Coding
- Physician Practice Management
- Healthcare Economics
Background:
- Limited data exist on physician accuracy in service coding.
- Accurate coding is crucial for healthcare reimbursement and data analysis.
Purpose of the Study:
- To assess the Current Procedural Terminology (CPT) evaluation and management coding accuracy of family physicians.
- To identify demographic factors influencing coding accuracy.
Main Methods:
- Six hundred family physicians received hypothetical patient progress notes and a demographic survey.
- Physicians assigned CPT evaluation and management codes; accuracy was compared to expert coders.
Main Results:
- Physicians agreed with expert codes for 52% of established patient notes (predominantly undercoding).
- Physicians agreed with expert codes for only 17% of new patient notes (predominantly overcoding).
- No demographic variables correlated with coding accuracy.
Conclusions:
- Physician CPT coding accuracy is substantially flawed, particularly for new patients.
- Coding guideline complexity and insufficient physician training likely contribute to errors.