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Related Experiment Videos

Expert agreement in Current Procedural Terminology evaluation and management coding.

Mitchell S King1, Martin S Lipsky, Lisa Sharp

  • 1Department of Family medicine, Northwestern University Medical School, Chicago, IL, USA. m-king1@nwu.edu

Archives of Internal Medicine
|February 28, 2002
PubMed
Summary

Certified coding specialists showed low agreement on Current Procedural Terminology (CPT) evaluation and management (E/M) codes, mirroring physician inaccuracies. This suggests CPT E/M guidelines may be too complex for consistent application.

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Area of Science:

  • Medical Coding
  • Health Information Management
  • Healthcare Administration

Background:

  • Physician accuracy in Current Procedural Terminology (CPT) evaluation and management (E/M) coding is approximately 55%.
  • The consistency of coding specialists in applying CPT E/M guidelines has not been previously studied.
  • This study aimed to assess the agreement level among certified coding specialists using CPT E/M guidelines.

Observation:

  • 300 certified professional coding specialists participated in the study.
  • Participants were randomly selected from the American Health Information Management Association membership.
  • They were provided with 6 hypothetical office visit progress notes and a demographic survey to code and complete.

Findings:

  • Coding specialists achieved agreement on CPT E/M codes for only 57% of the cases.

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  • Individual case agreement ranged from 50% to 71%.
  • Established patients were more frequently undercoded, while new patients were more often overcoded relative to consensus codes.

    • Implications:

    • There is significant disagreement among coding specialists regarding CPT E/M guideline application.
    • The complexity and subjectivity of CPT E/M guidelines may hinder consistent application by both physicians and coding specialists.
    • Findings suggest a need for clearer, more objective coding guidelines to improve accuracy and reduce discrepancies in healthcare billing.