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Determining benchmarks for evaluation and management coding in an academic division of general surgery
Paul C Kuo1, Ann R Douglas, Darren Oleski
1Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA.
Journal of the American College of Surgeons
|June 26, 2004
Summary
Academic surgery divisions can increase revenue by optimizing evaluation and management (E&M) coding. This study found that E&M coding is underutilized, representing a significant missed revenue opportunity for surgical departments.
Area of Science:
- Health Economics
- Surgical Practice Management
Background:
- Academic surgery divisions face financial pressures, necessitating revenue enhancement strategies beyond cost-cutting.
- Evaluation and Management (E&M) coding is a critical, yet often overlooked, revenue source in surgical care.
Purpose of the Study:
- To assess the revenue potential of E&M coding in an academic general surgery division.
- To identify opportunities for increased revenue generation through improved E&M coding practices.
Main Methods:
- Financial records from a Division of General Surgery (Jan 2001-June 2003) were analyzed for inpatient procedures and hospital visits (CPT codes 99231-99233).
- ICD-9 and All Patient Refined Diagnosis Related Groups (APR-DRG) data were used to identify billable inpatient-days for secondary medical diagnoses.
Main Results:
- Actual E&M charges were 40%-47% of predicted minimums during the study period.
- This underutilization suggests a potential annual revenue increase of $400,000 to $600,000.
Conclusions:
- E&M coding represents a significant underutilized revenue stream in academic surgery departments.
- ICD-9 and APR-DRG data can serve as benchmarks for assessing E&M revenue potential.
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