Examining the relationship between physician and facility level-of-service coding in outpatient wound centers:...

The evaluation and management (E/M) services for the physician and the hospital-based outpatient center ("facility") are calculated using different federal regulations. In addition, patients visiting outpatient wound care centers require different levels of care from the physician than the facility. The purpose of this study was to analyze and compare physician and facility E/M level-of-service coding using the electronic wound registry records from three geographically diverse, hospital-based outpatient wound centers. De-identified data on 9,985 patient visit level-of-service codes were prospectively collected using an electronic health record (EHR) system that internally and automatically audits the chart and calculates the physician and the facility E/M level of service based on the documentation present in the chart. Correlations were calculated using Kendall's tau b/Goodman-Kruskal gamma statistics. Correlations were weak between facility and physician E/M level-of-service codes, varying from 0.084 to 0.179 for follow-up and from 0.066 to 0.354 for initial visits. Although facility E/M levels of service followed a normal distribution, physician E/M visits were heavily skewed toward higher levels of care (3 to 5). These findings confirm that, especially during the initial visit, patients presenting at outpatient wound centers require different levels of care from the physician than from the facility. The finding that initial physician level of service coding was higher than facility E/M levels of service for both initial and follow-up visits is not unexpected, considering the high number of comorbidities in many wound patients and the general risk of their presenting problems.