Assessing coding practices for gastrointestinal surgery over time in the United States

Area of Science:

• Health Services Research
• Medical Economics
• Surgical Outcomes

Background:

• Hospital billing variations may stem from patient risk differences or intentional upcoding driven by payer policies.
• The study investigates changes in gastrointestinal surgery coding practices and their link to costs.

Purpose of the Study:

• To assess temporal trends in gastrointestinal surgery coding practices.
• To evaluate the association between upcoding and in-hospital costs.

Main Methods:

• Analysis of 1,344,152 gastrointestinal operations from the National Inpatient Sample (2001-2011).
• Comparison of coding practices by hospital and patient characteristics.
• Multivariable analysis to determine the relationship between coding and costs.

Main Results:

• The proportion of upcoded admissions (>9 codes/admission) rose from 14.1% to 32.9% between 2001 and 2011.
• Upcoding increased across all gastrointestinal operations, most notably hepatectomy.
• Upcoded admissions were linked to $13,754 higher in-hospital costs, irrespective of payer or comorbidity status.

Conclusions:

• A significant increase in upcoded patient admissions for gastrointestinal surgery was observed over a decade.
• This trend necessitates enhanced education, regulation, and scrutiny of medical coding practices.