Impact of Early Educational Intervention on Coding for First-year Emergency Medicine Residents

Coding of a medical visit is based on provider documentation in the medical record; the documentation should reflect the level of care that was provided. To maximize coding and subsequent billing, providers must complete various components of the record to best convey the complexity of the case. Little education is provided to resident physicians regarding appropriate documentation practices, and studies suggest a need for improved education in this area. The primary goal of this study is to determine if implementing an early educational intervention will improve billing and coding.

This was a randomized, prospective controlled study in an academic Level I emergency department (ED). Interns without prior experience in billing and coding were eligible participants. Participants in the intervention group each received an interactive lecture on coding, evaluation and management (E/M) levels, and documentation macros, prior to their first ED rotation at the base hospital. A pocket card with E/M level requirements was given as a resource. Biweekly feedback was given to the residents to address any patterns of mistakes. The number of charts for each E/M level was collected from both groups, which were converted to relative value units (RVUs). A multivariate analysis using multivariate linear regressions controlling for age, sex of patient, admission rate, and month of encounter was used to statistically evaluate billing outcomes.

The mean RVUs per hour and encounter in the intervention group were, respectively, 3.52 and 3.84 while in the control group they were, respectively, 3.36 and 3.72 (p = 0.0112). Intervention group encounters had 27% greater odds (odds ratio = 1.27) of having a level 5 chart compared to the control group (p = 0.0025).

The focused longitudinal educational interventions resulted in improved billing performances, reflected by better documentation, in the intervention group versus the control group.