Surgical CPT Coding Discrepancies: Analysis of Surgeons and Employed Coders

Area of Science:

• Medical Billing and Coding
• Healthcare Administration
• Surgical Practice Management

Background:

• Current Procedural Terminology (CPT) codes are essential for specifying patient treatment and billing in healthcare.
• Discrepancies in CPT coding between surgeons and professional coders can impact revenue and patient care documentation.

Purpose of the Study:

• To investigate and quantify coding discrepancies between surgeons' initial CPT code submissions and final codes determined by professional billing coders.
• To determine the impact of these discrepancies on annual relative value units (RVUs).

Main Methods:

• Retrospective analysis of 500 patients' CPT codes over a 3-month period.
• Comparison of surgeons' first-pass coding against employed coders' final coding.
• Quantification of discrepancies and calculation of changes in annual RVUs for high-impact codes.

Main Results:

• A 161% increase in total CPT codes was observed, with professional coders submitting 1594 codes versus 987 by surgeons.
• The addition of distinct codes by billing professionals was the most frequent cause of discrepancies, affecting 54.51% of patients.
• Significant variations in CPT coding practices between surgical providers and dedicated coders were identified.

Conclusions:

• Coding discrepancies between surgeons and billing professionals are prevalent and substantial.
• These discrepancies, particularly the addition of codes by coders, significantly alter the final billing submission.
• Further research is warranted to explore communication strategies between surgeons and billing professionals to mitigate these discrepancies.