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Enhancing Hospital Reimbursement Through a Pediatric Surgery Resident Orientation Program: A Focus on Accurate
Owen Cordaro1, Cortnie Vaughn1, Hector Osei2
1Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA.
Background:
The usage of specific ICD-10 diagnosis codes significantly influences hospital reimbursement compared to non-specific codes. This study hypothesized that a formal orientation program for pediatric surgery residents would enhance the selection of accurate and specific diagnosis codes for acute appendicitis such as K35.30 for "Acute appendicitis with localized peritonitis" rather than K35.80 for "Unspecified acute appendicitis," thereby improving hospital reimbursement.
Methods:
We implemented a comprehensive orientation for pediatric surgery residents at our institution in late 2020, a component of which emphasized the importance of having specific ICD-10 diagnosis codes. We conducted a retrospective analysis of laparoscopic appendectomy billing data for pediatric patients, comparing the use of specific versus unspecified diagnosis codes and associated hospital reimbursement rates before (2020) and after (2022) the program's initiation. Patients without payment were excluded. Statistical significance was determined by a two-tailed p-value of ≤0.05.
Results:
Analysis of 267 patient records showed a significant increase in the use of the specific diagnosis code (K35.30) from 3.6% in 2020 to 87.5% in 2022 (p < 0.0001). Adjusted for inflation and billing changes, mean hospital reimbursement per case increased by $661 (from $4414 to $5,075, p = 0.027), totaling an additional $84,616 in 2022, just for a single subset of appendicitis patients.
Conclusions:
A targeted resident orientation program significantly improves the use of specific ICD-10 codes for acute appendicitis, leading to increased hospital reimbursement. Such programs represent a valuable approach for enhancing the financial outcomes of pediatric surgical care while reinforcing the importance of accurate medical documentation.
Study Design:
Retrospective.
Level Of Evidence:
III.
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