Orthopaedic Provider Coding Trends After 2021 Changes to the Current Procedural Terminology Evaluation and Management...

Area of Science:

• Healthcare Administration
• Medical Billing and Coding
• Orthopaedic Surgery

Background:

• Changes to the 2021 Current Procedural Terminology Evaluation and Management (E&M) Centers for Medicare and Medicaid Services guidelines were implemented.
• Training was provided to healthcare providers on these new E&M coding guidelines.

Purpose of the Study:

• To assess the impact of the 2021 E&M guideline changes on orthopaedic coding practices.
• To determine if changes in coding levels were sustained post-implementation.

Main Methods:

• Retrospective analysis of outpatient encounters from December 2020 to January 2023.
• E&M codes for new and established patients were categorized by complexity level.
• Coding data was grouped by provider and analyzed across specified time points.

Main Results:

• A statistically significant increase in E&M coding levels for both new and established patients was observed immediately after guideline changes (P < 0.001).
• For new patients, the utilization of Level 4 codes increased from 16% to 54%, and Level 5 codes from 3% to 6% (P < 0.0001).
• This elevation in higher-level coding was sustained for new patients over the two-year study period.

Conclusions:

• The updated E&M guidelines led to a statistically significant shift towards higher coding levels for both new and established patients.
• The observed changes in coding practices were maintained for a duration of two years.