Coding Patterns and Implications for Reimbursement in Foot-and-Ankle Surgery.

Area of Science:

• Orthopedic Surgery
• Medical Coding and Billing

Background:

• Accurate medical coding is vital for surgeons to quantify work and determine compensation.
• Variations in coding practices can lead to discrepancies in reimbursement.
• Understanding coding patterns is essential for financial health in surgical practices.

Purpose of the Study:

• To evaluate coding patterns and variations among foot-and-ankle orthopedic surgeons.
• To quantify the impact of coding variations on surgeon reimbursement.
• To identify potential discrepancies in Current Procedural Terminology (CPT) code application.

Main Methods:

• A survey of 12 patient cases was distributed to fellowship-trained foot-and-ankle orthopedic surgeons.
• Surgeons identified appropriate CPT codes and modifiers for each case scenario.
• Reimbursement was calculated based on total work-relative value units (RVUs) and the 2024 Medicare conversion factor.

Main Results:

• Significant variability in CPT coding was observed, with only 33.3% of cases having four out of five surgeons agree on the primary code.
• Modifier usage also showed considerable variation, with only one case achieving 100% agreement.
• The difference in reimbursement between the highest and lowest RVU respondents was over $3,600.

Conclusions:

• Substantial variability exists in coding practices among foot-and-ankle surgeons, especially for midfoot procedures.
• Surgeons must recognize these coding differences and their substantial impact on work quantification and reimbursement.
• Enhanced competency in medical coding and billing is recommended across all surgical specialties.