Resident billing can have huge financial implications on academic institutions. A poster from the Icahn School of Medicine at Mount Sinai aimed to assess new medical coding lectures and a modified note template at Winter Clinical Dermatology Conference.
Resident billing was examined at the 19th Winter Clinical Dermatology Conference, held January 14 to 19, in Kauai, Hawaii, by comparing effectiveness of the new coding and modified note template on resident billing accuracy from before and after implementation.1
The researchers recorded all Current Procedural Terminology (CPT) codes and modifiers for 256 patient encounters before and after intervention. The intervention was 4 monthly billing lectures with 2 quizzes as well as a note template designed by Michael Tassavor, MD. The note template automatically lists the correct procedural codes according to the numbers and types of procedures chosen from a dropdown list, according to the poster. After, the billing accuracy is checked by 2 attending dermatologists through chart review and is then compared between 2 time periods.
Overall, 513 patient visits were included in the billing data, 257 from before the intervention and 256 from after, which were all checked for accuracy. The Evaluation & Management Services (E/M) level of service were comparable post-intervention (44.4% vs 44.8%, respectively). The same was found of the undercoding and overcoding, with 35.4% undercoded and 8.1% overcoded pre-intervention and 35.8% and 8.9% post-intervention, respectively.
There were improvements in the rate of errors with both procedural codes and modifiers, the researchers noted, with 22% of procedural codes incorrectly billed pre-intervention and 3.7% incorrect post-intervention. Likewise, 55.2% of modifiers were incorrectly billed pre-intervention and 27.3% were incorrect post-intervention.
Overall, the accuracy of billing by dermatology residents were improved after the lectures and it was found most often residents were consistently undercoding E/M rather than overcoding. The researchers suggested this could be due to the perception that there is no meaningful benefit to maximizing their billing.
1. Tassavor M, MD, Owji S, BS, Han J, BS, et al. Improving dermatology resident billing. Icahn School of Medicine at Mount Sinai. Poster. Presented at: Winter Clinical Dermatology Conference, January 14-19, Kauai, HI.