Kuo Paul C, Douglas Ann R, Oleski Darren, Jacobs Danny O, Schroeder Rebecca A
Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA.
J Am Coll Surg. 2004 Jul;199(1):124-30. doi: 10.1016/j.jamcollsurg.2004.03.002.
Academic divisions of general surgery are facing ever-increasing financial pressures. Cost-cutting is a common approach to maintaining profitability, but strategies to increase revenue should not be ignored. One specific avenue for enhanced revenue generation in general surgery is that of coding for evaluation and management (E&M). Although this is the financial life-blood for many of the consultative services in departments of medicine, E&M coding is an often neglected and misunderstood component of surgical care.
The financial records for the Division of General Surgery were reviewed for the period of January 2001 to June 2003. Specifically, charges and receipts for inpatient procedures and hospital visits (CPT codes 99231, 99232, and 99233) were determined. The analysis was limited to surgeons with a primary clinical focus based at the University hospital rather than the neighboring community or Veteran's Affairs hospitals. In addition, ICD-9 and All Patient Refined Diagnosis Related Groups (APR-DRG) data were analyzed to determine the surgeon-specific number of inpatients and inpatient-days with more than one ICD-9 code or secondary ICD-9 codes, or both, or an APR-DRG severity of illness score of 2, 3, or 4. These categories were defined to determine the number of inpatient-days for which E&M coding could be billed for management of secondary medical diagnoses.
Analysis demonstrates that actual E&M charges were 40% to 47% of predicted minimums for E&M charges for the period under study. In theory, this result translates into an annual gain in receipts of 400,000 dollars to 600,000 dollars.
We conclude that the ICD-9 and APR-DRG models may serve as benchmarks to determine the limits for E&M revenue stream, and E&M coding may represent an underutilized source of revenue among academic departments of surgery.
普通外科的学术部门正面临日益增加的财务压力。削减成本是维持盈利能力的常见方法，但增加收入的策略也不应被忽视。普通外科增加创收的一个具体途径是评估与管理（E&M）编码。虽然这是内科许多咨询服务的财务命脉，但E&M编码却是外科护理中经常被忽视和误解的组成部分。
回顾了普通外科部门2001年1月至2003年6月期间的财务记录。具体而言，确定了住院手术和医院就诊（CPT编码99231、99232和99233）的收费和收入情况。分析仅限于以大学医院为主要临床工作地点的外科医生，而非邻近社区医院或退伍军人事务医院的外科医生。此外，分析了国际疾病分类第九版（ICD-9）和所有患者精细化诊断相关分组（APR-DRG）数据，以确定具有一个以上ICD-9编码或二级ICD-9编码，或两者皆有，或APR-DRG疾病严重程度评分为2、3或4的外科医生特定住院患者数量和住院天数。定义这些类别是为了确定可就二级医疗诊断管理收取E&M编码费用的住院天数。
分析表明，在所研究期间，实际E&M收费为E&M收费预测最低值的40%至47%。从理论上讲，这一结果意味着年收入增加40万至60万美元。
我们得出结论，ICD-9和APR-DRG模型可作为确定E&M收入流限额的基准，且E&M编码可能是外科学术部门中未得到充分利用的收入来源。
