University of Tennessee - Campbell Clinic, Department of Orthopaedic Surgery, Memphis, Tennessee.
University of Tennessee - Campbell Clinic, Department of Orthopaedic Surgery, Memphis, Tennessee.
J Surg Educ. 2014 Mar-Apr;71(2):182-5. doi: 10.1016/j.jsurg.2013.07.005. Epub 2013 Oct 3.
Because of the importance of current procedural terminology (CPT) coding in both resident education evaluation and practice management, this study was undertaken to evaluate the correlation and interrater reliability between residents and attending physicians in CPT coding for orthopedic foot and ankle surgeries as well as to determine attending surgeons' and residents' familiarity with and confidence in the coding process.
CPT codes from resident case logs were compared with those submitted by attending surgeons, and Pearson's correlation coefficient and interrater reliability were calculated to examine coding congruency. An online survey was also used to examine attending surgeon and resident perceptions and habits regarding CPT codes and the coding process.
CPT codes recorded by 20 residents (1164) were compared with those recorded by 3 attending foot and ankle surgeons (1259). Correlation between attending and resident codes was poor (r = -0.015). Interrater reliability demonstrated a kappa value of 0.04, indicating poor agreement. Compared with attending CPT coding, residents concordantly coded 42% of the time, with an individual resident range from 2% to 65%. Additionally, 43% of residents reported being uncomfortable about foot and ankle CPT coding, and they reported rarely or never discussing CPT codes with attending surgeons in the perioperative period.
Resident and attending surgeon concordance in CPT coding for foot and ankle procedures is poor, and residents have a low level of confidence in logging CPT codes, possibly because of a lack of training and preparation in coding. Because CPT coding is used not only for practice management but also has implications for evaluating institutions by accreditation bodies, educational initiatives to improve resident confidence and accuracy with CPT coding may be warranted.
由于当前操作术语 (CPT) 编码在住院医师教育评估和实践管理中都非常重要，因此进行了这项研究，以评估住院医师和主治医生在骨科足踝手术 CPT 编码方面的相关性和评分者间可靠性，并确定主治外科医生和住院医师对编码过程的熟悉程度和信心。
将住院医师病例日志中的 CPT 代码与主治外科医生提交的代码进行比较，并计算 Pearson 相关系数和评分者间可靠性，以检查编码一致性。还使用在线调查来检查主治外科医生和住院医师对 CPT 代码和编码过程的看法和习惯。
对 20 名住院医师（1164 例）记录的 CPT 代码与 3 名主治足踝外科医生（1259 例）记录的 CPT 代码进行了比较。主治医生和住院医生代码之间的相关性较差（r = -0.015）。评分者间可靠性显示 κ 值为 0.04，表明一致性差。与主治医生的 CPT 编码相比，住院医师一致编码的比例为 42%，个别住院医师的比例为 2%至 65%。此外，43%的住院医师表示对足踝 CPT 编码感到不舒服，并且他们报告在围手术期很少或从不与主治医生讨论 CPT 代码。
住院医师和主治外科医生在足踝手术 CPT 编码方面的一致性较差，住院医师对记录 CPT 代码的信心较低，这可能是由于缺乏编码培训和准备。由于 CPT 编码不仅用于实践管理，而且对认证机构评估机构也有影响，因此可能需要开展提高住院医师对 CPT 编码的信心和准确性的教育计划。
