Department of Orthopaedic Surgery, Acclaim Bone and Joint Institute, Fort Worth, TX.
Office of Clinical Research, John Peter Smith Hospital, Fort Worth, TX.
J Arthroplasty. 2020 Dec;35(12):3464-3466. doi: 10.1016/j.arth.2020.06.088. Epub 2020 Jul 3.
Many orthopedic practices routinely code hip fracture hemiarthroplasty as Current Procedural Terminology (CPT) 27125 even though 27236 is the correct CPT code. Our objective is to determine the financial impact this simple mistake has on surgeon reimbursement.
Our data comprised cases assigned International Classification of Diseases, Tenth Revision code S72.001A through S72.035A and CPT code 27125 or 27236 within the American College of Surgeons National Surgical Quality Improvement Program 2016-2017 database. Relative value units (RVUs) per CPT code and the Centers for Medicare and Medicaid Services reported that RVU conversion factor of $36.0896 per 1 RVU was used to calculate reimbursement per case. The dollar difference and percent difference per case was then calculated between cases assigned CPT code 27125 and those assigned 27236.
Our total sample consisted of 12,287 National Surgical Quality Improvement Program cases. Of those, 4185 (34%) were cases of a hip fracture treated with hemiarthroplasty that were incorrectly coded as CPT code 27125. That error in coding results in a decrease in reimbursement of $35.01 per case, a 5.51% difference.
Since the current healthcare reimbursement model relies solely on CPT codes to determine RVUs, it is imperative that orthopedic surgeons understand the financial impact of incorrect coding. Although correct coding of hemiarthroplasty procedures for hip fractures is an easy task to fix in the future, we hope that through this study a greater emphasis is placed on coding in orthopedic surgery.
许多骨科医生通常将髋关节骨折半髋关节置换术编码为 CPT 27125，尽管正确的 CPT 代码应为 27236。我们的目的是确定这个简单错误对医生报销的经济影响。
我们的数据包括美国外科医师学会国家手术质量改进计划 2016-2017 数据库中分配的国际疾病分类，第十版代码 S72.001A 至 S72.035A 和 CPT 代码 27125 或 27236 的病例。每个 CPT 代码的相对价值单位（RVU）和医疗保险和医疗补助服务中心报告说，每 1 RVU 的 RVU 转换系数为 36.0896 美元，用于计算每个病例的报销金额。然后计算分配 CPT 代码 27125 和 27236 的病例之间的每个病例的美元差异和百分比差异。
我们的总样本包括 12287 例国家手术质量改进计划病例。其中，4185 例（34%）是髋关节骨折用半髋关节置换术治疗的病例，错误编码为 CPT 代码 27125。这种编码错误导致每个病例的报销减少 35.01 美元，差异为 5.51%。
由于当前的医疗保健报销模式仅依赖 CPT 代码来确定 RVU，因此骨科医生了解不正确编码的财务影响至关重要。尽管未来正确编码髋关节骨折的半髋关节置换术程序是一项简单的任务，但我们希望通过这项研究，更加重视骨科手术的编码。
