Graham Jack G, Plusch Kyle, Rivlin Michael, Sodha Samir, Gallant Greg G, Beredjiklian Pedro
Division of Hand Surgery, Rothman Orthopaedic Institute, Philadelphia, USA.
Department of Orthopaedic Surgery, Hackensack University Medical Center, New York, USA.
Cureus. 2022 Jul 21;14(7):e27125. doi: 10.7759/cureus.27125. eCollection 2022 Jul.
Beginning on January 1, 2021, the American Medical Association (AMA) and the Centers for Medicare and Medicaid Services (CMS) implemented considerable revisions with regard to the outpatient evaluation and management (E/M) criteria dictating the Current Procedural Terminology (CPT) code level selection. The primary goal of the current study was to determine how the recent E/M coding criteria changes have impacted code level selection by orthopedic hand surgeons in the outpatient setting.
All outpatient visits within the hand and wrist surgery division of a single orthopedic practice were collected during two timeframes: March 1, 2019, to June 30, 2019, and March 1, 2021, to June 30, 2021. Procedure codes and insurance categories were collected for each visit. The primary endpoint analyzed was the visit level of care based on CPT E/M codes. For each timeframe, we determined the number of total visits that were coded at each level and expressed them as a percentage of the total visits for that time period. The insurance plan billed for each visit was recorded and classified as Medicare, Medicaid, Workers' Compensation, or commercial.
In 2019, prior to the billing level requirement changes, 7.2% of all visits were billed as level 2, 84.8% of all visits were billed as level 3, and 7.8% of all visits were billed as level 4. In 2021, 1.9% of visits were billed as level 2, 47.3% of visits were billed as level 3, and 50.5% of visits were billed as level 4. Level 1 and 5 visits did not exceed 0.5% in either timeframe. Within each insurance category, the proportion of visit levels of care followed a similar trend of reduced level 2 and 3 visits and increased level 4 visits from 2019 to 2021.
We noted a significant trend toward higher code level selection following the recent code level changes, and we anticipate these recent code selection trends to have major financial implications moving forward.
从2021年1月1日起，美国医学协会（AMA）和医疗保险与医疗补助服务中心（CMS）对指导当前程序术语（CPT）代码级别选择的门诊评估与管理（E/M）标准进行了重大修订。本研究的主要目的是确定近期E/M编码标准的变化如何影响骨科手外科医生在门诊环境中的代码级别选择。
在两个时间段收集了一家骨科诊所手部和腕部手术科室的所有门诊就诊记录：2019年3月1日至2019年6月30日，以及2021年3月1日至2021年6月30日。收集每次就诊的程序代码和保险类别。分析的主要终点是基于CPT E/M代码的就诊护理级别。对于每个时间段，我们确定了每个级别编码的总就诊次数，并将其表示为该时间段总就诊次数的百分比。记录每次就诊所计费的保险计划，并将其分类为医疗保险、医疗补助、工伤赔偿或商业保险。
2019年，在计费级别要求变更之前，所有就诊中有7.2%被计费为2级，84.8%被计费为3级，7.8%被计费为4级。2021年，1.9%的就诊被计费为2级，47.3%的就诊被计费为3级，50.5%的就诊被计费为4级。1级和5级就诊在两个时间段均未超过0.5%。在每个保险类别中，从2019年到2021年，护理就诊级别的比例呈现出类似的趋势，即2级和3级就诊减少，4级就诊增加。
我们注意到近期代码级别变更后代码级别选择有显著提高的趋势，并且预计这些近期的代码选择趋势在未来会产生重大财务影响。
