Department of Orthopaedic Surgery, Nationwide Children's Hospital, Columbus, OH.
J Pediatr Orthop. 2023 Apr 1;43(4):232-236. doi: 10.1097/BPO.0000000000002359. Epub 2023 Feb 3.
In surgical specialties like orthopaedics, documenting the surgery performed involves applying the appropriate current procedural terminology (CPT) code(s). For limb reconstruction surgeons, the wide-ranging types of surgeries and rapid evolution of the field create a variety of factors making it difficult to code the procedures. We sought to (1) assess whether appropriate limb reconstruction codes currently exist and (2) determine whether there is agreement among experienced pediatric orthopaedic surgeons when applying these codes to similar cases.
A REDCAP survey comprised of 10 common pediatric limb reconstruction cases was sent to experienced pediatric limb reconstruction surgeons in the United States. Based on the description of each case, the surgeons were asked to code the cases as they usually would in their practice. There were no limitations regarding the number or the types of codes each surgeon could choose to apply to the case. Nine additional demographic and general coding questions were asked to gauge the responding surgeon's coding experience.
Survey participants used various codes for each case, ranging from only 1 code to a maximum of 9 codes to describe a single case. The average number of codes per case ranged from 1.2 to 3.6, with an average of 2.5 among all 10 cases. The total number of unique codes provided by the respondents for each case ranged from 5 to 20. Only 3 of the 10 cases had an agreement >75% for any single code, and only 2 of the 10 cases had >50% agreement on any combination of 2 codes.
There are dramatic variations in coding methods among pediatric orthopaedic limb reconstruction surgeons. This information highlights the need to improve the current CPT coding landscape. Possible solutions include developing new codes that better represent the work done, developing standardized guidelines with the existing codes to decrease variation, and improving CPT coding education by developing limb reconstruction coding "champions."
Level V.
在矫形外科等外科专业中，记录所进行的手术涉及应用适当的当前程序术语 (CPT) 代码。对于肢体重建外科医生来说，手术类型广泛且领域快速发展，这造成了各种因素，使得手术编码变得困难。我们试图：(1) 评估当前是否存在适当的肢体重建代码；(2) 确定在应用这些代码时，经验丰富的儿科矫形外科医生之间是否存在一致性。
向美国经验丰富的儿科肢体重建外科医生发送了一份包含 10 个常见儿科肢体重建病例的 REDCAP 调查。根据每个病例的描述，要求外科医生按照他们在实践中的通常做法对病例进行编码。对于每个病例，没有限制外科医生选择应用的代码数量或类型。还询问了 9 个额外的人口统计学和一般编码问题，以评估回应外科医生的编码经验。
调查参与者为每个病例使用了各种代码，从仅 1 个代码到描述单个病例的最多 9 个代码不等。每个病例的平均代码数范围为 1.2 至 3.6，所有 10 个病例的平均代码数为 2.5。每位受访者为每个病例提供的唯一代码总数范围为 5 至 20。只有 3 个病例中的任何单个代码的一致性>75%，只有 2 个病例中的任何两个代码的组合一致性>50%。
儿科矫形外科肢体重建外科医生的编码方法存在显著差异。这些信息突出了改进当前 CPT 编码环境的必要性。可能的解决方案包括开发更好地代表所做工作的新代码，制定现有代码的标准化指南以减少差异，以及通过开发肢体重建编码“冠军”来提高 CPT 编码教育。
5 级。
