Koolmees Dylan, White Micah T, Murphy Jeffrey, Azar Frederick M, Bettin Clayton C
From the Campbell Clinic Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center (Dr. Koolmees, Dr. White, Dr. Azar, Dr. Bettin), Memphis, TN, and the Murphy Statistical Services (Mr. Murphy), Warsaw, IN.
J Am Acad Orthop Surg Glob Res Rev. 2024 Oct 8;8(10). doi: 10.5435/JAAOSGlobal-D-24-00154. eCollection 2024 Oct 1.
The goal of this study was to determine changes in orthopaedic coding practices between December 2020 and January 2021 after training providers on the 2021 Current Procedural Terminology Evaluation and Management (E&M) Centers for Medicare and Medicaid Services guideline changes.
Outpatient encounters in December 2020, January 2021, December 2021, and January 2023 were grouped by provider and E&M code level. The codes used for established patients were 99211, 99212, 99213, 99214, and 99215, ordered from low to high-complexity visits. The codes used for new patients were 99201, 99202, 99203, 99204, and 99205 also in order of complexity from low to high.
A statistically significant increase was noted in coding levels for both new and established patients from December 2020 to January 2021 (P < 0.001). For new patients, there was an increase in level 4 codes from 16% to 54% and an increase in level 5 codes from 3% to 6% (P < 0.0001). This notable increase in level 4 and 5 codes was maintained through 2 years (January 2023) for new patients.
A statistically significant increase was noted in coding levels for both new and established patients since E&M guideline changes. This change was maintained for 2 years.
本研究的目的是确定在2020年12月至2021年1月期间，在向医疗服务提供者培训了医疗保险和医疗补助服务中心2021年现行程序术语评估与管理（E&M）指南变更后，骨科编码实践的变化。
将2020年12月、2021年1月、2021年12月和2023年1月的门诊就诊按医疗服务提供者和E&M编码级别进行分组。用于复诊患者的编码为99211、99212、99213、99214和99215，按就诊复杂度从低到高排序。用于初诊患者的编码同样为99201、99202、99203、99204和99205，也按复杂度从低到高排序。
从2020年12月到2021年1月，复诊患者和初诊患者的编码级别均出现了统计学上的显著增加（P < 0.001）。对于初诊患者，4级编码从16%增加到54%，5级编码从3%增加到6%（P < 0.0001）。初诊患者的4级和5级编码的这一显著增加在2年（2023年1月）内一直保持。
自E&M指南变更以来，复诊患者和初诊患者的编码级别均出现了统计学上的显著增加。这一变化持续了2年。
