Koolmees Dylan S, Kadrie Alec, Bettin Clayton C, Kelly Derek M, Sheffer Benjamin W
The University of Tennessee Health Science Center-Campbell Clinic Department of Orthopaedic Surgery and Biomedical Engineering, Memphis, TN, USA.
The University of Tennessee Health Science Center, College of Medicine, Memphis, TN, USA.
J Pediatr Soc North Am. 2024 Sep 16;9:100113. doi: 10.1016/j.jposna.2024.100113. eCollection 2024 Nov.
Starting in 2021, the Centers for Medicare and Medicaid Services and the American Medical Association revised the Evaluation and Management (E&M) criteria of the Current Procedural Terminology coding selection. This retrospective study determined the changes in E&M coding level for pediatric orthopaedic patients and examined the effect of the changes on percentage of work relative value units (wRVUs) from clinic and surgery.
Coding levels for all outpatient visits at our institution were analyzed from 2020, January 2021, December 2021, and January 2023. The total number of pediatric orthopaedic visits were collected, tabulated under the corresponding E&M code, and expressed as a percentage of total E&M codes within the corresponding time frame. The total change in wRVU generated from the E&M coding changes was compared between the clinic and operating room by examining the total average coding and percentage of total average for each group and the overall total and total percentage change in wRVUs.
There was a statistically significant difference in level of coding for both established and new patients from 2020 compared with January 2021, December 2021, and January 2023. Established patients showed a large decrease in level-2 visits and a complimentary increase in level-3 visits. New patients demonstrated a statistically significant increase in level-4 visits, which was sustained at the 2-year mark. From 2020 to 2021, there was a 29% increase in percentage of wRVUs from clinic, and a 6-point increase in wRVUs from clinic compared with surgery.
Our study found an increase in level of coding after the E&M guideline changes, especially for new patients. This finding does not indicate that there were more complex pediatric orthopaedic cases but rather the new E&M guidelines accurately captured the complexity of each visit. There was a substantial increase in wRVUs from clinics, comparing immediately before and after the guideline change, which was largely sustained at the 2-year mark.
(1)This study is important because it highlights specific specialty information for pediatric orthopaedic surgeons before and after the evaluation and management (E&M) guideline changes.(2)It is vital for pediatric orthopaedic surgeons to understand and appropriately apply the guidelines to each patient visit to ensure accurate coding.(3)Our study was the first to demonstrate the changes in level of coding after the E&M guidelines changed, and the effects of percent of work relative value units originating from clinic encounters.
Level III, retrospective case control.
从2021年开始，医疗保险和医疗补助服务中心以及美国医学协会修订了现行程序术语编码选择的评估与管理（E&M）标准。这项回顾性研究确定了儿科骨科患者E&M编码级别的变化，并研究了这些变化对门诊和手术工作相对价值单位（wRVU）百分比的影响。
分析了我们机构在2020年、2021年1月、2021年12月和2023年1月所有门诊就诊的编码级别。收集儿科骨科就诊的总数，按照相应的E&M编码进行列表，并表示为相应时间范围内E&M编码总数的百分比。通过检查每组的总平均编码和总平均百分比以及wRVU的总体总数和总百分比变化，比较了门诊和手术室因E&M编码变化产生的wRVU的总变化。
与2021年1月、2021年12月和2023年1月相比，2020年复诊患者和初诊患者的编码级别存在统计学上的显著差异。复诊患者二级就诊大幅减少，三级就诊相应增加。初诊患者四级就诊有统计学上的显著增加，并在两年时保持这一水平。从2020年到2021年，门诊wRVU百分比增加了29%，与手术相比，门诊wRVU增加了6个点。
我们的研究发现E&M指南更改后编码级别有所提高，尤其是初诊患者。这一发现并不表明儿科骨科病例更复杂，而是新的E&M指南准确反映了每次就诊的复杂性。指南更改前后门诊wRVU大幅增加，在两年时基本保持这一水平。
（1）本研究很重要，因为它突出了评估与管理（E&M）指南更改前后儿科骨科医生的特定专业信息。（2）儿科骨科医生理解并将指南适用于每次患者就诊以确保准确编码至关重要。（3）我们的研究首次证明了E&M指南更改后编码级别的变化，以及门诊就诊产生的工作相对价值单位百分比的影响。
三级，回顾性病例对照。
