Increased E&M Levels in a Pediatric Orthopaedic Department through a Single Didactic
Location
LSUHSC-NO Medical Education Building
Event Website
www.medschool.lsuhsc.edu/ortho/resident_programs.aspx
Document Type
Presentation
Start Date
23-6-2023 10:50 AM
End Date
23-6-2023 11:00 AM
Publication Date
June 2023
Description
Introduction: Evaluation and management (E&M) coding is a system used to represent clinical services provided by practitioners for billing purposes. Beginning in January 2021, Current Procedural Terminology (CPT) guidelines changed for office visit E&M codes in an effort to reduce unnecessary documentation and administrative burden. Other notable changes include reductions in the work relative value units (wRVU) per E&M level and the reimbursement per wRVU, with the E&M guidelines allowing the average orthopedic clinic visit to be billed at a higher level than under the previous system. Due to these important differences, education on the newly adopted system is critical. This study investigates the effect of a single quality improvement didactic session on the utilized E&M levels billed in our pediatric orthopaedic surgery department. Methods: Physicians and advanced practice providers (APP: PA’s and NP’s) in the pediatric orthopaedic department took part in a single interactive didactic session on appropriate billing practices and the 2021 changes to the E&M CPT coding system. E&M coding data for a 6-month period before and after the didactic session were obtained. Primary outcome was to observe changes in E&M CPT utilization for level 3 (ie. 99203/99213) and level 4 (ie. 99204/99214) codes. Secondary outcome was observed changes in E&M CPT utilization between providers who received training and those who did not participate in the didactic session. Results: A total of 7 physicians and 6 advanced practice providers were included. Total number of RVU codes utilized prior and after the single didactic session were analyzed, with focus on level 3 and level 4 CPT coding. There was a significant increase over time in level 4 coding (ie.99204/99214) after the didactic session (85 vs. 158 average incidence of these codes over 6 months, p = 0.031). There was also an observed decrease over time in level 3 coding (ie. 99203/99213), but significance was not obtained (199 vs. 181, p = 0.568). When trained providers were compared to those providers who did not receive any formal training, both level 4 and level 3 coding did not show any significant differences (level 4, p = 0.966; level 3, p = 0.278). Conclusion: Through our single interactive didactic session that reviewed the E&M levels in our department, we were able to significantly increase the utilization of E&M level 4 coding. We recommend providing similar sessions to better understand the critical nuances of the E&M coding system to remain in compliance with legal requirements and to ensure fair reimbursement.
Recommended Citation
Galvin, Gregory, "Increased E&M Levels in a Pediatric Orthopaedic Department through a Single Didactic" (2023). Dept. of Orthopaedics: Robert D. D’Ambrosia Lectureship & Research Day. 4.
https://digitalscholar.lsuhsc.edu/ortho_rd/2023/pres2/4
Increased E&M Levels in a Pediatric Orthopaedic Department through a Single Didactic
LSUHSC-NO Medical Education Building
Introduction: Evaluation and management (E&M) coding is a system used to represent clinical services provided by practitioners for billing purposes. Beginning in January 2021, Current Procedural Terminology (CPT) guidelines changed for office visit E&M codes in an effort to reduce unnecessary documentation and administrative burden. Other notable changes include reductions in the work relative value units (wRVU) per E&M level and the reimbursement per wRVU, with the E&M guidelines allowing the average orthopedic clinic visit to be billed at a higher level than under the previous system. Due to these important differences, education on the newly adopted system is critical. This study investigates the effect of a single quality improvement didactic session on the utilized E&M levels billed in our pediatric orthopaedic surgery department. Methods: Physicians and advanced practice providers (APP: PA’s and NP’s) in the pediatric orthopaedic department took part in a single interactive didactic session on appropriate billing practices and the 2021 changes to the E&M CPT coding system. E&M coding data for a 6-month period before and after the didactic session were obtained. Primary outcome was to observe changes in E&M CPT utilization for level 3 (ie. 99203/99213) and level 4 (ie. 99204/99214) codes. Secondary outcome was observed changes in E&M CPT utilization between providers who received training and those who did not participate in the didactic session. Results: A total of 7 physicians and 6 advanced practice providers were included. Total number of RVU codes utilized prior and after the single didactic session were analyzed, with focus on level 3 and level 4 CPT coding. There was a significant increase over time in level 4 coding (ie.99204/99214) after the didactic session (85 vs. 158 average incidence of these codes over 6 months, p = 0.031). There was also an observed decrease over time in level 3 coding (ie. 99203/99213), but significance was not obtained (199 vs. 181, p = 0.568). When trained providers were compared to those providers who did not receive any formal training, both level 4 and level 3 coding did not show any significant differences (level 4, p = 0.966; level 3, p = 0.278). Conclusion: Through our single interactive didactic session that reviewed the E&M levels in our department, we were able to significantly increase the utilization of E&M level 4 coding. We recommend providing similar sessions to better understand the critical nuances of the E&M coding system to remain in compliance with legal requirements and to ensure fair reimbursement.
https://digitalscholar.lsuhsc.edu/ortho_rd/2023/pres2/4