What are we Missing? A Retrospective Review of Coding Discrepancies in the Foot and Ankle Department at an Academic Hospital Center

Research Type: Level 3 - Retrospective cohort study, Case-control study, Meta-analysis of Level 3 studies Introduction/Purpose: There is a dearth of research on the coding of foot and ankle procedures comparing institutional coders from operative reports and surgeon’s coding their own procedures. Based on assigned Relative Value Units (RVUs) and payment structure, this could have implications for both hospital collections and surgeon payment. Methods: A retrospective chart review of the foot and ankle department surgeries at a large academic medical center was reviewed over a period of 3 months. Two surgeons with foot and ankle fellowship training as well as experience coding their own procedures reviewed the operative reports individually and listed the codes they would have billed for. Differences were resolved by discussion and agreement. This was then cross referenced against the codes billed by the coding department of the institution, taking from hospital payment records. Results: Orthopedic surgeon coding resulted in an average 93.91 RVUs increase over a 3 month period or 31.30 RVUs per month versus coders. There was one incidence of ‘overcoding’ by the institution which resulted an additional 4.58 RVUs. Conclusion: This information provides information for both billers/coders and surgeons on what codes are typically missed/over coded for in an orthopedic foot and ankle department. This can be useful for both surgeons and hospitals seeking to get accurately reimbursed for their procedures.