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Coding Pros: CPT system confusing, subjective. (Study Assesses Professional Coders).

ATLANTA -- CPT evaluation and management coding is so complex and subjective that even coding specialists disagree with each other nearly half the time, according to a study.

Physicians have long been criticized for inaccurate CPT evaluation and management (E&M) coding. Some research shows that doctors are accurate only 50%-55% of the time, Dr. Martin Lipsky said at the annual meeting of the American Academy of Family Physicians.

The accuracy of professional coding specialists has not been studied until now. As a remedy for that, progress notes from six hypothetical office visits and a demographic survey were sent to 300 coding specialists. The participants were members of the American Health Information Management Association, which certifies them to review codes assigned by physicians. There was a 46% response rate, said Dr. Lipsky, chair and professor of family medicine at Northwestern University Chicago.

The coding specialists, who had an average of 10 years of coding experience, agreed on the CPT E&M codes for the six cases 59% of the time. That is only slightly better than physicians typically do, Dr. Lipsky said.

The range of agreement on individual cases was from 50% to 71% among the coding experts. "There are considerable differences in coding, even among the experts," he commented.

The coding professionals tended to undercode progress notes for established patients and overcode for new patients. Dr. Lipsky offered one potential solution: Use separate coding guidelines for established and new cases,

He also called for revising and simplifying the CPT E&M coding system. "These codes are very important because large amounts of money can be involved in terms of reimbursement," he noted.

Although fraud and abuse are big concerns, Dr. Lipsky attributed the widely recognized variability in physician coding to the subjectivity and complexity of the guidelines. "Sometimes I think I would do better throwing a dart at a dartboard to get agreement with experts," he said.

The study results might make physicians feel a bit better about coding because even the certified experts disagree on the proper codes, he added.

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Comment:Coding Pros: CPT system confusing, subjective. (Study Assesses Professional Coders).
Author:McNamara, Damian
Publication:Family Practice News
Article Type:Brief Article
Geographic Code:1USA
Date:Feb 15, 2002
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