Accuracy of CPT evaluation and management coding by family physicians.

TLDR

Limited data exist on physicians’ coding accuracy, and the complexity of CPT guidelines plus limited training likely explain the observed errors. The study aimed to assess CPT E/M coding accuracy among family physicians and identify demographic factors associated with accuracy, using 600 randomly selected members who received six hypothetical office visit notes and a survey. Physicians coded six hypothetical progress notes and completed a survey, while five expert coders independently assigned codes for comparison. Physicians agreed with expert codes on 52 % of established patient notes and only 17 % of new patient notes, with undercoding most common for established and overcoding for new, and no demographic factor predicted accuracy, indicating a substantial coding error rate especially for new patients.

Abstract

Limited data are available on physicians' accuracy in coding for their services. The purpose of this study was to determine the current procedural terminology (CPT) evaluation and management coding accuracy of family physicians and define demographic variables associated with coding accuracy.Six hundred randomly selected active members of the Illinois Academy of Family Physicians were sent six hypothetical progress notes of office visits along with a demographic survey. The study group assigned CPT evaluation and management codes to each of the progress notes and completed the demographic survey. Five expert coders also assigned codes to each of the cases. The accuracy of family physicians in determining CPT E/M codes was determined relative to that of expert coders.Family physicians agreed with the experts' CPT evaluation and management codes for 52% of established patient progress notes, the most common error being undercoding. In contrast, for new patient progress notes, family physicians agreed with the experts only 17% of the time, the predominant error being overcoding. No surveyed demographic variable was associated with coding accuracy.The error rate for physician CPT coding is substantial and occurs more commonly with new patients. The complexity of the CPT coding guidelines, along with limited physician training in CPT coding, likely account for these results.