[2012] Continuous Quality Improvement: Procedural Standardization of Intra-Operative Consultation Coding in Surgical Pathology

Sadia Sayeed, Tasha Lea, Celeste N Powers, Michael O Idowu. Virginia Commonwealth University, Richmond, VA

Background: Continuous quality improvement is necessary not only to prevent preanalytic and diagnostic errors, but also to ensure accurate CPT coding. For intraoperative consultations (IC) accurate coding relies upon clear documentation of the procedure (frozen[FS] section, touch preparation[TP] or both), number of specimen(s) and number of ICs performed on each specimen (first FS, second FS, etc). The purpose of this study was to evaluate and improve our documentation system for ICs to minimize coding and billing errors.
Design: Documentation and coding of all ICs over a 3 month period in 2010 prior to procedural standardization (PS) was reviewed, by correlating entries in the IC logbook with documentation in final pathology reports and CPT codes entered in the Cerner Laboratory Information System (LIS). We then instituted PS requiring 1) dictation of specific IC procedure using templates based on CPT terminology, 2) coding for IC at the time of dictation, 3) daily correlation of IC logbook entries with CPT codes in the LIS. We compared a three month period 18 months following implementation of PS.
Results: There were 334 specimens with IC reviewed during the pre-PS period in 2010, of which 105 (31%) were incorrectly coded. The improper coding was due to insufficient documentation and inconsistent use of CPT terminology. Following implementation of PS, of the 405 specimens reviewed, 31 (8%) were incorrectly coded (Table 1). Incorrect coding leading to revenue loss was primarily due to either absent codes or under-coding (Table 2). Reimbursement was issued for cases with over-coding. Coding errors more commonly occurred with complex specimens where TP and FS were utilized.
Conclusions: Significant improvement in IC coding followed implementation of PS. PS and continuous monitoring is important for minimizing / eliminating miscoding errors. Education of staff, residents and faculty is essential. Laboratories should consider PS with continuous monitoring to minimize errors.

Table 1. Pre and post implementation of PS and IC Coding
 Pre Procedural StandardardizationPost Procedural Standardization
 Properly coded specimensImproperly coded specimensProperly coded specimensImproperly coded specimens
Type IC  
Additional FS40%60%67%33%
Gross only50%50%89%11%

Table 2. Coding Errors
 Pre PS (n=105)Post PS (n=31)
No code56 (53.3%)10 (32%)
Under-coding34 (32.4%)14 (45%)
Over-coding15 (14.3%)7 (23%)
Extrapolated Revenue loss for the year using Medicare Expect$31,702$3,821

Category: Quality Assurance

Tuesday, March 5, 2013 9:30 AM

Poster Session III # 269, Tuesday Morning


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