Miscoding Rates for Professional Anesthesia Billing: Trial Results - Software Solution

Abstract

Background: Accurate anesthesia billing requires selection of Anesthesia Current Procedural Terminology (Anesthesia CPT-4) codes that are in concordance with the American Medical Association CPT-4 (AMA CPT-4) codes selected by the surgeon. We present a study examining the impact of a novel software at addressing sources of coding error. Methods: An exploratory coding trial was performed using a constructed surgical procedure data set (n=142). Two expert anesthe- sia coders coded each procedure using standard surgery-to-anesthesia conversion techniques. Coding accuracy was subsequently determined by consensus of experts and the type of error (if present) was categorized. After analyzing the process and sources of error, a software solution was developed. Using two different but similarly constructed data sets, the trial was repeated with the new software solution (n=298) and after an enhanced version (n=334). Results were reported using descriptive statistics. Results: There was a 38% error rate using standard coding; 16% from selecting the wrong body region, 11% from under coding and 6% from over coding the anesthesia CPT-4 code. After design and implementation of the software, the error rate was reduced to 4% and then to 3% using the enhanced version. Conclusions: Using the current cross-referencing system to determine Anesthesia CPT-4 codes has the potential for error. Using a computerized system has the potential to diminish this error. Further investigation is warranted to determine whether miscoding is elevated in other settings and if this solution can be more broadly applied.