Coding multiple diagnoses for patient visits at which procedures were performed: no evidence for abuse by physicians.
BACKGROUND
A problem area in the reimbursement of physicians is the office visit at which both procedures and evaluation/management services are performed. Insurers are concerned that frequent reporting of diagnoses unrelated to procedures may represent an abuse of the claims process.


OBJECTIVE
To determine the frequency of secondary diagnoses that are present at visits at which procedures are performed and to compare the frequency with that reported in Medicare claims.


METHODS
The 1998 and 1999 National Ambulatory Medical Care Survey (NAMCS) data were used to provide data unrelated to claims for payment. The results were compared with Medicare claims data from the 1998 to 1999 Medicare Current Beneficiary Survey. NAMCS visits were limited to patients who were 65 year old or greater to limit the analysis to the Medicare population.


RESULTS
In the NAMCS dataset, 52% of the visits for actinic keratoses at which a procedure was performed were associated with multiple diagnoses. Similarly, in the Medicare Current Beneficiary Survey dataset, 52% of these visits had multiple diagnoses listed.


CONCLUSIONS
The frequency of visits with multiple diagnoses is the same in both administrative claims and epidemiologic survey databases. There is no evidence for widespread abusive coding by physicians. It is incumbent on payers to respect the integrity of the coding system in order to assure fair reimbursement for physician services.
Feldman
Steven R
SR
Wake Forest University School of Medicine, Department of Dermatology, Winston-Salem, NC 27157-1071, USA. sfeldman@wfubmc.edu
Fleischer
Alan B
AB
Shaffer
Christy L
CL
Kiang
Shwol-Huo
SH
Williford
Phillip M
PM
Lupton
Frederick A
FA
Chen
G John
GJ
D000556:Ambulatory Surgical Procedures / Q000145:classification*; D039702:Current Procedural Terminology; D003880:Dermatology / Q000191:economics / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006801:Humans; D007344:Insurance Claim Reporting / Q000145:classification*; D007642:Keratosis / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D006278:Medicare / Q000706:statistics & numerical data*; D009819:Office Visits; D014481:United States