title: Ethical and educational considerations in coding hand surgeries.
abstract: OBJECTIVE
  To assess treatment coding knowledge and practices among residents, fellows, and attending hand surgeons.
  
  
  METHODS
  Through the use of 6 hypothetical cases, we developed a coding survey to assess coding knowledge and practices. We e-mailed this survey to residents, fellows, and attending hand surgeons. In additionally, we asked 2 professional coders to code these cases.
  
  
  RESULTS
  A total of 71 participants completed the survey out of 134 people to whom the survey was sent (response rate = 53%). We observed marked disparity in codes chosen among surgeons and among professional coders.
  
  
  CONCLUSIONS
  Results of this study indicate that coding knowledge, not just its ethical application, had a major role in coding procedures accurately. Surgical coding is an essential part of a hand surgeon's practice and is not well learned during residency or fellowship. Whereas ethical issues such as deliberate unbundling and upcoding may have a role in inaccurate coding, lack of knowledge among surgeons and coders has a major role as well.
  
  
  CONCLUSIONS
  Coding has a critical role in every hand surgery practice. Inconstancies among those polled in this study reveal that an increase in education on coding during training and improvement in the clarity and consistency of the Current Procedural Terminology coding rules themselves are needed.
authors.affiliation: Rothman Institute, Thomas Jefferson University, Philadelphia, PA; Department of Hand Surgery, Johns Hopkins Bayview Medical Center, Johns Hopkins/University of Maryland, Baltimore, MD; Department of Hand and Orthopaedic Surgery, Massachusetts General Hospital, Harvard University, Boston, MA; Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA.
authors.forename: Scott D
authors.initials: SD
authors.lastname: Lifchez
authors.affiliation: Rothman Institute, Thomas Jefferson University, Philadelphia, PA; Department of Hand Surgery, Johns Hopkins Bayview Medical Center, Johns Hopkins/University of Maryland, Baltimore, MD; Department of Hand and Orthopaedic Surgery, Massachusetts General Hospital, Harvard University, Boston, MA; Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA. Electronic address: bikeberry@comcast.net.
authors.forename: Charles F
authors.initials: CF
authors.lastname: Leinberry
authors.affiliation: Rothman Institute, Thomas Jefferson University, Philadelphia, PA; Department of Hand Surgery, Johns Hopkins Bayview Medical Center, Johns Hopkins/University of Maryland, Baltimore, MD; Department of Hand and Orthopaedic Surgery, Massachusetts General Hospital, Harvard University, Boston, MA; Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA.
authors.forename: Michael
authors.initials: M
authors.lastname: Rivlin
authors.affiliation: Rothman Institute, Thomas Jefferson University, Philadelphia, PA; Department of Hand Surgery, Johns Hopkins Bayview Medical Center, Johns Hopkins/University of Maryland, Baltimore, MD; Department of Hand and Orthopaedic Surgery, Massachusetts General Hospital, Harvard University, Boston, MA; Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA.
authors.forename: Philip E
authors.initials: PE
authors.lastname: Blazar
mesh_terms: D059019:Clinical Coding / Q000145:classification / Q000941:ethics*; D002983:Clinical Competence; D004503:Education, Medical, Graduate / Q000941:ethics*; D005260:Female; D006225:Hand / Q000601:surgery*; D006801:Humans; D007396:Internship and Residency / Q000941:ethics; D008297:Male; D008505:Medical Staff, Hospital / Q000941:ethics; D009985:Orthopedics / Q000193:education*; D014481:United States
keywords: Coding; ethics