title: A multidisciplinary approach to vascular surgery procedure coding improves coding accuracy, work relative value unit assignment, and reimbursement.
abstract: BACKGROUND
  Vascular surgery procedural reimbursement depends on accurate procedural coding and documentation. Despite the critical importance of correct coding, there has been a paucity of research focused on the effect of direct physician involvement. We hypothesize that direct physician involvement in procedural coding will lead to improved coding accuracy, increased work relative value unit (wRVU) assignment, and increased physician reimbursement.
  
  
  METHODS
  This prospective observational cohort study evaluated procedural coding accuracy of fistulograms at an academic medical institution (January-June 2014). All fistulograms were coded by institutional coders (traditional coding) and by a single vascular surgeon whose codes were verified by two institution coders (multidisciplinary coding). The coding methods were compared, and differences were translated into revenue and wRVUs using the Medicare Physician Fee Schedule. Comparison between traditional and multidisciplinary coding was performed for three discrete study periods: baseline (period 1), after a coding education session for physicians and coders (period 2), and after a coding education session with implementation of an operative dictation template (period 3). The accuracy of surgeon operative dictations during each study period was also assessed. An external validation at a second academic institution was performed during period 1 to assess and compare coding accuracy.
  
  
  RESULTS
  During period 1, traditional coding resulted in a 4.4% (P = .004) loss in reimbursement and a 5.4% (P = .01) loss in wRVUs compared with multidisciplinary coding. During period 2, no significant difference was found between traditional and multidisciplinary coding in reimbursement (1.3% loss; P = .24) or wRVUs (1.8% loss; P = .20). During period 3, traditional coding yielded a higher overall reimbursement (1.3% gain; P = .26) than multidisciplinary coding. This increase, however, was due to errors by institution coders, with six inappropriately used codes resulting in a higher overall reimbursement that was subsequently corrected. Assessment of physician documentation showed improvement, with decreased documentation errors at each period (11% vs 3.1% vs 0.6%; P = .02). Overall, between period 1 and period 3, multidisciplinary coding resulted in a significant increase in additional reimbursement ($17.63 per procedure; P = .004) and wRVUs (0.50 per procedure; P = .01). External validation at a second academic institution was performed to assess coding accuracy during period 1. Similar to institution 1, traditional coding revealed an 11% loss in reimbursement ($13,178 vs $14,630; P = .007) and a 12% loss in wRVU (293 vs 329; P = .01) compared with multidisciplinary coding.
  
  
  CONCLUSIONS
  Physician involvement in the coding of endovascular procedures leads to improved procedural coding accuracy, increased wRVU assignments, and increased physician reimbursement.
authors.affiliation: Division of Vascular Surgery, University of Massachusetts Medical School, Worcester, Mass. Electronic address: francesco.aiello@umassmemorial.org.
authors.forename: Francesco A
authors.initials: FA
authors.lastname: Aiello
authors.affiliation: Division of Vascular Surgery, University of Massachusetts Medical School, Worcester, Mass.
authors.forename: Dejah R
authors.initials: DR
authors.lastname: Judelson
authors.affiliation: Division of Vascular Surgery, University of Massachusetts Medical School, Worcester, Mass.
authors.forename: Louis M
authors.initials: LM
authors.lastname: Messina
authors.affiliation: Division of Vascular Surgery, Yale Medical School, New Haven, Conn.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Indes
authors.affiliation: Division of Vascular Surgery, University of Massachusetts Medical School, Worcester, Mass.
authors.forename: Gordon
authors.initials: G
authors.lastname: FitzGerald
authors.affiliation: Division of Vascular Surgery, University of Massachusetts Medical School, Worcester, Mass.
authors.forename: Danielle R
authors.initials: DR
authors.lastname: Doucet
authors.affiliation: Division of Vascular Surgery, University of Massachusetts Medical School, Worcester, Mass.
authors.forename: Jessica P
authors.initials: JP
authors.lastname: Simons
authors.affiliation: Division of Vascular Surgery, University of Massachusetts Medical School, Worcester, Mass.
authors.forename: Andres
authors.initials: A
authors.lastname: Schanzer
mesh_terms: D000046:Academic Medical Centers; D059019:Clinical Coding / Q000191:economics; D039702:Current Procedural Terminology; D000068598:Data Accuracy; D004282:Documentation / Q000145:classification / Q000191:economics; D057510:Endovascular Procedures / Q000009:adverse effects / Q000145:classification* / Q000191:economics; D018588:Fee-for-Service Plans; D006801:Humans; D006278:Medicare / Q000145:classification / Q000191:economics; D010348:Patient Care Team / Q000145:classification* / Q000191:economics; D010818:Practice Patterns, Physicians' / Q000145:classification / Q000191:economics; D011446:Prospective Studies; D015895:Relative Value Scales; D015203:Reproducibility of Results; D009626:Terminology as Topic; D014481:United States; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000145:classification* / Q000191:economics