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Thursday, March 16, 2000

Study finds coders alone slip on TKA complications

Professional coders alone are not qualified to make a decision about what is a complication of total hip arthroplasty, according to a study presented in poster exhibit 10.

The researchers observe that current procedural terminology (CPT) coding of complications is important for health care practices, not only for appropriate hospital and physician reimbursement, but also for correct assessment of complication rates. The results of coding can direct practice and referral patterns.

One hundred consecutive primary total hip arthroplasties were performed at one medical center by two orthopaedic surgeons from Jan. 1, 1997 to Dec. 9, 1997. Medical and surgical complications were recorded by professional coders according to the Health Care Finance Administration guidelines, and these were submitted to Medicare for hospital reimbursement. Another team with orthopaedic experience also reviewed the charts and coded the complications.

The number of discrepancies between the two sets of codes were tabulated and statistically analyzed. The primary review by professional coders revealed a complication rate of 74 percent with a medical complication rate of 72 percent and a surgical complication rate of 13 percent. The most common surgical complications included unspecified complication of a procedure (998.89) and those involving the cardiovascular and gastrointestinal systems (997.1, 997.4). The secondary review revealed a total complication rate of 28 percent, which was significantly lower . The medical complication rate was 26 percent, which was significantly lower, and the surgical complication rate was 7 percent, which also was lower.

The major discrepancies included over-diagnosing anemia and listing nonexistent complications. The primary coders recorded 997/998 codes 13 times, while the secondary team only recorded these codes seven times.

The researchers concluded there are three important principles regarding the standard of coding and quality control that need to be addressed. They are the qualifications of the coders, an interaction between coders and health care professionals to check that coding is accurate and reproducible and a provision for an interplay between various health professionals (including the primary surgeon) and coders to help decide what is listed as a complication.

Co-authors of the study, all of Johns Hopkins University, are Simon Mears, MD, orthopaedic resident; Michael A. Mont, MD, associate professor orthopaedic surgery; Pat Pietryak, RN, director of clinical studies, division of arthritis surgery; Lynne C. Jones, PhD, assistant professor, orthopaedic surgery; David S. Hungerford, MD, professor, orthopaedic surgery; and Annemarie Krackow, PhD, consultant, department of orthopaedic surgery, Good Samaritan Hospital, Baltimore, Md.; and and Maneesh Bawa, BA, medical student, Johns Hopkins School of Medicine.

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2000 Academy News March 16 Index B

Last modified 06/March/2000 by IS