Burris-Fowlkes, Kathleen E and Everhart, Jeannine and Lovern, Stephen and Hull, Benjamin An Analysis of Current Procedural Terminology Accuracy for Professional Services: A Comparison Between Certified Professional Coders and Physicians. 2023. Radford University, Doctoral Capstone Project. Radford University Scholars' Repository.
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Abstract
Medical coding is the translation of a medical provider’s documentation into alphanumerical codes. These codes become part of the patient’s medical record and are used by insurance companies and hospitals to generate costs for medical procedures. There are over 70,000 defined medical codes to describe a patient’s condition and treatment, and each code has specific rules to dictate when and how the code should be applied. Medical coding is quite complex since coding rules are numerous and vary across different insurance companies. In addition, there is no federal requirement regarding the training/expertise required for those performing medical coding. In combination, these issues affect medical coding accuracy. Inaccurate coding costs the United States healthcare system an estimated $82 billion to $272 billion dollars annually. To better understand the specific factors associated with coding inaccuracies, approximately 2.5 million claims, provided by a large national healthcare system were examined, with 4,036 observations that met the criteria for analysis. Results found that certified professional coders were the most accurate at CPT selection out of the groups studied, while surgical providers were the least accurate. Findings from this study may be used to target corrective measure to improve medical coding accuracy, encourage policy change to mandate coder certification, and encourage education program creation for providers during their residency training.
| Item Type: | Doctoral Capstone Project |
|---|---|
| Subjects: | A General Works > AS Academies and learned societies (General) |
| Divisions: | Radford University > Waldron College of Health and Human Services > Health Sciences Program |
| Date Deposited: | 11 Jul 2023 02:02 |
| Last Modified: | 11 Jul 2023 02:02 |
| URI: | http://wagner.radford.edu/id/eprint/1009 |
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