Current procedural terminology coding: do the experts agree?

During the past decade, the Health Care Financing Administration (HCFA) has revised the current procedural terminology (CP1) coding guidelines in an effort to clarify the work of physicians. In today's climate of health care regulation, the accuracy of how physicians use CPT coding to define their evaluation and management (ElM) services is receiving more attention. Because coding is tied to reimbursement, there is concern that financial incentives might lead to coding inaccuracies. Inaccuracies in coding, however, might also stem from the complexity of the revised coding systems rather than a financial motivation to overcode. Ultimately a physician's coding accuracy is judged by experts who audit physician charts and examine whether the coding level reflects the documented services provided. Despite the financial and legal implications of coding appropriately, there is little research examining the agreement among expert coding specialists in their interpretation of HCFA guidelines. Previous studies have focused on physicians' coding.14 In this pilot study, we sought to examine the level of agreement among expert coding specialists in their evaluations of the intensity of services provided during physician office visits using the Medicare CPT FJM coding guidelines.