Expert Agreement in Current Procedural Terminology Evaluation and Management Coding
Mitchell S. King, MD;
Martin S. Lipsky, MD;
Lisa Sharp, PhD
Arch Intern Med. 2002;162:316-320.
Background Available data suggest that physicians are accurate in approximately
55% of Current Procedural Terminology (CPT) evaluation and management (E/M) coding for their services. This
accuracy is relative to observers' or auditors' assigned codes for these services,
a group that has not been studied for their consistency in application of
the CPT E/M coding guidelines. The purpose of this
study was to determine the level of agreement of certified coding specialists
in their application of CPT E/M coding guidelines.
Methods Three hundred certified professional coding specialists randomly selected
from the active membership of the American Health Information Management Association
were sent 6 hypothetical progress notes of office visits along with a demographic
survey. The study group assigned CPT E/M codes to
each of the progress notes and completed the demographic survey.
Results Coding specialists agreed on the CPT E/M codes
for 57% of these 6 cases. The level of agreement for the individual cases
ranged from 50% to 71%. Relative to the most common or consensus code, undercoding
of established patients occurred more commonly than overcoding. In contrast,
for new patient progress notes, overcoding relative to the consensus code
was more common than undercoding.
Conclusions There is substantial disagreement among coding specialists in application
of the CPT E/M coding guidelines. The results of
this study are similar to results of prior studies assessing physician coding
accuracy, suggesting that the CPT coding guidelines
are too complex and subjective to be applied consistently by coding specialists
or physicians.
From the Department of Family Medicine, Northwestern University Medical
School, Chicago, Ill.
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