Document Detail

Reliability of assigning correct current procedural terminology-4 E/M codes.
MedLine Citation:
PMID:  12192349     Owner:  NLM     Status:  MEDLINE    
STUDY OBJECTIVES: We determine the degree of interagency and intra-agency agreement on Current Procedural Terminology-4 (CPT-4) coding levels for emergency department medical records. We hypothesized that the level of agreement among coding agencies would be poor, but the distribution of codes would be similar and not significantly different. METHODS: We performed a prospective observational study consisting of 3 separate randomized, blinded trials: 2 interagency comparisons and 1 intra-agency comparison. The setting was 2 suburban academic EDs. In the 2 interagency audits, 4 coding agencies were used. In the intra-agency comparison, we used 5 individual coders from within our own internal agency. The main outcome measures were the level of agreement not due to chance estimated with the multiple-rater weighted kappa statistic and the Kendall tau-b. We measured the distribution of codes by agency or by individual coders with the chi(2) test. RESULTS: Our sample for the 2 interagency audits consisted of 194 and 195 records, respectively. We observed poor agreement in the level of coding assigned to individual charts among the 4 coding agencies, with kappa values of 0.28 (95% confidence interval [CI] 0.275 to 0.285) and 0.287 (95% CI 0.283 to 0.291). Our intra-agency comparison consisted of 100 records. The agreement in the intra-agency review was significantly better but still fair (kappa=0.436; 95% CI 0.428 to 0.444). The distribution of CPT-4 codes was significantly different for all 3 comparisons (P <.001). CONCLUSION: For our patient population, group of physicians, and methods of documentation, we identified poor-to-fair agreement in coding of emergency charts between coding agencies. Only fair agreement was measured in the intra-agency sample. The distribution of assigned CPT-4 codes was significantly different in each comparison. These findings have important financial and legal implications regarding the reliability of coding methods.
Patricia N Bentley; Andrew G Wilson; Mary Elizabeth Derwin; Robbie Scodellaro; Raymond E Jackson
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Annals of emergency medicine     Volume:  40     ISSN:  0196-0644     ISO Abbreviation:  Ann Emerg Med     Publication Date:  2002 Sep 
Date Detail:
Created Date:  2002-08-22     Completed Date:  2002-09-18     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8002646     Medline TA:  Ann Emerg Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  269-74     Citation Subset:  AIM; IM    
Department of Emergency Medicine, William Beaumont Hospital System, A Wayne State University School of Medicine Affiliated Program, Royal Oak, MI 48073-6769, USA.
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MeSH Terms
Centers for Medicare and Medicaid Services (U.S.)
Emergency Medicine*
Medical Audit
Medical Records Systems, Computerized / classification*
Randomized Controlled Trials as Topic
Reproducibility of Results
Terminology as Topic*
United States
Comment In:
Ann Emerg Med. 2003 Jun;41(6):888-9; author reply 889-90   [PMID:  12790124 ]
Ann Emerg Med. 2002 Sep;40(3):275-9   [PMID:  12192350 ]

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