Coding Practices in Hand Surgery and Their Relationship to Surgeon Compensation Structure

Coyle, Ryan M.; Tawfik, Amr; Green, Anna; Katt, Brian M.; Glickel, Steven Z.

doi:10.1016/j.jhsg.2021.04.004

Cited by 3 publications

(2 citation statements)

References 14 publications

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“…Our data support the hypothesis that there is widespread variability in reporting and billing of lymphatic reconstruction procedures using existing CPT codes. In comparison with reported heterogeneity in hand surgery coding, lymphatic surgery coding uses a 3 to 5 times greater number of CPT codes per procedure 29 . These findings illuminates the divide between current practice of lymphatic reconstruction, and the procedural terminology used to describe it.…”

Section: Discussionmentioning

confidence: 88%

“…In comparison with reported heterogeneity in hand surgery coding, lymphatic surgery coding uses a 3 to 5 times greater number of CPT codes per procedure. 29 These findings illuminates the divide between current practice of lymphatic reconstruction, and the procedural terminology used to describe it. Beyond a mismatch between what is performed and what is recorded, the lack of appropriate CPT codes and defined valuation has several effects that ultimately limit patient access to care.…”

Section: Discussionmentioning

confidence: 97%

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We Are Not Speaking the Same Language

Attalla,

Becker,

Clark

et al. 2024

Ann Plast Surg

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Introduction Current Procedural Terminology (CPT) codes provide a uniform language for medical billing, but specific codes have not been assigned for lymphatic reconstruction techniques. The authors hypothesized that inadequate codes would contribute to heterogeneous coding practices and reimbursement challenges, ultimately limiting surgeons' ability to treat patients. Methods A 22-item virtual questionnaire was offered to 959 members of the American Society of Reconstructive Microsurgeons to assess the volume of lymphatic reconstruction procedures performed, CPT codes used for each procedure, and challenges related to coding and providing care. Results The survey was completed by 66 board-certified/board-eligible plastic surgeons (6.9%), who unanimously agreed that lymphatic surgery is integral to cancer care, with 86.4% indicating that immediate lymphatic reconstruction should be offered after lymphadenectomy. Most performed lymphovenous bypass, immediate lymphatic reconstruction, liposuction, and vascularized lymph node transfer. Respondents reported that available CPT codes failed to reflect procedural scope. A wide variety of CPT codes was used to report each type of procedure. Insurance coverage problems led to 69.7% of respondents forgoing operations and 32% reducing treatment offerings. Insurance coverage and CPT codes were identified as significant barriers to care by 98.5% and 95.5% of respondents, respectively. Conclusions Respondents unanimously agreed on the importance of lymphatic reconstruction in cancer care, and most identified inadequate CPT codes as causing billing issues, which hindered their ability to offer surgical treatment. Appropriate and specific CPT codes are necessary to ensure accuracy and consistency of reporting and ultimately to improve patient access to care.

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Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 97%