Payment by results (PbR) in orthopaedic trauma: Where are we losing?

Abstract

external fixator or plating anteriorly. 17 patients (group 2) exhibited minimal displacement less than 5 mm and were not stabilised. Rotational instability >2 cm was characterised by complete fracture of the sacrum posteriorly. Stabilisation of the pelvic ring in group I was associated with a significant reduction of the VAS within 72 h from surgery, early ambulation and discharge from the hospital. Conclusion: This study supports the view that not all LCI fracture patterns are mechanically stable. Examination under anaesthesia of the pelvic ring can assist the clinician in the decision-making progress.Background: Clinical coding has attracted significant interest recently as it has become synonymous with reimbursement. We hereby present the results of first and largest study in the UK involving 547 orthopaedic trauma cases wherein a meticulous in-depth analysis was performed. Study design: Completed audit cycle. Objectives: To review the existing coding for orthopaedic trauma, to ascertain accuracy of procedural codes and to identify limitations, implement changes, re-evaluate and close the audit loop. Methods: All orthopaedic trauma surgeries (244 cases) performed over 1 month (March 2006) were comprehensively analysed. The primary procedural accuracy of OPCS4.2, its limitations and loss of revenue due to missing codes (6 patients) were determined. Changes were implemented to streamline/optimise financial reimbursement and improve data quality/accuracy by education/training. Electronic discharge summaries were implemented to enhance efficiency. The audit loop was subsequently closed to evaluate implementation of these changes by re-auditing all trauma surgeries performed in the same month the following year, i.e. March 2007 (303 cases) against OPCS4.3 codes. Results: The primary procedural accuracy was 95.38% (11/238 coding errors) and omissions in 6 patients resulted in net loss of

Differences in evaluation and management coding of outpatient clinic visits for patients undergoing elective spine surgery with use of a standardized template

“…The use of a template for clinical documentation can also serve as a means for improving resident instruction in coding. Other studies have shown that coding errors and omissions in patients resulted in cumulative loss of revenue of £46,750 ($60,130.08) over the course of one year ( 3 ). One study by Murphy et al has shown low levels of concordance between resident and attending surgeons in CPT coding, possibly due to a lack of training ( 9 ).…”

“…One specific study reported an estimated revenue loss of over $80,000 in a 1-year period at a university outpatient clinic due to fewer level 4 visits when compared to Medicare normative data ( 2 ). These discrepancies result from incomplete clinical documentation which results in inadequate medical reimbursements ( 3 ). Previous studies have demonstrated that electronic medical record template use improves accuracy and completeness of both operative and clinical notes in orthopedic surgery, contributing to ease in interdisciplinary communication ( 4 - 6 ).…”