Orthopaedic Provider Coding Trends After 2021 Changes to the Current Procedural Terminology Evaluation and Management Coding Guidelines: A Retrospective Cohort Study
Abstract
BACKGROUND: The goal of this study was to determine changes in orthopaedic coding practices between December 2020 and January 2021 after training providers on the 2021 Current Procedural Terminology Evaluation and Management (E&M) Centers for Medicare and Medicaid Services guideline changes.
METHODS: Outpatient encounters in December 2020, January 2021, December 2021, and January 2023 were grouped by provider and E&M code level. The codes used for established patients were 99211, 99212, 99213, 99214, and 99215, ordered from low to high-complexity visits. The codes used for new patients were 99201, 99202, 99203, 99204, and 99205 also in order of complexity from low to high.
RESULTS: A statistically significant increase was noted in coding levels for both new and established patients from December 2020 to January 2021 (P < 0.001). For new patients, there was an increase in level 4 codes from 16% to 54% and an increase in level 5 codes from 3% to 6% (P < 0.0001). This notable increase in level 4 and 5 codes was maintained through 2 years (January 2023) for new patients.
CONCLUSIONS: A statistically significant increase was noted in coding levels for both new and established patients since E&M guideline changes. This change was maintained for 2 years.
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence.
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