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Query: EC:2.3.1.21 (CPT)
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As health care costs continue to rise, alternatives to the traditional fee for service system of physician reimbursement are being explored. Recently a resource-based relative-value system was enacted by Congress to correct some of the perceived inequities of Medicare reimbursement. Since reimbursement for evaluation and management services, also known as cognitive services, are based on Current Procedural Terminology (CPT-4) codes, we reviewed Medicare claims data for fiscal year 1986-87 to identify the coding habits of Connecticut urologists. We found that Connecticut urologist file 99% of their claims for cognitive services in one of six categories. Furthermore, we found that within these broad categories an average of 82% of the claims were filed under one primary practice specific code. The particular code selected, however, varied markedly between practices. Our data suggest that Connecticut urologists have adopted different standards for using CPT-4 codes and have adjusted for these differences through their fee schedules. These findings highlight the need for increased precision in CPT code definitions for cognitive services before they can be adapted to a reimbursement system based upon relative-value scales.
Conn Med 1990 Sep
PMID:Variations in coding practices among Connecticut urologists for the Medicare population. 222 18

With the accelerated development of managed care systems in the 1990s, physician practices experienced curtailed authorization for length of stay (LOS) for in-patient care. Using lumbar discectomy (CPT 63030) as a surgical model, we reviewed records of patients from 1994 and 1996 as these two years were within the period of accelerated managed care penetration in our state. The Chi Square and Fisher Exact tests were used to explore statistical significance and differences in population characteristics, management and outcome in the two years. Factors including age, sex, associated medical conditions, other presenting symptoms and signs, cause of disc herniation, and duration of symptoms were not significantly different. We demonstrated that the shortened LOS did not adversely influence the medical or functional outcome from lumbar discectomy but that there appeared to be a shift of the burden of care to the postoperative outpatient setting. Functional outcome was not significantly different between the two years when assessed by either Prolo Outcome or return-to-work rate. These findings were corroborated with a more recent review of patients operated upon in 2000. As spinal surgery grows in complexity, managed care companies should initiate programs that routinely assist physician offices in accelerating postoperative rehabilitation. In addition, as emphasis grows for evaluation and management services, surgical outcome studies should document the intensity of postoperative management to document better the overall nonoperative care that surrounds any spinal surgery.
Conn Med 2004 Mar
PMID:The effect of curtailed hospitalization on the management and outcome of lumbar discectomy patients in a private practice setting. 1505 3