2019 HSC Section 2 - Practice Management

TABLE 2. Survey Results of all Current General Surgical Residents at OUHSC to Identify Coding Habits, Limitations to Accurate Coding on ACGME Case Log Entry

n /response proportion (%) ( n ¼ 27)

Survey questions

Response

What are the biggest challenges to accurately coding procedures using the ACGME case log system? (check all that apply)

Unsure about operative role in the case Unsure exactly what procedure was performed Unfamiliarity with available codes in the ACGME CPT directory Unable to fi nd precise code on the ACGME search interface Lack of formal education on procedural coding Delay in entering case codes

4 (15) 2 (7) 16 (59) 6 (22) 23 (85) 10 (37) 1 (4) 5 (19) 5 (19) 5 (19) 9 (33) 2 (7) 2 (7)

How often do you input your procedural codes into the ACGME case log system?

After each case

Daily

Multiple times per week Multiple times per month

Monthly

Less frequently than monthly

What is your perception of your own procedural coding accuracy using the ACGME case log system?

I believe I correctly code the procedure performed ALL the time I believe I correctly code the procedure performed MOST of the time I believe I correctly code the procedure performed SOME of the time I believe I RARELY code the procedure performed correctly I believe I NEVER code the procedure performed correctly

20 (74)

4 (15)

1 (4)

0 (0)

“ I believe that at the end of my residency training, my ACGME case log will accurately represent my operative experience. ”

Strongly agree

3 (11) 18 (67) 4 (15)

Agree Neutral Disagree

2 (7) 0 (0)

Strongly disagree

current general surgery residents (27/27). Survey results indicated that inability to fi nd the precise code within the ACGME search interface and unfamiliarity with available CPT codes were by far the most common perceived barriers to accuracy (85.19% and 59.26%, respectively). Survey results also indicated that most residents (74.07%) believe they code accurately most of the time and agree that their case log would accurately represent their operative experi- ence (66.6%). Furthermore, the results from questions regarding coding habits show that the highest proportion of respondents (33%) log cases only once a month. The remaining respondents reported input frequency of “ daily, ” “ multiple times per week, ” and “ multiple times per month ” as the next most frequent responses (18.5% for all). DISCUSSION A number of potential factors in fl uence case log accuracy, which makes capturing the actual surgical procedures challenging. When looking at each individual resident, we found at best a 60% accuracy proportion over the course of

This study was approved by the University of Oklahoma Health Sciences Center Institutional Review Board.

RESULTS A total of 5799 entries from 7 residents were retrieved from the ACGME case log system. Of these, 1443 (25%) entries could not be matched to the billing database. The following results summarize the remaining 4356 entries that were successfully matched. Table 1 summarizes coding accuracy by surgery residents. In general, the number of procedures performed by all 7 residents increased with increasing PGY ( r ¼ 0.88, p o 0.0001). For all residents, the coding accuracy ranged from low to modest; the overall accuracy proportion for all residents was 52.82% (range: 43.32%- 60.07%). Only 1 resident showed signi fi cant improvement in accuracy during his/her training (p ¼ 0.0043); however, this may have been a result of his or her ’ s PGY1 coding accuracy being disproportionately much lower than all the other residents. Table 2 summarizes the results from our 4-question survey distributed to all current general surgery residents at our institution. The survey response rate was 100% of all

Journal of Surgical Education Volume 73/Number 6 November/December 2016

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