“Charting practices associated with preserved emergency ultrasound coding in the 2023 and beyond era”

Abstract

BackgroundIn 2023, coding in Emergency Medicine transitioned to be reliant on medical decision making (MDM). Secondary to this change, a point of care ultrasound (POCUS) in the Emergency Department (ED) can be incorporated into the MDM to increase chart complexity and Evaluation / Management (E/M) code. However, ‘bundling’ the POCUS into the MDM in this manner will make the study ineligible for separate coding. ObjectivesTo investigate the impact of the 2023 coding guideline changes on the proportion of complete POCUS examinations that are successfully coded separately from the primary ED visit E/M code. In addition, we sought to investigate charting elements that were associated with preserved POCUS coding. MethodsThis was a retrospective study at a single academic ED. All diagnostic POCUS examinations performed over the 2-month period of 1/1/2023 to 2/28/2023 were included. Prior to January 1, 2023, our ED coding group was trained to code all fully documented POCUS examinations separately except when the POCUS would be the determining factor in increasing the E/M level. Two separate investigators reviewed medical records and POCUS coding reports using a standardized data form. Variables within the “Data” column of the American Medical Association (AMA) MDM matrix were evaluated to assess if their presence or absence were associated with POCUS coding. ResultsThere were 611 POCUS examinations in the specified time period, with 440 of those eligible for coding due to complete documentation being present. Amongst these 440 studies, 332 were separately coded under the appropriate POCUS Current Procedural Terminology (CPT) code, while 108 were bundled into the MDM and not coded. Of the variables evaluated, the presence of an independent interpretation of a separate diagnostic test (IIDT) was associated with preserved POCUS coding, with 67 % of the independently coded POCUS studies having a documented IIDT (95 % confidence interval (CI) of 62–72) compared to 49 % of the studies not coded (95 % CI 40–58), p = 0.0007. ConclusionFollowing the 2023 ED coding update, POCUS examinations can become bundled into the MDM of the ED chart, making them ineligible for separate coding. Documentation of IIDT was associated with preserved POCUS coding. Employing IIDT when appropriate may help ensure POCUS coding is not unnecessarily curtailed.