Optimizing Resident Charge Capture with Disappearing Help Text in Note Templates.

Abstract

To assist residents in selecting the correct Current Procedural Terminology (CPT) code for evaluation and management (E/M) services thru the addition of disappearing help text into a standardized note template. We created a disappearing text block that summarizes E/M requirements and embedded it into the note template used by residents at a pediatric urgent care clinic. An intervention cohort composed of post graduate year 1 (PGY 1) residents was instructed to use this note template, while senior residents (PGY 2-3) were instructed to use an identical template that lacked the help text. We evaluated the incidence of CPT change by the attending physician for each visit as a proxy for improvement in resident billing practices. Logistic regression with a primary outcome of whether the encounter CPT code was changed was completed. There were 2,869 encounters during the 255-day study period; the help text was used in 1,112 (38.8%) encounters. There was some crossover in note use; i.e., PGY 1s using the note without help text and PGY 2s using the note with help text. Nevertheless, all residents who used the help text had a lower unadjusted rate of CPT change (22.1% vs 30.6%, OR= 0.64, p < 0.0001). This pattern persisted when stratified by trainee level - PGY 1 (22.6% vs 45.3%, OR=0.35,p < 0.0001) and PGY 2-3 (12.2% vs 27.8%, p = 0.018). Adjusting for multiple factors, the use of help text was associated with a lower incidence of CPT change (odds ratio [OR] = 0.28, 95% confidence interval [CI]: 0.19-0.44). Residents' use of the disappearing help text was associated with a large decrease in CPT code adjustment by attending physicians, which demonstrates its promise for improved E/M coding and for other applications.