Improving dermatology resident billing - UCB Resident Poster Competition.pptx


.

.

.

.

.

.

.

.

.

.

Improving Dermatology Resident Billing
Michael Tassavor, MD, Shayan Owji, BS, Joseph Han, BS, Cula Dautriche, MD, Jonathan Ungar, MD

Department of Dermatology, Icahn School of Medicine at Mount Sinai

METHODS

• All CPT codes and modifiers were 
recorded for approximately 256 
patient encounters before and after 
our intervention.

• The intervention consisted of four 
monthly billing lectures with two 
associated quizzes as well as a note 
template designed by author MT that 
automatically lists the correct 
procedural codes according to the 
numbers and types of procedures 
chosen from a dropdown list

• Billing accuracy was verified by two 
attending dermatologists through 
chart review and compared between 
the two time periods

• State population 
and setting

CONCLUSIONS

• Lectures on medical coding and a 
template that automatically lists the CPT 
codes for procedures greatly improved 
the billing accuracy of dermatology 
residents at our institution, significantly 
decreasing the rate of errors for 
procedural codes and modifiers

• Residents consistently undercoded E/M 
rather than the opposite, perhaps due to 
a perception that there is no meaningful 
benefit to maximizing their billing

• Our lectures seemed to be most impactful 
on procedural codes and modifiers

RESULTS

• Billing data from 513 patient visits, 257 from the pre-intervention period and 256 
from the post-intervention period, were checked for accuracy

• The accuracy of resident-billed E/M levels of service was similar between pre- and 
post-intervention (44.4% vs. 44.8%)

• Similar rates of undercoding and overcoding were noted between the pre- and 
post-intervention periods (35.4% undercoded and 8.1% overcoded vs. 35.8% and 
8.9%).

• Substantial improvements were noted in the rate of errors with procedural codes 
and modifiers in the post-intervention period

• 22.0% of procedural codes were incorrectly billed pre-intervention while only 3.7% 
were incorrectly billed post-intervention (p<0.05). 

• 55.2% of modifiers were incorrectly billed pre-intervention while only 27.3% were 
incorrectly billed post-intervention (p<0.05).

SYNOPSIS

• Resident billing performance can 
have significant financial implications 
for the academic institutions 
employing them

• To assess the impact of newly 
implemented medical coding lectures 
and a modified note template on 
resident billing accuracy, resident 
billing accuracy from the pre- and 
post- intervention periods were 
compared

• Billing lectures and a modified note 
template yielded a clear improvement 
on resident billing accuracy at our 
institution

Figure 1: Breakdown of the percentage of undercoded and 
overcoded E/M codes in the pre- and post-intervention periods. 

Figure 2: Percentage of total procedural codes and 
modifiers that were incorrectly billed in the pre- and 
post-intervention periods.

CRYOSURGERY: 
Number of lesions treated: *** 
Location of lesions treated: *** 
Procedure: Liquid nitrogen applied to lesion(s) for *** seconds, for *** freeze-thaw 
cycles. 
Complications: None. 

CPT Codes: 
Premalignant: 17000 for 1, also add 17003 for 2-14 (units = number of lesions). 
17004 used alone for 15+ (units = 1). 
Benign: 17110 for 1-14, 17111 for 15+ (units = 1 for both)

Figure 3: Screenshot of the note template 
addition that lists the correct codes for each 
procedure