Bentley PN, Wilson AG, Derwin ME, et al. Reliability of assigning correct current procedural terminology-4 E/M codes. Ann Emerg Med 2002; 40:269-274.

Agreement in coding of emergency charts between coding agencies was only poor to fair, and the distribution of assigned Current Procedural Terminology (CPT)-4 codes was significantly different, says this study from William Beaumont Hospital System in Royal Oak, MI. The researchers did three prospective trials, with two interagency audits and one intra-agency audit. In addition to poor agreement in coding, they found that the distribution of CPT-4 codes was different significantly in each group. "We find this latter observation startling and disturbing, and if generalizable, this will have important economic and legal ramifications," they wrote, pointing to the possibility of prosecution for billing fraud. They suggest the following solutions:

  • using templates to reduce variation of documentation;
  • requiring more rigorous formatting of dictations for more consistent documentation;
  • performing a more thorough review of documentation guidelines provided by the Baltimore-based Centers for Medicaid & Medicare Services for use in assigning CPT codes.