Orthopedic Coding Alert

Comparing your code use with CMS' statistics may not be completely accurate because the CMS database lists only Medicare utilization data, whereas your patients are probably not 100 percent Medicare. Many compliance consultants recommend measuring only your Medicare charts to the CMS data to ensure continuity.

A more involved method allows you to compare overall medical complexity in your office to Medicare's averages. Frank Cohen, senior analyst at Medical Information Technology Systems, a national healthcare consulting firm, coined the phrase the "Cohen acuity factor," or CAF, to describe this.

"You can compare your practice's data to CMS' by reviewing the complexity of diagnosis and treatment for a typical Medicare patient and measuring that information against the practice's," Cohen says. To do this, he recommends reviewing all procedure codes with relative value units (RVUs) assigned to them. He advises practices to add all of the RVUs together, then add the number of procedures in the group. Divide the number of procedures into the number of RVUs to get an RVU per procedure.

"The RVU is supposed to represent the overall resources consumed, and that is measured largely by the complexity of the encounter," Cohen says. He advises the practice to then add together all of the orthopedic codes they use and get an RVU per procedure within the office. "Let's say the national average RVU per procedure for orthopedic surgery was 3.5, and at this practice it's 4.5. That means the practice's patients have a higher level of overall medical complexity than the general Medicare population. Therefore, we'd expect their E/M utilization to be a little higher than average."