Discordance in current procedural terminology coding for foot and ankle procedures between residents and attending surgeons

Abstract

Objective: Because of the importance of current procedural terminology (CPT) coding in both resident education evaluation and practice management, this study was undertaken to evaluate the correlation and interrater reliability between residents and attending physicians in CPT coding for orthopedic foot and ankle surgeries as well as to determine attending surgeons' and residents' familiarity with and confidence in the coding process.

Methods: CPT codes from resident case logs were compared with those submitted by attending surgeons, and Pearson's correlation coefficient and interrater reliability were calculated to examine coding congruency. An online survey was also used to examine attending surgeon and resident perceptions and habits regarding CPT codes and the coding process.

Results: CPT codes recorded by 20 residents (1164) were compared with those recorded by 3 attending foot and ankle surgeons (1259). Correlation between attending and resident codes was poor (r = -0.015). Interrater reliability demonstrated a kappa value of 0.04, indicating poor agreement. Compared with attending CPT coding, residents concordantly coded 42% of the time, with an individual resident range from 2% to 65%. Additionally, 43% of residents reported being uncomfortable about foot and ankle CPT coding, and they reported rarely or never discussing CPT codes with attending surgeons in the perioperative period.

Conclusions: Resident and attending surgeon concordance in CPT coding for foot and ankle procedures is poor, and residents have a low level of confidence in logging CPT codes, possibly because of a lack of training and preparation in coding. Because CPT coding is used not only for practice management but also has implications for evaluating institutions by accreditation bodies, educational initiatives to improve resident confidence and accuracy with CPT coding may be warranted.

Keywords: Medical Knowledge; Practice-Based Learning and Improvement; Systems-Based Practice; current procedural terminology codes; foot and ankle surgery; orthopedic surgery; residency.