Utility of rapid database searching for quality assurance: 'detective work' in uncovering radiology coding and billing errors

摘要

When the first quarter of 2010 Department of Radiology statistics were provided to the Section Chiefs, the authors (SH, BC) were alarmed to discover that Ultrasound showed a decrease of 2.5 percent in billed examinations. This seemed to be in direct contradistinction to the experience of the ultrasound faculty members and sonographers. Their experience was that they were far busier than during the same quarter of 2009. The one exception that all acknowledged was the month of February, 2010 when several major winter storms resulted in a much decreased Hospital admission and Emergency Department visit rate. Since these statistics in part help establish priorities for capital budget items, professional and technical staffing levels, and levels of incentive salary, they are taken very seriously. The availability of a desktop, Web-based R1S database search tool developed by two of the authors (WK, WB) and built-in database functions of the ultrasound miniPACS, made it possible for us very rapidly to develop and test hypotheses for why the number of billable examinations was declining in the face of what experience told the authors was an increasing number of examinations being performed. Within a short time, we identified the major cause as errors on the part of the company retained to verify billable Current Procedural Terminology (CPT) codes against ultrasound reports. This information is being used going forward to recover unbilled examinations and take measures to reduce or eliminate the types of coding errors that resulted in the problem.