Optimize Your OR by Reframing How You Use CPT Codes

Current Procedural Terminology, or CPT coding, has become the industry standard for classifying medical procedures for claims processing, and more.   Many hospitals are attempting to use CPT codes to schedule surgery cases, often with vast negative unintended consequences in terms of OR access, escalating supply costs, and inaccurate schedules.

CPT codes were initially developed by the US Department of Health and Human Services to keep day-to-day operations efficient and organized. But as healthcare continually advances, the opposite has become true for many ORs. 

We’ll summarize how organizations can optimize the ways in which they use CPT codes to increase efficiency.

Common Issues With CPT Codes

While CPT codes are meant to help organizations stay organized, they have now reached a granularity that can make it difficult to achieve efficiency. 

Issues With CPT Codes for Scheduling

The main issue when it comes to using CPT codes for surgery scheduling is that surgeons often do not know exactly what will be required for a procedure before it begins. CPT codes are designed with specificity in mind, but this level of specificity simply cannot be known before the procedure. In turn, using CPT codes for scheduling results in inaccuracies and becomes counterproductive.

Here are just a few examples of this in action:

  • Reconstructions and Exploratory Lap: during certain operations regarding hand or facial reconstruction surgeries, the exact procedures that need to be performed will not be known until after surgery, making it difficult (if not impossible) to build procedure files when scheduling.
  • Pathology reports: CPT coding systems need a tumor designation of “benign” or “malignant” before a correct code can be assigned. It is not uncommon for tumors identified as malignant on frozen section examination to be listed as benign on the final pathology report.
  • Excision, mass, or tumor removal: the size of a lesion or tumor determines which CPT code is assigned to it. However, this cannot be accurately determined during scheduling.
  • Multiple-procedures: several common, multiple-procedure cases are scheduled as one procedure to save time. This can cause the CPT codes to be inaccurate.
  • Surgeons don’t often schedule with CPT codes: it is often the case that surgeons don’t know the exact details of a procedure until the patient is under the knife, making accurate scheduling ahead of time nearly impossible. For example, although surgeons may know how many grafts or jumps they are going to do during a coronary artery bypass graft (CABG) procedure, they often do not know what they will use for the jump until they see how the vessels look.
  • Information systems are unoptimized: surgery information systems typically take into account each surgeon’s history in order to calculate certain factors such as case duration estimates. If the files are based on CPT codes, it becomes difficult for the systems to identify an accurate surgeon-specific estimate. It is also extremely tedious for surgery department staff to have to sort through hundreds of CPT codes, while cross-referencing the surgeon’s notes, in order to identify the proper one.

Why Not Create Procedures Cards For Each CPT Code?

Debates about using CPT codes for the OR procedure file are not uncommon within healthcare organizations. However, creating procedures based on CPT codes is a bad approach for not only the reasons cited above, but also because they are too specific and can be confused with the procedure that actually is performed. 

Procedures should be coded only after all relevant information, including pathology, is available, with an optional field for CPT codes in the booking and case documentation phases. 

How Sullivan Healthcare Consulting Optimizes CPT Code Management

Because healthcare continues to evolve and medical procedures are becoming ever-granular, there are now hundreds of thousands of CPT codes and modifiers. Sullivan Healthcare Consulting has worked with hundreds of organizations and observed how CPT code misuse can cause hindrances including issues in scheduling and billing departments. 

Sullivan has been creating a new standard in CPT code use cases for the past 15 years. 

Our approach is to work with client organizations to help them group procedures into preference cards that utilize similar equipment and methods. We encourage healthcare facilities to focus on the top 20 procedures performed each year at their organization. Generally, staff does not need to maintain preference cards for procedures done once or twice yearly. It is much easier to identify those that are being done 4 or 5 times per week and keep those in order, which helps increase operational efficiencies.

Sullivan experts also recognize that this strategy is often easy to grasp in theory, but hard to adopt in practice. Having had careers as healthcare professionals ourselves, we know how difficult it can be for surgeons and leaders to overhaul such processes. That’s why we take the time to work with leadership teams to find out how we can make seamless, gradual shifts and realize how they make measurable impacts on operations, and ultimately, their bottom line.

Sullivan Is Your Partner in Optimizing Hospital Efficiency

Our team of seasoned, leading-edge perioperative experts has helped hundreds of healthcare organizations manage higher margins by optimizing surgical services. We’ve been improving the ways in which CPT codes are utilized in order to boost operational and billing efficiencies for healthcare organizations just like yours.

Our recommendations are always realistic, achievable, and sustainable over the long haul. 
To learn more or to schedule a consultation, get in touch today!

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