Introduction: Anesthesiologists' pre-operative evaluation records may allow hospitals to improve facility fee charge capture by correctly identifying concurrent disease. Hospitals typically are reimbursed for care through a prospective payment system based on diagnosis related groups (DRGs). Payment for DRGs is based on the weight of the DRG and the federally determined hospital rate (DRG payment = weight * rate). While developed for Medicare and Medicaid, many payers have adopted the methodology. When complications and comorbidities (CC) are identified, the DRG may change to a more highly reimbursed one that reflects the increased utilization of hospital resources. Most hospitals rely on the hand-written record, especially for anesthesia records. A structured response form has previously demonstrated improved data capture in the Anesthesia Pre-Operative Evaluation (APE) (1).
Methods: In this retrospective coding data analysis, billing records, APEs, and DRGs were reviewed. The DRG with and without the additional information from the APE as well as the hospital charge for the two DRGs were collected without the use of patient identifiers. APEs at this institution were hand-written using a structured response format that included space for free text entries. Records that had changes in coding based on the information on the APE were identified.
Results: Data were collected for 8350 cases in the 12-month period from March 2005 through February 2006. 65 cases (0.78 %) were identified in which the APE contributed to a change in coding. The mean charge for these cases was $15,197 with the additional information versus a calculated mean charge of $8,393 without APE information, for a difference of $6,804 per case and a total of $442,252 in additional charges due to proper coding over that time period. For records in which the inclusion of APE information changed the DRG, the average weight of the DRG increased from 1.2340 to 2.2410.
Discussion: This study demonstrates that APE information can be used to improve hospital facility fee charge capture. While other studies have shown that the electronic record improves charges capture (2), this study demonstrates that manual structured-response forms also have significant contributions to increased facility fee coding. A complete APE can contribute to additional funds for the hospital by appropriately identifying existing CC. This increase in charges (and concomitant increase in revenue) should be considered when analyzing the financial contributions of the anesthesiology department.
Conclusion: A detailed anesthesia pre-operative evaluation results in increased charges by the hospital by allowing correct coding that appropriately identifies comorbidities and complications.
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