Consequences of Resident Case Unbundling on Future Billing Habits

Objectives: Recognize differences between CPT coding habits of otolaryngology residents compared to attending physicians, and analyze the possibility that resident case unbundling may affect future billing habits. Methods: A prospective survey was designed with four case scenarios reflecting four common procedures (septorhinoplasty, tympanomastoidectomy, thyroidectomy, and FESS) and presented to residents and staff physicians from Wayne State University. Respondents were asked to record up to 12 CPT codes for each procedure, per standard billing practices. Each procedure was accompanied by a list of all 17 categorized CPT codes found on the Accreditation Council for Graduate Medical Education (ACGME) Resident Case-Log system. The survey results were then analyzed to determine the number of CPT codes entered per case per respondent. Results: Seventeen responses to the survey were recorded (14 residents, 3 attendings). Multivariate analysis comparing resident and attending responses was performed using GraphPad. Residents entered, on average, 12.86 codes in total for the 4 scenarios, attending physicians entered 8.67 (t-test, p = 0.049). Further analysis, including comparison of individual scenarios and post-graduate year, did not yield significant results; however, in all but one scenario resident response numbers were consistently elevated per procedure compared to attending physician responses. Conclusions: The practice of CPT code case unbundling in residency may affect future billing habits. Our small study indicates residents regularly over-code routine surgical procedures compared to attending physician practices. An extension of the surveyed population will allow us to increase our data and hopefully establish wider conclusions.