Coding Practices in Hand Surgery and Their Relationship to Surgeon Compensation Structure

PURPOSE: To evaluate the coding practices of hand surgeons in the American Society for Surgery of the Hand with respect to practice compensation structure using common, representative hand surgery cases. METHODS: We developed a survey of demographic factors and 4 commonly encountered hypothetical hand surgery cases. This survey was emailed to the members of the American Society for Surgery of the Hand. Respondents were asked to code these cases using prepopulated applicable Current Procedural Terminology codes or any other codes of their choosing. The membership responses were then compared with those of 3 independent orthopedic coders. RESULTS: Of the 4,477 invitations sent, a total of 421 (9.4%) respondents completed the survey. There was notable heterogeneity in the Current Procedural Terminology code choices for the trapeziectomy and distal radius fracture cases. Physicians with a collections-based model coded for significantly higher work-related value units on average compared with the fixed salary– and relative value unit–based physicians for the trapeziectomy case (14.41 vs 13.65 and 13.67, respectively; P < .05). The 3 independent coders all chose a single Current Procedural Terminology code for the carpal tunnel release, distal radius fracture, and scaphoid nonunion cases. The percentages of physician responses that selected only these codes were 84.6% (carpal tunnel release), 61.0% (distal radius fracture), and 73.6% (scaphoid nonunion). Physicians were less likely to code in line with the independent coders for the distal radius fracture case compared with other cases, particularly those physicians with a collections-based model. CONCLUSIONS: The compensation model may be associated with coding practices for more complicated hand cases. The additional work-related value units potentially billed can quickly accumulate for frequently performed procedures. This wide variation supports a need for more frequent and accessible communication and education on coding practices in hand surgery. CLINICAL RELEVANCE: Improved communication and education regarding appropriate coding practices as well as easily accessible reference material may assist in minimizing coding discrepancies for surgical hand procedures.