Gollin, G and Moores, DM. "Turning whine into wine: The fiscal impact of comprehensive documentation and billing for non-operative pediatric surgical services." Journal of Pediatric Surgery 41.6 (2006): 1093-1095. ( 6/2006 )
Purpose: Many pediatric surgeons rarely document non-operative services, believing that the reimbursement provided for such care is negligible. We evaluated the impact of comprehensive documentation and billing for non-operative, pediatric surgical care.
Methods: All bills submitted for inpatient, non-operative care for one year were reviewed. Total receipts for documented admissions, consultations, critical care, and daily care were determined. The evaluation and management (E&M) code billed for each service was recorded and the total and average payment attributable to each E&M code was calculated.
Results: 58% of services were covered by Medicaid and 31% by a commercial insurer. There were 607 billed admission H&Ps for which reimbursement totaled $43,493. Critical care services were provided to 49 patients and yielded $8,964 in payments. 639 inpatient consultations were performed with a reimbursement of $42,830. Daily care services were billed 1044 times and produced $71,579 in payments. Overall reimbursement for documented, non-operative services was $166,866. This represented 16.2% of total, non-contracted income for the practice.
Conclusion: Despite a payer mix heavily weighted toward Medicaid, comprehensive documentation and billing for non-operative services increased total, non-contracted reimbursement by almost 20%. The yield from properly-documented, non-operative care can be substantial and, if done efficiently, worth the effort.