ABSTRACT
Background Competent medical coding is key to maintaining a successful dermatology practice. Resident billing performance can have significant financial implications for the academic institutions employing them. During their residency training, dermatology residents commonly find themselves responsible for the billing of patient encounters. However, despite the importance of adequate knowledge and skill in medical coding, recent data show inadequacies in this aspect of resident education. The goal of this study is to evaluate the impact of an interventional coding curriculum on dermatology residents' billing accuracy at our institution. Methodology Billing data, including evaluation and management (E/M) level of service, procedural codes, and current procedural terminology modifiers (if applicable) were queried from the electronic medical records (EMR) at a resident clinic seeing patients on three half-days each week. Billing codes were gathered from patient visits occurring in two separate time periods, before and after the intervention. The intervention consisted of monthly resident lectures on E/M and procedural billing in outpatient dermatology with associated quizzes. Billing accuracy was verified by three attending dermatologists through chart review and compared between the two time periods. Results Overall, billing data from 532 patient visits, 267 from the pre-intervention period and 265 from the post-intervention period, were checked for accuracy. The accuracy of resident-billed E/M levels of service was similar between the pre- and post-intervention periods (44.3% vs. 44.8%). Similar rates of undercoding and overcoding were noted between the pre- and post-intervention periods (35.2% undercoded and 8% overcoded vs. 35.7% and 8.9%, respectively). However, substantial improvements were noted in the rate of errors with procedural codes and modifiers in the post-intervention period. Overall, 21.9% of procedural codes were incorrectly billed pre-intervention compared to 3.7% post-intervention (p < 0.05). Moreover, 55.2% of modifiers were incorrectly billed pre-intervention versus 27.3% post-intervention (p < 0.05). Conclusions Our analysis suggests that billing lectures yielded a clear improvement in resident billing accuracy at our institution. While there was no improvement in E/M coding, there was a significant improvement in the usage of procedural codes and modifiers. Similar analyses can be used by other residency programs to monitor resident billing performance and the efficacy of educational programs on medical billing.
ABSTRACT
BACKGROUND: In the SARS-CoV-2/COVID-19 pandemic, we need to understand the impact of immunomodulatory medications on COVID-19 symptom severity in patients with inflammatory diseases, including the type 2/Th2 polarized skin disease, atopic dermatitis (AD). OBJECTIVE: Because it is believed that type 1/Th1 immunity controls viral infections and that there is a Th1/Th2 counter-regulation, we hypothesized that Th2 targeting with the IL-4Rα-antagonist, dupilumab, in patients with moderate-to-severe AD would rebalance the Th1/Th2 axis, potentially leading to attenuated COVID-19 symptoms. METHODS: A total of 1237 patients with moderate-to-severe AD in the Icahn School of Medicine at Mount Sinai Department of Dermatology were enrolled in a registry. Patients were screened for COVID-19-related symptoms and assigned a severity score (asymptomatic [0]-fatal [5]). Scores were compared among 3 treatment groups: dupilumab (n = 632), other systemic treatments (n = 107), and limited/no treatment (n = 498). Demographic and comorbid covariates were adjusted by multivariate generalized logistic regression models. RESULTS: The dupilumab-treated group showed reduced incidence and severity of COVID-19 symptoms versus other treatment groups. Dupilumab-treated patients were less likely to experience moderate-to-severe symptoms versus patients on other systemics (P = .01) and on limited/no treatment (P = .04), and less likely to experience any symptoms versus patients on other systemics (P = .01). This effect was seen in our entire cohort and in the subgroup of patients with verified COVID-19 or high-risk exposure. CONCLUSIONS: Patients on dupilumab experienced less severe COVID-19 manifestations and lesser symptoms compared with patients on other systemics and on limited/no treatment. These results suggest that Th2 modulation with dupilumab may have a protective effect on anti-viral immune response in patients with AD.