ABSTRACT
Background: In a large teaching institution with providers of various levels of training and backgrounds, and a coding department responsible for all evaluation and management (E&M) billing, variations in documentation can hinder accurate medical management and compensation. The purpose of this study is to assess differences in re-imbursement between templated and non-templated outpatient documentation for patients who eventually underwent single level lumbar microdiscectomy and anterior cervical discectomy and fusion (ACDF) both before and after the E&M billing changes were implemented in 2021. Methods: Data was collected from three spine surgeons on 41 patients who underwent a single level lumbar microdiscectomy at a tertiary care center from July 2018 to June 2019 and 35 patients seen by four spine surgeons from January through December of 2021 given the new E&M billing changes. ACDF data was collected for 52 patients between 2018 and 2019 for three spine surgeons and 30 patients from January through December of 2021 from four spine surgeons. Billing level was decided by independent coders for preoperative visits. Results: During the study period from 2018-2019 for lumbar microdiscectomy, each surgeon averaged about 14 patients. Results showed variability of billing level between the three spine surgeons (surgeon 1, 3.2±0.4; surgeon 2, 3.5±0.6; and surgeon 3, 2.9±0.8). Interestingly, even after the implementation of the 2021 E&M billing changes, there was a statistically significant increased level of billing for templated notes for lumbar microdiscectomy (P=0.013). However, this did not translate to the clinic visits for patients who underwent ACDF in 2021. When data was aggregated for all the patients from 2021 who either underwent lumbar microdiscectomy or ACDF, using a template still resulted in a statistically significant higher level of billing (P<0.05). Conclusions: Utilization of templates for clinical documentation reduces variability in billing codes. This impacts subsequent reimbursements and potentially prevents significant financial losses at large tertiary care facilities.
ABSTRACT
Early investigations into the magnetic resonance imaging (MRI) appearance of articular cartilage imaging relied on assessment of the morphology, with subsequent investigators reporting identifying increased T2 signal intensity, bright signal, in degenerated cartilage. The cartilage "black line sign" is a finding that has recently been described in the radiology literature to characterize cartilage pathology. This sign refers to a focal linear hypointense signal within articular cartilage that is oriented perpendicular to the subchondral bone on T2-weighted MRI. The diagnostic significance and clinical relevance of this sign is debated. Since its first description, several papers have further delineated the etiology, prevalence, and clinical relevance of these and other dark cartilage abnormalities. The intent of this article is to summarize these findings, with hopes of bringing to light the importance of dark cartilage lesions and their clinical implication in the world of knee surgery. We will briefly discuss the most probable etiologies of dark cartilage abnormalities and the major factors determining the unique signal intensity. The described anatomical patterns of this finding, the clinical importance, potential mimics, and current treatment recommendations will be reviewed.
