Transactions for the 2005 Council on Resident Education in Obstetrics and Gynecology and The Association of Professors of Gynecology and Obstetrics Annual Meeting
Development and assessment of a Web-based evaluation and management coding curriculum for residents

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Objective

The purpose was to assess a Web-based learning module for residents on evaluation and management coding, and to determine whether using a point system based on reimbursement is an effective way to measure improvement in performance.

Study design

Nineteen residents at a university-based residency completed an online module on evaluation and management coding. Pretest and posttest were administered consisting of 10 actual patient notes from which to abstract the level of service. Tests were scored by percent correct as well as assigning points to correct responses equal to 2004 Medicare reimbursement for that item's level of service. Incorrect responses were debited points equal to the absolute difference in reimbursement between the incorrect and correct evaluation and management level.

Results

Average percent correct was 44.2 on the pretest and 45.3 on the posttest (P = 1.0), with only 47% of subjects improving their performance. The mean point score was 513.44 on the pretest and 555.87 on the posttest (P = .02), with 84% improving. Most subjects (84%) rated the module equal or superior to a didactic format and felt that their knowledge was improved by the exercise.

Conclusion

An electronic learning module on evaluation and management coding for residents, using scoring based on reimbursement schedules, is effective for instruction and assessment and well accepted by learners.

Section snippets

Material and methods

The study population consisted of obstetrics and gynecology residents at the Medical College of Wisconsin Affiliated Hospitals. Residents were assigned an electronic online teaching module on the topic of E&M coding and documentation in the outpatient setting. The author and the departmental professional billing staff composed the learning module. It was conducted using the ANGEL electronic course management system (CyberLearning Labs, Indianapolis, IN) that is in use at the Medical College of

Results

Twenty-one residents completed the online module. Of these, 19 consented to have their data used for analysis. The mean score on the pretest was 44.2% (range 10% to 70%) using percent correct scoring and 513.44 (range 274.00 to 620.89) using point scoring. The mean score on the posttest was 45.3% using percent correct scoring and 555.87 (range 409.74 to 633.36) using point scoring . Only 47.4% of residents (9 of 19) improved their performance after completion of the module when assessed by

Comment

Understanding proper coding and documentation helps to develop practice habits that save time, ensure proper reimbursement, and protect both from fraud allegations and medical malpractice claims. To the practicing physician, the importance of understanding E&M coding and documentation is obvious. Despite its importance, physicians commonly report insecurity in their own competence in this area. The literature bears this out, showing marked discrepancies between levels of service coded versus

Acknowledgment

I thank Donna Kroening, CCS, for her invaluable help in the preparation of the E&M coding module as well as William Herbert, MD, and the rest of the faculty of the Association of Professors of Gynecology and Obstetrics/Solvay Educational Scholars Development Program for substantive guidance and advice.

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