A frequent inquiry at the AANS regional coding and reimbursement courses concerns the use of handheld computers, or personal digital assistants (PDAs), as a component of information technology used to manage a neurosurgical practice. In a simplistic sense, the PDA is a compact storage device, with varying and often expandable memory capacity, which allows the user to access and store information. See PDA Primer
Although most of those who have PDAs use them as calendars and address books, the memory and recording capability of these tools coupled with the ease with which information can be exchanged suggests that we are underutilizing the PDAs in medical practice. Several examples that will be explored in this Coding Corner include reference resources, prescription writing and transmission, Evaluation and Management (E&M) documentation and coding, as well as surgical procedure code capture and submission.
The Resources Are Inside
The PDA can allow the physician to keep a variety of reference resources close at hand. For example, Handheldmed https://www.handheldmed.com sells multiple reference texts for the PDA, including Taber’s Medical Dictionary, the Washington Manual, Harrison’s Companion Handbook, and the Merck Manual. Although specific guides are available for some specialties see https://www.pocketmedicine.com, references specific to neurosurgery remain in development. Moreover, the growing availability of wireless access found on these machines can allow access to Medline and online journals from any location.
PDAs commonly are used for prescription writing and transmittal. Although simple completion of a prescription on a PDA may seem unnecessary, prescription-writing software reduces paperwork and allows the physician to check for drug interactions that may be harmful to the patient. An article in Medical Economics, “Electronic Prescribing: What Does Your State Allow?” https://www.memag.com, reviews the use of PDAs for electronic prescriptions and examines the state-by-state regulations concerning writing and transmission of electronic prescriptions. Also see
PDAs Promote PDQ in the Spring 2002 issue of the Bulletin. A variety of prescription-writing programs are available including AllScripts, ePhysician, ePocrates and iScribe.
However, the most desired application of PDA technology for physicians is the efficient capture of the procedural services that are provided to patients on a daily basis. Several programs are available on the Palm Operating System or the Windows CE platform to record and transmit patient encounter information. For example, one can document E&M services using a pop-down menu that allows entry of history, examination, and medical decision-making components of hospital and office patient encounters. Several programs suggest possible E&M levels of service to help navigate the complex documentation guidelines in determining the proper code to use. In addition, one can look up and record the surgical procedures performed to allow immediate access to procedural coding information and efficiently transmit charge data to the office computer. MD Coder for Neurosurgery by Mobile Design Technologies combines ICD-9, CPT, and patient tracking information to facilitate charge capture and documentation. A product available for a free online trial is Tops E&M Coder https://www.e-mds.com. Other programs include Pocket Billing, Pocket Practitioner, ZapCode and ZapBill. These and other products can be compared and purchased at https://www.pdamd.com and https://www.handheldmed.com.
IT Solutions for Benchmarking Daata Sought
Despite these innovations, neurosurgeons and other specialists continue to be limited by inadequate benchmarking data in the quest for effective practice management. Through a modified resolution originally presented by Robert Schwetschenau, MD, to the Council of State Neurosurgical Societies, an ad hoc committee has been formed, co-chaired by Mark Linskey, MD, and me, to organize practice managers around the country. We are inviting them to a meeting during the CSNS annual meeting in Philadelphia this September to explore the development of an independent organization that will facilitate collection of benchmarking data for overhead and professional liability costs, as well as provide a forum for discussing problems and solutions that might enhance the efficiency of everyone’s practice.
In conclusion, the obvious benefit to the neurosurgeon from the growth of information technology is the convenient availability of portable information storage and exchange. Although the PDA does not eliminate the need to document physician work and submit charges, it facilitates capture of physician work that was either previously collected on note cards or obtained long after the fact through hospital OR logs or chart reviews. However, in our current competitive reimbursement and liability environment, it behooves us to explore novel methods for improving practice accuracy and efficiency.
See Typical Day With a PDA to see how one doctor harnesses IT with a PDA.
Gregory J. Przybylski, MD, is associate professor of neurological surgery at Northwestern Memorial Faculty Foundation of Northwestern University in Chicago and a faculty member for AANS-sponsored coding and reimbursement courses.