In his book “Atomic Habits,” James Clear writes “too often, we convince ourselves that massive results require massive action.” Neurosurgeons transitioning from residency to practice seem to have this perspective when it comes to CPT coding. With all the challenges they face in their transition, CPT coding seldom makes it to the top of list of priorities. After all, who has time to take a comprehensive coding course on neurosurgical procedures in the midst of moving and starting a practice? However, Clear argues quite successfully throughout his book that the exact opposite fosters the improvement. Massive results come from small actions, over time. One conscious decision to improve a little bit every day will make a tremendous difference. Clear writes: “improving by 1% isn’t particularly notable, sometimes it isn’t even noticeable, but it can be far more meaningful, especially in the long run.” The “long run” is your neurosurgical career, while the short term is your case submission for ABNS Board certification.
Among the data that ABNS candidates need to submit for their ABNS Patient Outcomes of Surgical Therapies (POST) case logs, accurate CPT codes for the procedure performed are critical. The neurosurgeon who makes the conscious decision to learn CPT coding during the ABNS POST case submission process will be in a very different position than the neurosurgeon who does not at the end of case collection and submission process. The one percent that needs to be put into practice is something as straightforward as looking up the CPT code which was billed for the procedure, using a coding manual or an online resource for the procedures that you routinely perform. Eventually, this routine may lead to a comprehensive neurosurgical coding course. The impact of incorporating that one decision and that one action will pay immediate dividends over the course of your ABNS POST case log submission. For a neurosurgeon early in his/her career, this “atomic habit” will also create a better understanding of the billing and coding practices they work under. But the real benefit may be realized over the long term. Imagine the value to a neurosurgeon who achieves a mastery of neurosurgical coding over the span of a 20- or 30-year career. It may be difficult to fathom in terms of maximizing remuneration and peace of mind.
The opposite has the potential to lead to dire consequences. Ignoring knowledge gaps in CPT coding can lead to calamitous consequences. In the review of a case log that required a systematic review for coding issues, an ABNS candidate wrote the following, “I apologize for my limited knowledge when it comes to billing and coding. Coding was not something that they taught us in residency. After residency, I took a job with the same program where I did my training. As an employed physician there, our billers and coders submit the CPT codes and do the billing for the program. Therefore, my involvement, or the involvement of any physician, is quite limited.”
In the past 24 months, 25% of all case logs submitted to the ABNS had coding concerns. These concerns can rise to a level that may prompt an additional audit of the entire case log or even a hearing with the ABNS Board. In addition, taking the ABNS oral exam can be one of the most stressful experiences of a neurosurgeon’s career; having to spend valuable time defending the use of a CPT code is not the moment to realize one is responsible for the code submitted.
While none of those options sound particularly appealing, they pale in comparison with a Department of Justice settlement. A quick review of health care fraud settlements revealed that routine miscoding of neurosurgical procedures led to settlements in the millions of dollars. It is important to note that in many of these settlements, surgeons performed the appropriate procedures for their patients. It was the coding that was incorrect. From that standpoint another one of James Clear’s statements is quite prescient: “A single decision is easy to dismiss, but when we repeat 1% errors day after day by replicating poor decisions, duplicating tiny mistakes, and rationalizing little excuses, our small choices compound into toxic results.”
The transition from a neurosurgery residency to practice should be a clarion call to begin learning neurosurgery CPT coding. A board-eligible neurosurgeon should consider adding mastery of CPT coding as one of their goals to achieve over the ABNS case collection and case log submission process. That one conscious decision to improve coding knowledge by 1% every month, every week or everyday, will pay long term dividends. In the short term, it will provide the ABNS candidate with the confidence that their ABNS POST case log submission will avoid the potential and avoidable turbulence of coding concerns that can require extensive revisions, multiple queries and resubmissions. That conscious effort to learn coding will dispel the notion that CPT is an enigmatic and cryptic entity. In the long term, it will provide the neurosurgeon with the knowledge that codes submitted accurately capture the work they performed at the time of surgery and provide the peace of mind throughout a career that only coding certitude can afford.
One final thought regarding the transition from neurosurgery residency to practice from “Atomic Habits”… “Time magnifies the margin between success and failure. It will multiply whatever you feed it.” Among the things you feed post-residency, feed CPT knowledge. There is no better time to start that process, and there is no better investment of that time. The Atomic Habits that you form over the span of your case collection will form the foundations very fulfilling and enriching neurosurgical career.
It all begins with that first step…
