Accurate Documentation
& Billing of
Implant(s) Used

Intervention

• Educating sessions were conducted with OT nurses on implant documentation issues and billing errors.
• Vendor to send summary of invoices to OT nurse clinician for follow up. After validation, nurse clinician to send endorsed invoices to acknowledge the invoices were received and processed for payment.
• Billing codes created for all implants used in Orthopaedic surgical procedures, associated with accurate pricing, based on contract.
• In the new electronic medical record system, implant description include size, reference no. are built in with auto population of billing code and price.
• Revised workflow on dispatching invoices, OT clerk also email to MMD the summary of endorsed invoices collated.

Cost Savings

Estimated time savings from nursing documentation per orthopaedic surgical procedure: 10mins, translate into nursing manpower savings:

• Cost for Average Staffing per OT, per 10 minutes (per case): $7.73
• Cost for Average Staffing per OT (average 3 cases per OT), per 30 minutes: $23.19
• Cost for Average Staffing for 6 OTs (average 3 cases per OT), per 30 minutes for 80 days: $11,131.2

This is exclusive of other savings e.g. energy savings and ability to increase OT utilization from saved time.

Problems Encountered

• Time consuming in identifying implant without billing code at the initial stage, targeted into sub-specialty, e.g. adult recon, spine etc.
• Staff unable to find the product in system by using the reference number on the physical packaging, as the product reference number in the contract is different from the physical packaging. Included reference number on physical packaging in electronic medical record system
• Implants with revised pricing, nurse clinician did not send updated quotation to Ops support team for billing code price revision.
• Non diligent in documenting implant quantity.

Strategies for Sustaining the Gains

• Continuous training for OT Staff to be more vigilant while documenting implants used in OT
• Constant monitoring and maintenance to ensure implant price & description are accurate
• Timely feedback to check on the issues faced by ground staff
• Sharing and implementing in other surgical disciplines.

Lessons Learned

• Effective communication with team members and stakeholders
• Seeking feedback from ground continuously
• Concerted effort from all staff and teamwork is important.
• Constant monitoring and maintenance is essential.
• Frequent training to the ground staff

Presented at:

OR Manager Conference third place poster winner showcases impactful documentation, billing improvements of implants in orthopedic surgery

The poster presentations at the 2024 OR Manager Conference showcased exceptional perioperative initiatives, highlighting advancements and innovative practices. From streamlining documentation and optimizing billing processes to ensuring patient and staff safety in postanesthesia settings, the posters selected last year showed the ingenuity and dedication of healthcare professionals committed to excellence in perioperative care.

This year’s third place poster winner, presented by Lee Sow Fong, Zhang Yaqin, and Edwin Lim, was an orthopedic implant documentation and billing initiative. The project aimed to improve accuracy by addressing issues such as non-specific billing codes, incorrect implant pricing, and misplaced invoices. Interventions included staff training, streamlined workflows, creation of specific billing codes, and integration of implant descriptions into the electronic health record (EHR). These efforts saved some 10 minutes per procedure and improved billing accuracy. Challenges like mismatched reference numbers and delayed pricing updates were addressed through continuous monitoring and feedback. The initiative has been expanded to other surgical specialties to replicate its success. 

Q: What sparked the interest and need for this initiative?

Yaqin: There was an increasing trend in requests to approve bill amendments and adjustments mostly related to implants. With the feedback from respective nursing officers and frontline staff on implant documentation and billing process, the project was initiated to address the challenges and issues faced by staff.

Q: Can you share details of the pilot?

Yaqin: This initiative was piloted with orthopedic surgery because of its high usage of surgical implant. Firstly, we identified the implants with no billing code. Then we grouped the implant based on categories such as adult reconstruction, sports, spine, trauma-related, and so forth. The project was implemented in phases to create a billing code, and the researchers worked with a new EHR system to associate the billing code and price with the implant description which include size and reference number:

• Phase I: Focus on knee, hip, shoulder & sports-related implants
• Phase II: Spine implants
• Phase III: Trauma-related implants

Q: What was the process of getting multiple stakeholders on board?

Yaqin: Meetings were conducted with stakeholders to understand the challenges faced by frontline staff and gather feedback. After that, we engaged the nursing officers and frontline nursing staff to streamline the implant description to establish standardization and eliminate confusion and inefficiency. Meanwhile, we worked with nursing officers to improve on the process of dispatching invoices.

Q: What are the big takeaways from this initiative? 

Yaqin: The takeaways from this initiative includes but are not limited to the following:

• Improved efficiency: Streamlined descriptions of implants generated an estimated time savings of about 10 minutes per orthopedic surgical procedure.
• Enhanced accuracy: The billing codes and prices are associated with the implant descriptions in the new EHR system, which prevents documentation errors in prices or size orders of implants.

Q: What's next?

Yaqin: This initiative had been shared with the following surgical disciplines who encounter high usage of implants:

• Cataract and glaucoma implants in ophthalmology
• Ear, hearing, and cochlear implants in otorhinolaryngology
• Urogenital implants in urology

Billing codes are being created and implant descriptions are being updated in the new EHR system. We expect to see similar time saving benefits in these disciplines as well.