Investigating the Problems of Coding Orthopedic Surgery Procedures in Iran Based on the Tariffs’ Book of Relative Values of Health Services

In Iran, the tariffs’ book of “Relative Values of Health Services” is the basis for calculating the costs of health services. Since orthopedic surgery is one of the largest fields of surgery in which most body tissues are involved, coding orthopedic procedures is more difficult. The present study aims to investigate the problems of coding orthopedic procedures using the Tariffs’ book.

This descriptive cross-sectional study was conducted in 2020 in university and non-university hospitals of Ahvaz, Iran. Participants were 73 people including orthopedic physicians, insurance experts, and revenue auditors who were selected by a census method. A questionnaire in two paper and online forms was used to collect information. The collected data were analyzed in SPSS software, version 22.

Among the problems of coding common in three groups, the biggest problem was related to the lack of an intelligent system for calculating the percentage of codes if they were multi-codes (78.75%). Regarding the adjustment codes, the highest level of familiarity was related to the code 51 about multiple surgeries (64.82%), and the lowest level was related to the code 20 about independent surgery ( 55.76 % ).

The development of an intelligent software for coding orthopedic procedures in Iran can facilitate the coding process and reduce the coding errors.