Lessons learned from a single-center vascular quality improvement audit for thoracic and complex endovascular aortic repair.

Abstract

IntroductionThe Vascular Quality Initiative (VQI) of the Society for Vascular Surgery (SVS) is a collection of 14 registries that collects data on over 1,000,000 vascular procedures performed in North America. These registries exist in order to improve the quality, safety, and cost of vascular healthcare. Centers participating in the VQI are subject to routine audits to ensure accurate and comprehensive data entry. The aim of the study is to describe a single-institution experience with the VQI audit of the thoracic endovascular aortic repair (TEVAR)/complex endovascular aneurysm repair (EVAR) registry, highlighting the benefits and lessons learned from participating in the audit.MethodsIn 2022, our institution received a VQI audit notification to review all TEVAR/complex EVAR procedures performed between January 1^st, 2021 and December 31^st, 2021. The institutional financial department obtained claims validation data for all procedures billed under corresponding CPT codes for the listed dates. This was matched against the procedures entered manually into the VQI database by institutional data managers and abstracters. Mismatches between claims validation data and VQI entries were identified and sent to a coding specialist for review and possible revision.ResultsBetween January 1, 2021 and December 31, 2021, there were 125 unique TEVAR/complex EVAR patients identified by either the claims validation data or manually entered VQI registry data. Sixteen patients were listed in the VQI registry only and one patient was identified by claims validation data only, leaving 108 patients that were identified by both the registry and claims data, for an 86% (108/125) match rate. The audit revealed that 13 patients were incorrectly billed, of which 12/13 patients were incorrectly billed as TEVAR extensions (CPT 33886) instead of new TEVAR procedures (CPT 33880). Recoding and rebilling these patients had significant financial implications to the institution.ConclusionThis audit highlighted the importance of meticulous coding and manual review to maintain registry accuracy and optimize financial outcomes. Our findings underscore the necessity of ongoing education for coding and billing personnel and the value of VQI participation in identifying coding discrepancies and improving institutional practices.