The number of new patient E/M visits and initial hospital care codes skyrocketed from 2009 to 2010, driven by CMS’s decision to eliminate consult codes effective Jan. 1, 2010. All consult codes (99241-99255) were non-billable in 2010 and providers billed 99201-99205 and 99221-99223 instead. This shift in billing had no effect on denial rates, which fell for all the codes that replaced consults, a Part B News analysis shows.

Negotiating and renegotiating payer contracts can be a complex and extensive task, says Mark Misiunas, a contracting specialist who runs Managed Healthcare Solutions, LLC in Atlanta. The first step is to decide whether your practice has the resources to prepare for and engage in contracting talks with payers, which can last anywhere from 30 days to six months, he says.

A wide variety of procedures top the list of high-denial codes that also saw a big jump in utilization from 2009 to 2010, the latest year for which CMS claims data is available. NOTE: Lab codes and supply codes were excluded from analysis, as were codes with low utilization, low denial rates and/or low utilization growth over the one-year period. NOTE: A slew of E/M codes, such as 99201-99205 and 99304-99306, saw the biggest growth in billing and had fairly high denial rates, but their utilization increases were a direct result of 2010 being the first year CMS stopped using consult codes. These other E/M codes were used as a replacement, boosting their utilization artificially (see related story).

What CPT codes would be appropriate for excision and ligation of varicose veins in three anatomic locations? For example: “Excision of abnormal varicose vein clusters left mid-back (prone to rupture/bleeding), left distal anterior thigh, and distal right volar arm.”

Download this month's tool -- a spreadsheet showing how to set up utilization data and compare your allowables.

Use this tool to help calculate how much money you’re being paid by each payer and plan, for each of your top 25 codes, using the payers’ different allowables and your own utilization data to see whether one or more of your payers is paying much lower than others and your contract needs to be renegotiated.

Your nurse practitioners (NPs) and certified nurse midwives (CNMs) stand to collect $21,250 each under the Medicaid electronic health record (EHR) incentive program, a little-known fact because no non-physician practitioner (NPP) of any kind can participate in the Medicare EHR program, which pays out $18,000 in the first year. NOTE: Physician assistants working in a federally qualified health center or rural health clinic are also eligible for the Medicaid incentive.