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Benchmark of the Week
The series of preventive services codes that practices turned to most frequently did not change much between 2018 and 2019, except that their utilization continues to climb.
by: Roy Edroso
CMS has been pushing for wider use of its behavioral health codes, which you can see in the big push to get providers to use 99483 (Assessment of and care planning for a patient with cognitive impairment). The uptake has been on the slow side, but signals are flashing that the pace may pick up over time.
Watch a recent addition to the HHS Office of Inspector General’s (OIG) Work Plan: It may have implications for practices that frequently report a procedure and an E/M visit during the same patient encounter.
You might expect that the most-used codes billed under place of service (POS) 11 (Office) would closely mirror the most-reported codes overall. But aside from the two most popular E/M codes, they don’t much overlap.
Medical practices returned reams of money on leading services that they reported with modifier 26 (Professional component), including a spate of X-ray codes, tissue exams and other testing codes.
In a recent five-year span, the use of inpatient codes declined at a faster rate than they had in previous years, and denial rates dropped even more quickly.
Mastering the use of modifiers can be lucrative business for physician practices, as the latest modifier 59 (Distinct procedural service) utilization numbers reveal. In 2019, providers pulled in nearly $1.5 billion from Medicare on thousands of codes paired with the modifier.
Though CMS estimates that one in five Americans aged 65 years and over has either type 1 or type 2 diabetes, Medicare’s codes for services that help diabetic patients cope with their disease have not performed very strongly in recent years, and are beset with high denial rates.
Providers pulled in nearly $1.5 billion in payments for subsequent nursing facility encounters in 2019, continuing a strong rate of growth largely fueled by an uptick in nurse practitioner visits.
While it’s not used as often as other care management services in Medicare Part B, transitional care management (TCM) has witnessed steady growth overall, and its denial rates remain low. But there are some provider types claiming from some facility types that don’t do so well with them.


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