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Benchmark of the Week
There are 115 CPT codes accepted by Medicare that relate to the removal of a foreign body, and in 2016, the most recent year for which we have Medicare data, they were used only 491,376 times, with 18 codes being used fewer than 100 times, and 62163 (Neuroendoscopy, intracranial; with retrieval of foreign body) used zero times.
As CMS considers significant E/M pay revisions, your reimbursement may vary based on the exact proposals the agency winds up adopting. The chart below compares the pay-rate differences between the current E/M rates and the single-stream rates for codes 99212-99215. The chart also details the positive impact of the proposed add-on codes that would apply to a dozen specialists.

Many specialists who often report blood-draw code 36415 (Collection of venous blood by venipuncture) outperform their peers in a comparison of national denial rates, according to Medicare claims data from 2016, the latest year available.


If you’re wondering whether you have a good chance of getting paid for the patient monitoring code 99091, newly unbundled in 2019, the current utilization and denial rates of other remote care codes give you some reason for optimism

Some specialties, including podiatry and dermatology, would see a significant pay increase for E/M services should CMS’ proposal to group level 2 through 5 outpatient codes into one payment basket go into effect on Jan. 1, according to a reimbursement estimates contained in the proposed 2019 Medicare physician fee schedule released July 12.
Modifier 25 (Significant, separately identifiable E/M service) is, as the name implies, supposed to be used with E/M codes to distinguish the work done on those codes from other services that would ordinarily be bundled with them. But some non-E/M codes were logged with 25 on claims, and a few had surprisingly low denial rates.

Family practice and internal medicine providers would be big winners under a revamped E/M payment scheme recommended by the Medicare Payment Advisory Commission (MedPAC).

Non-physician practitioners (NPPs) have lower-than-average denial rates on E/Ms, but our analysis suggests they have trouble with other types of codes. 
Practices that perform transitional care management (TCM) services (99495-99496) should work with inpatient facili­ties to confirm the date a patient was discharged. The documentation for TCM services should include the date the patient was discharged from an inpatient facility, such as a hospital or skilled nursing facility. However, a comparative billing report performed last year found that some TCM claims did not have a matching discharge record from the facility.
Practices around the country are providing a greater number of obesity-counseling services, as the 307,000 claims of G0447 (Face-to-face behavioral counseling for obesity, 15 minutes) in 2016 indicate.


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