Part B News | Benchmark of the Week

Repeat modifier 76 works great in most cases – but sometimes wipes out

02/17/2020

Modifier 76 (Repeat procedure or service by same physician) is a pretty good bet in most cases, but there are a lot of codes for which it’s seldom or never accepted.

One genomic testing code skyrockets, another fluctuates, but denials remain lofty

02/10/2020

by: Jim Dresbach

As practices find expanded coverage of Next Generation Sequencing tests, two CPT codes used most frequently — 81432 (Genomic sequencing procedures and other molecular multianalyte assays) and 81445 (Targeted genomic sequence panel, neoplasm, 5-50 genes) — are on divergent paths.

Sleep study codes hold steady – but CPAP startup code is a denial trap

02/03/2020

by: Roy Edroso

While sleep studies and continuous positive airway pressure (CPAP) devices are getting more popular, Medicare billing for them so far has held pretty steady. But as the tough denial rates for a major CPAP code show, you still have to be careful about billing them.

Hyberbaric oxygen therapy claims, under CMS’ gaze, seesaw between 2015 and 2018

01/27/2020

by: Jim Dresbach

Medicare claims data for non-emergent hyperbaric oxygen (HBO) therapy and the introduction of a prior authorization model to support the procedure disclosed numbers that show the CMS program is working as intended — to curtail overuse.

Nurse practitioners, physician assistants kept rising in 2018, but other NPPs faltered

01/20/2020

by: Roy Edroso

Even before the accommodations that CMS made for non-physician practitioners (NPPs) kicked in this year, the two biggest NPP specialties in Medicare were performing in overdrive. Other NPP groups, however, are falling off the pace.

Payments tied to advance care planning codes 99497, 99498 enjoy three-year climb

01/13/2020

by: Jim Dresbach

The time-based codes for advance care planning (ACP), 99497 and 99498, that debuted in 2016 have witnessed strong utilization and payment increases over the past three years.

Practices express desire to use new CCM codes, while virtual visits remain untapped

01/06/2020

by: Richard Scott

Many providers anticipate seizing the new chronic care management (CCM) add-on code that’s debuting Jan. 1, 2020, but far fewer plan to dive into the virtual realm of tech-backed E/M services in the new year.

Even without being required, X modifier use is on the upswing

12/30/2019

by: Roy Edroso

Despite CMS’ dithering, X modifiers seem to have picked up some slack from modifier 59 (Distinct procedural service) since being introduced in 2015.

Multiple specialties zapped by 99201 denials as claims, revenue plummet

12/16/2019

by: James Dresbach

Nurse practitioners, orthopedic surgeons, general surgeons and family practice providers have all faced significant hurdles with their 99201 claims, with denial rates ranging from 10% to 22% in 2018, the latest year of available Medicare claims data. But no specialty matched chiropractic’s dismal return — a 100% denial rate on nearly 93,000 services, with a loss of $5 million.

Growth in use, and decline in denials, may have doomed old biopsy codes

12/09/2019

by: Roy Edroso

The two skin biopsy codes that were replaced by six more specific codes this year experienced huge growth in the past 10 years, which may explain why the switch was made.

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