Part B News | Benchmark of the Week

Oft-reported drug, injection codes often pass through cleanly

06/26/2017

You can give yourself a pat on the back for your drug-code billing — many of the most-reported drug codes showed low denial rates over calendar years 2014 and 2015.

Specialties billing million-plus new-patient E/Ms mostly beat denial curse

06/19/2017

by: Roy Edroso

Maybe practice makes perfect. Some specialties that billed new patient office E/M codes more than a million times in 2015 actually did well with them, compared with the generally high overall denial rate for those codes.

Modifier 78: Little used, and much denied — for some codes in particular

06/05/2017

by: Roy Edroso

Modifier 78 (Unplanned return to the operating/procedure room by the same physician) is a tough one to get accepted by Medicare contractors. In fact, an analysis of the most recent Medicare data available shows the aggregate denial rate for codes with 78 was 83%. But some codes do much better with it than others.

Hepatitis B screening, on the rise, projected to continue upward growth

05/22/2017

by: Richard Scott

Rising claims for the screening of hepatitis B virus (HBV) may have received an additional jolt after CMS expanded eligibility criteria to include more patients.

Few new codes in 2015 become widely used

05/15/2017

by: Roy Edroso

Most of the new CPT/HCPCS codes CMS added in 2015, the most recent year for which we have Medicare data, were not particularly lucrative — but some of them became very popular.

Post-op E/M codes tied to modifier 24 show fluctuating denial rates

05/08/2017

by: Richard Scott

During the three-year span from 2013 to 2015, providers generally achieved an increasing degree of success when reporting post-op E/M services with modifier 24 (Unrelated E/M service by the same physician during a postoperative period).

In surprise, AWV, IPPE use goes up, denials go down — even with 25

05/01/2017

by: Roy Edroso

The historically high denial rates on initial preventive physical examination (IPPE) and annual wellness visit (AWV) codes have seen a slight dip — even when billed with modifier 25 (Significantly, separately identifiable E/M service), commonly used when the physical results in a procedure.

Lab-code denial rates may augur increased scrutiny from auditors

04/24/2017

by: Richard Scott

You’ll find sky-high improper payment rates for several groupings of lab codes spanning glucose testing, urinalysis, blood counts and others, according to CMS data from the 2016 Improper Payments Report.

Primary care highest billers of hyperbaric treatment code – but denial rates stiff

04/17/2017

by: Roy Edroso

Medicare allows hyperbaric oxygen therapy for conditions ranging from cyanide poisoning to necrotizing fasciitis to decompression illness. But a remarkable number of the Medicare claims for 99183 (Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session) were supplied under primary care in 2015, according to the most recent Medicare claims data. And for providers of any kind, the denial rates weren’t so hot.

Practices see revenue gains for obesity-counseling code G0447

04/10/2017

by: Richard Scott

Payments for obesity-counseling code G0447 (Face-to-face behavioral counseling for obesity, 15 minutes) continue to climb as the service gains traction among medical practices.

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