Part B News | Benchmark of the Week

Foreign body codes usually get over, but watch for problems – and play the odds on 65210

08/13/2018

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.

Add-on E/M codes produce payment gains under CMS proposals

08/13/2018

by: Richard Scott

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.

Oft-reported venipuncture code shows scant denial rates among most specialists

08/06/2018

by: Richard Scott

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.

Denial rates on current remote codes suggest good odds for newly-unbundled 99091

07/30/2018

by: Roy Edroso

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

Single-rate E/M pay structure creates winners, losers under proposed fee schedule

07/23/2018

by: Richard Scott

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 used on non-E/M codes gets surprisingly forgiving denial rates

07/16/2018

by: Roy Edroso

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.

07/09/2018

by: Richard Scott

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).

Outside of E/Ms, surgical team and injections, NPPs have denial trouble

07/02/2018

by: Roy Edroso

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.

Check the discharge: TCM claims should be backed by the inpatient discharge record

06/25/2018

by: Julia Kyles, CPC

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.

Obesity-counseling claims keep rising but high denial rates stick

06/18/2018

by: Richard Scott

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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