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Benchmark of the Week

Of the 82 CPT codes that are to be cleared out as part of the latest CPT changes, two popular codes slated for deletion may especially have an effect on your revenue if you’re not paying attention.


Get ready to pivot to a new suite of imaging codes in 2018 to avoid revenue disruptions that may occur as a slate of current X-ray codes go on the chopping block.

Take note of some interesting patterns among specialties when it comes to hospital inpatient codes, even if the codes’ utilization and denial rates haven’t changed much in recent years.

Many specialty groups beyond primary care took in significant chronic care management (CCM) payments in 2015, with the $31.3 million in reimbursement spread across dozens of specialties.


Of the six eye exam codes eye that will be bundled in new CCI code pairs, four had relatively stable denial rates between 2011 and 2015 — but two of them had remarkably high and much less stable denial rates.

Some specialty providers, including those in pathology, nephrology and orthopedic surgery, may have a difficult time seizing payments for apheresis services following a supervision change in one Medicare administrative contractor’s (MAC’s) jurisdiction.

With a few exceptions, Medicare providers seem to have a pretty good understanding of modifier 26 (Professional services) and see denial rates mostly lower than 10%, though some notable exceptions exist.

As a new flu vaccine debuts in 2017, the vaccine’s billing rules hold cross-specialty appeal because primary care providers are not the only ones to report flu claims.
The use of therapy modifiers — GO (Services delivered under an outpatient speech language pathology plan of care); GN (Services delivered under an outpatient occupational therapy plan of care); or GP (Services delivered under an outpatient physical therapy plan of care) — changes the billing results on always- and sometimes-therapy codes, especially if you’re a therapy provider using the wrong one.
Payments for E/M services appended with modifier 25 (Significant, separately identifiable E/M service) topped $2.5 billion in 2015, according to the latest available Medicare claims data.


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