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Benchmark of the Week
Specialty winners and losers: Who’s up, who’s down under 2020 fee schedule
11/18/2019
by: Richard Scott and Laura Evans, CPC
Ophthalmology and vascular surgery are among the specialty groups expected to take a payment hit in 2020, while clinical social workers, clinical psychologists and podiatrists are slated for a reimbursement bump.
Smoking cessation codes use grows – and so do denials
11/11/2019
by: Roy Edroso
As new coding guidelines emerge for vaping and e-cigarette use, you may find it instructive to look at how the codes for treatment for non-electronic smoking have fared over the years. In short, practices have ramped up activity but denial rates have increased, too.
Practices cite prior authorizations, QPP as most burden-inducing regs, survey finds
11/04/2019
by: Jim Dresbach
The past three regulatory burden surveys from the Medical Group Management Association (MGMA) point to prior authorizations, Medicare’s Quality Payment Program (QPP) and audits and appeals as the biggest culprits in draining money and time from medical practices.
Most-used modifiers: Obscure all-purpose modifier checks in first
10/28/2019
by: Roy Edroso

You may guess that 25 (Significant, separately identifiable E/M service) and 59 (Distinct procedural service) would be the most-used modifiers in Medicare Part B, but according to the latest figures they’re only #8 and #14, respectively.
 

Providers favor standalone psychotherapy codes, and the longer the better
10/21/2019
by: Richard Scott
When reporting a series of oft-used psychotherapy services (90832-90838), providers tend to stick to a pattern of long-duration standalone codes and shorter-duration add-on codes.
Chronic care management spike: CPT code 99489 goes up, up and away
10/14/2019
by: Jim Dresbach
The utilization of complex chronic care management (CCM) code 99489 increased more than 285% between 2017 and 2018, as practices appeared to embrace longer-lasting care management episodes.
Outpatient E/M use — especially 99214 — continued to rise in 2018
10/07/2019
by: Roy Edroso

Medicare has published its 2018 patient claims data, which shows a pretty smooth rise in spending for total claims — and a bit of a spike for established patient office E/M code 99214.

A tale of two sides: Practices report more right- than left-side modifiers
09/30/2019
by: Richard Scott

     When delivering common injection and procedure services, providers tend to veer to the right side of the body more often than the left. That’s what an inspection of claims with RT (Right side) and LT (Left side) modifiers reveals.
A tale of two sides: Practices report more right- than left-side modifiers
09/30/2019
by: Richard Scott
When delivering common injection and procedure services, providers tend to veer to the right side of the body more often than the left. That’s what an inspection of claims with RT (Right side) and LT (Left side) modifiers reveals.
Not worth it: Codes wrongly bundled with blood draws pay too well to trifle with
09/23/2019
by: Roy Edroso

Auditors emphasize the amount of improper payments attributed to common venipuncture code 36415 with bundled codes in 2018. But it’s also worth noting that the codes with which 36415 may have been improperly claimed generally pay more — and it’s really not worth potentially gumming up your claims on those codes for a small extra payment on a blood draw.

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