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Benchmark of the Week
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.
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 (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.

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.

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.

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).

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.


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.

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.

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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