The following graph illustrates the denial rates for 2011 psychotherapy codes. Even though those codes have been deleted, you can use the CMS claims data and Part B News’ analysis to get an idea of what to expect when using the new 2013 codes (see crosswalk, below and related story). For most services, denial rates were low — under 10% — but providers struggled most when billing interactive therapy (90810) and the initial psychiatric exam (90802). And while psychologists, clinical social workers and psychiatrists billed these codes the most, primary care providers, such as family practitioners, suffered overall denial rates above 30%.  

Imagine that you’re about to hire a physician who left a practice because of another doctor’s pattern of overcharging and incorrectly coding procedures. Under a proposed rule published April 29, if the former colleague was caught and owed an outstanding Medicare debt, your new physician’s enrollment could be denied.

Make sure your therapy claims can withstand recovery auditor (RAC) scrutiny now that those contractors will review your claims for patients who have exceeded the $3,700 therapy threshold.

Medicare administrative contractors (MACs) are using warnings in the form of new remittance advice to let you know your therapy claims will not process without G-codes or C-modifiers starting July 1.

Services rendered by non-physician practitioners (NPPs) enable physician practices to lower the cost of providing care, but be mindful of state-specific scope of practice issues and private payer and Medicare policies to bill and get paid correctly.

Even though denial rates for new and established patient E/M services remained stable since 2007 — even dipping slightly in 2011 — the rate at which providers have been billing level 4 and level 5 new and established patient E/Ms has grown tremendously, according to Part B News’ analysis of CMS claims data.