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Healthcare Billing and Denial Patterns for Top Services: 2001–2008

Several top-billed codes have seen a denials increase from 2001–2008, and health care providers should consider reviewing and updating their billing and coding criteria and related templates in order to avoid denials based on billing or coding errors. A recent analysis of statistics derived from the latest available CMS claims data shows that three of the top ten most common codes saw denial rates increase over the eight-year time frame.

The three codes seeing an increase in denials include: (1) 17003, a low-level dermatology service; (2) 95004, a common allergy test; and (3) 99213, the most commonly billed code for office/outpatient visits. One particularly noteworthy denial rate increase is the allergy test code, which has doubled from 8.4% in 2001 to 16.8% in 2008. The alarming increase in denials for allergy tests may be attributable to coding errors, such as using wrong diagnosis codes or leaving off modifier 25 for tests done on the same day as an unrelated office visit.

Source: Part B News 6/7/10

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About this Author

Stacey A. Borowicz, Regulatory, Health care industry, attorney, Dinsmore Shohl,

Stacey Borowicz is an accomplished attorney who dedicates the majority of her business and regulatory practice to health care providers. Stacey brings with her more than a decade of front line experience in the health care industry as she acquired a rare set of skills as a medical researcher/scientist prior to entering the practice of law.

Stacey's experience in the healthcare representation is diverse and includes Medicare/Medicaid audit and overpayment appeals, voluntary disclosures and refunds. Stacey also brings a wealth of experience in...