Gastroenterology Coding Alert

Create a benchmarking analysis to determine where you stand.

Medical practice staffers often express interest in comparing themselves to other gastroenterology offices in terms of their billing and coding trends, but aren’t sure how to do that. Benchmarking can be the answer to helping you figure out where you stand in comparison to other practices.

Background: In essence, benchmarking creates a standard against which you can compare your own data to historical internal results or industry standards. Once you know where your practice’s coding trends stand, you can keep an eye on them to see whether they go up or down.

Benchmark Against Yourself First

The first step in creating a benchmarking study at your practice is compiling your practice’s E/M distribution so you can determine exactly which codes you’re reporting the most frequently in each category. Track this data on a monthly basis — the key is to look for and identify trends over time rather than taking a snapshot of one month and focusing on that.

Besides comparing intra-category codes (comparing the distribution of new patient codes over all of the levels as well as the distribution of established patient codes over all of the levels, etc.), the practice should also look at intra-category comparisons, such as established patients to new patients, established patients to initial hospital visits, and initial hospital to subsequent hospital services. You’ll also want to track which doctors at your office are billing which codes most frequently.

If you see trends that indicate that one doctor in your practice reports more 99215s and another reports mostly 99212s, examine why. The answer may be that the doctors are both justified in reporting the codes they bill, but it’s something you should look into.

Compare Against National Averages As well

Once you compare your most frequently-billed codes within your practice, you can then track that data against the national averages. However, don’t panic if your coding trends don’t line up with the other gastroenter­ologists’. You may be treating a specific patient base that requires higher-complexity visits than the average physician. Therefore, benchmarking may not be an exact science because it cannot take into account all the idiosyncrasies in the population base.  

To check out CMS benchmarking data for gastroen­terologists, see our clip and save chart, “Here’s Your Breakdown of Which Codes Gastroenterologists Are Reporting Nationally” on page 46.

Practices should never change their coding practices just to stay within the averages. Although benchmarking gives you a good springboard for discussion, it doesn’t mean you should try and line your code usage up with national averages. It is more likely to make you stop and examine your records. Since the most often-billed code by gastroenterologists is 99213, you might want to stop and figure out the reason if your most-frequently-billed code is 99215 instead. Are your doctors upcoding or are you justified in reporting high-level services?

Bottom line: Use benchmarking to begin an examination of your practice’s coding trends, both internally and externally, and perform these analyses frequently to ensure that you stay on track.