Medicare Compliance & Reimbursement

If you've ever wondered whether your billing patterns are out-of-whack with the rest of the country's, the time to find out the answer is here.

Medicare recently released its utilization statistics for Part B services that it paid in 2006, revealing the top five codes that CMS reimbursed.

Medicare paid practices for established patient E/M code 99213 more than 100 million times in 2006, making it the top-billed code overall, followed by 36415 (blood collection via venipuncture), 99214 (established patient E/M), 99232 (inpatient E/M) and 85025 (complete blood count).

The most frequently reimbursed surgery codes were 17000 and 17003 (lesion destruction), 11721 (6 or more nail debridements) and 20610 (major joint or bursa injections).

E/M service codes offer surprises: For E/M coding, physicians often wonder how many high-level codes they perform in comparison to other same-specialty doctors, so the 2006 utilization data lists each E/M code's billing frequency by specialty.

Internists billed the most 99205s, with 339,591 claims paid in this category. But internal medicine practices obviously bill a wide range of codes because they were also the top billers of 99211 during the same period.

"This contrast may look puzzling at first, but internists often spend a lot of time during new patient visits because they are usually called upon to make diagnoses deemed very difficult by other physicians," says Jay Neal, a coding consultant in Atlanta. "And then again, they see a lot of patients for quick follow-up visits, often with the nurse, which would warrant 99211," he says.

Consult code redux: Consultations are another source of angst -- medical practices think they're coding these services wrong, says Heather Corcoran of CGH Billing.

The Medicare data shows that the top single-category consult billers were ophthalmologists, who collected for 99244 more than 677,000 times in 2006, with orthopedic surgeons taking a close second, billing 99243 more than 670,000 times the same year.

Neurologists were the most frequent billers of the top-paying consult code, 99245, with 329,000 claims paid in 2006.

Resource: You can view the Medicare utilization files online at http://www.cms.hhs.gov/MedicareFeeforSvcPartsAB/04_MedicareUtilizationforPartB.asp.