Practice Management Alert

You'll also want to include a code for "above usual and customary" because this is most frequently the reason for adjustments.

Customize for specialty interests: You want to "create codes only for the adjustments you find most prevalent in your practice," Hammer says. So an internal medicine practice probably wouldn't create an adjustment code pertaining to global periods or surgical procedures, but would be more interested in E/M issues, such as denials for preventive care and a problem visit on the same date, she adds.

8 Ways to Make Adjustment Codes Pay Up

Using adjustment codes creatively can allow you to assess an employee's efficiency, calculate the cost of certain billing blunders and much more. Hammer offers these eight examples of how adjustment codes may become a handy billing office tool:

1. Keep track of how much you're spending - and writing off - on DME supplies that a certain payer always bundles with the procedure code.


2. Identify when and why billers are adjusting off 100 percent of a charge. This reveals a biller who doesn't want to bother with appeals and writes off charges instead.


3. Calculate how much denials for no preauthorization are costing you monthly, and use this to show the responsible staff how their inefficiency affects the practice's bottom line.


4. Track adjustments for missed filing deadlines by biller to see if some employees have too much on their plate or just aren't staying on top of things.


5. Run a report of adjustments for missed appeal deadlines to show billers why appeals need to go out the door faster.


6. Total adjustments for a certain PPO discount and bring that information to the negotiating table. For example, if the PPO wants to increase your participating discount from 8 to 10 percent, you can prove the discount already costs you $150,000 per year, and you're not willing to go any lower.


7. Tally every adjustment for services charged by a noncredentialed provider to show billing staff the importance of quickly credentialing new providers when they come on board.


8. Track "above usual and customary" adjustments by payer. If this type of adjustment is rare for a certain carrier, that might mean your fees are too low. Once you see the carrier is paying 100 percent on most of your charges, you'll know to increase your fees.