Pulmonology Coding Alert

Examine the outcomes from this comparative billing report for the scoop.

Pulmonologists are among the most frequent billers of subsequent hospital care — but does frequency equate to accuracy?

That’s what auditors sought to determine as part of a new comparative billing report (CBR) compiled by RELI Group, Inc., which CMS contracts to develop, produce, and distribute CBR reports. The firm found that the average percentage of services billed with 99233 (Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: A detailed interval history; A detailed examination; Medical decision making of high complexity … 35 minutes are spent at the bedside and on the patient’s hospital floor or unit) was 30.7 percent — although that number was higher for pulmonologists. It’s therefore a good idea for your practice to check out how many of your claims were billed with this code to see where you stand.

Read on to find out more on this and other subsequent hospital care topics that the CBR discovered.

Here’s What the Report Included

After the 2018 Medicare Fee-for-Service Supplemental Improper Payment Data Report showed a 21.6 percent projected improper payment rate for level one subsequent hospital care code 99231 and a 19.1 percent improper payment rate for 99233, RELI was charged with evaluating the code utilization for these services, said RELI’s Annie Barnaby.

RELI then reviewed claims billed with subsequent hospital care codes 99231-99233, in addition to the percentage of patients discharged within one day of a 99233 service, and the average allowed minutes per encounter.

Remember: The feds use CBRs as a tool to offer insight into billing and coding trends across different specialties and healthcare settings. CMS partners with its contractor RELI to produce the reports, which you can find at www.cbrinfo.net. You can use this data from the CBRs to see where you stand when it comes to the frequency of billing certain services, codes, or modifiers — and more importantly, utilize these peer measurements to eradicate your coding problems.

How the stats were found: To get the data for the CBR, RELI examined subsequent hospital care claims from over 158,000 providers for the year between November 1, 2017 and October 31, 2018.

Check out the Findings

When evaluating the percentage of beneficiaries discharged within one day of a 99233 service, the auditors found that the national average was 26.1 percent. However, that number varied, Barnaby said. The average for pulmonologists was much lower, at 2.1 percent, but the percentage for hospitalists was 27.9 percent.

When it came to the average allowed minutes per encounter, RELI found that the national average was 27.1 minutes, even though many providers had much lower and higher time spans. The number for pulmonology specialists was just slightly above average, at 28.9 minutes – however, this was the highest rate overall among all specialists evaluated.

As for the average percentage of total services billed with 99233, the national average was 30.7 percent, although that number varied quite a bit from one provider to the next. For pulmonologists, the percentage was 43.0 percent, which was the highest among all specialists. Ranking lowest were orthopedic surgeons at 14.4 percent.

Keep in mind that if you do report 99233 more frequently than the average, it doesn’t necessarily mean you’re billing improperly. Billing patterns may differ for a wide variety of reasons — for instance, perhaps you practice in an underserved urban or rural area, or in areas with a higher proportion of sicker Medicare beneficiaries. However, if you do find that your ratio of 99233 claims is significantly higher than the average, it’s worth your time to perform a self-audit to find out whether all of these services were billed properly.

Resource: For more on the findings of this comparative billing report, visit  https://cbr.cbrpepper.org/About-CBR/CBR-201903.