DecisionHealth, DecisionHealth - 2011 Issue 9 (September)

Benchmark of the Week: Top 10 high-growth, high-denial codes, 2009-2010

A wide variety of procedures top the list of high-denial codes that also saw a big jump in utilization from 2009 to 2010, the latest year for which CMS claims data is available. NOTE: Lab codes and supply codes were excluded from analysis, as were codes with low utilization, low denial rates and/or low utilization growth over the one-year period. NOTE: A slew of E/M codes, such as 99201-99205 and 99304-99306, saw the biggest growth in billing and had fairly high denial rates, but their utilization increases were a direct result of 2010 being the first year CMS stopped using consult codes. These other E/M codes were used as a replacement, boosting their utilization artificially (see related story).

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