DecisionHealth, DecisionHealth - 2012 Issue 8 (August)

Benchmark of the Week: Initial E/M with modifier 25 denial rates by POS

This chart presents the denial rates for initial patient E/M codes (99201-99205) that were appended with modifier25 (separately identifiable E/M service), separated by the place-of-service code. Hospital place-of-service codes – inpatient (21) and emergency room (23) – are grouped together, as are office (11) and outpatient hospital (22). Note: All data were derived from a Part B News analysis of Medicare claims data from 2010, the latest year available. (For a breakdown of the same denial rates, but for established patient visits, check out next week’s Benchmark of the Week.)

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