DecisionHealth, DecisionHealth - 2011 Issue 4 (April)

Benchmark of the Week: Primary care vs. specialists on surgery codes

This chart examines how primary care practices fare against specialists when billing the biggest, most common surgical procedures furnished in the office and outpatient hospital settings (place of service codes 11 and 22 respectively). Denial rates are clearly higher for primary care than for specialists, on a code-by-code basis. The percentages above the bars indicate the denial rate for each code in a given year; all denial rates are an average that reflects data from multiple specialties, e.g. “primary care” is an average of family practice, general practice, internal medicine, geriatrics and OB/GYN.

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