Big Surprises in Code Denials
Written by Editor   
Tuesday, May 06, 2014 05:10 PM

Centers for Medicare and Medicaid Services (CMS) data from the month of March in 2014, shows which CPT codes are among the top five procedures unexpectedly denied for reimbursement.   The data for March also show which codes, which providers, and the top reasons for denial:

Top Five Denied Codes

  • outpatient doctor visit, level 3 (99213),
  • outpatient doctor visit, level 4 (99214),
  • therapeutic procedure (97110),
  • routine blood capture (36415), and
  • manual therapy techniques (97140).

Top Five Reasons for Denial

  • duplicate claim (18),
  • benefit for service included in another payment or allowance (97),
  • claim lacks information or has a billing error (16),
  • noncovered charges (96), and
  • time limit for filing has expired (29).

The top five specialists with the most unexpected denials:

  • physical therapist (13%),
  • family medicine (11%),
  • radiology (10%),
  • internal medicine (10%), and
  • pediatrics (10%).

Source:  http://www.medpagetoday.com/PrimaryCare/GeneralPrimaryCare/45572