15 statistics on the top unexpected denials

Denials are a significant stumbling block when it comes smooth revenue cycle management. Here are 15 statistics on the top physician practice unexpected denials, according to a Physicians Practice report.

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Top unexpected denials in May 2014 by CPT code

1.    99213: outpatient physician visit, level 3
2.    99214: outpatient physician visit, level 4
3.    36415: routine blood capture
4.    97110: therapeutic procedure, one or more areas, each 15 minutes
5.    99232: subsequent hospital care, level 2

Top reason codes for denial

1.    18: duplicate claim/service
2.    16: claim/service lacks information or has billing errors
3.    97: benefit for service is included in the payment for another service/procedure that has already been adjudicated
4.    96: non-covered charges
5.    29: time limit for filing has expired

Top specialties with the most unexpected denials

1.    Physician therapy: 12 percent
2.    Pediatrics: 12 percent
3.    Family medicine: 11 percent
4.    Internal medicine: 10 percent
5.    Radiology: 9 percent

CPT Copyright 2013 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.

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