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.
More Articles on Coding and Billing:
Narrow networks: ASC industry boon or bane?
5 articles on ASC out-of-network strategy
Partnership pitfall: what happens to ASC software after joint venturing?
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.