Medical Fees Increased Significantly in 2016

Based on an analysis of over 1 billion actual charges, the median fees for all CPT codes (excluding Anesthesia) increased  5.64% during 2016. Most medical professionals do not use all of the CPT code sections, but there are significant variations in the rate of increase for different sections of the CPT coding system.

Evaluation & Management Services      

Almost all providers use the E & M codes, and use them with higher frequency than codes for procedures and diagnostic tests. For all E & M CPT codes (excluding Newborn Care, Delivery/Birthing Room Attendance and Inpatient Neonatal Intensive Care), the median increase in fees was 7.00%.

For Newborn Care, Delivery/Birthing Room Attendance and Inpatient Neonatal Intensive Care services only, the median increase in fees  is 27.44%.

CPT Code Section Table with Median Percent Increases

The table below summarizes the findings of the analysis by CPT section. The most important result is that fees increased for sections of the CPT coding system.

CPT Code Section Median Percent Increase
Surgery Services  
Integumentary System 5.76%
Orthopedic Surgery 4.98%
Respiratory System 4.80%
Cardiovascular System Surgery 4.63%
Hemic And Lymphatic Systems 5.21%
Digestive System 5.81%
Urinary System 5.67%
Male Genital System 5.80%
Female Genital System 4.85%
Maternity Care And Delivery 6.03%
Endocrine System 1.50%
Nervous System 5.94%
Eye And Ocular Adnexa 5.81%
Auditory System 8.28%
Radiology (All Sections)                                11.45%
      Diagnostic Radiology 6.71%
      Diagnostic Ultrasound 5.01%
      Radiation Therapy 18.37%
Pathology And Laboratory                        12.53%
Medicine Services (All Sections)  10.22%
      Psychiatry 6.66%
      Cardiology Medical Services 10.35%
      Neurology & Neuromuscular Procedures 10.58%
      Chemotherapy 13.26%
      Physical Medicine 5.20%

What About Your Fee Increases?

Health insurance companies will never tell you your fees are too low. Your fee for a particular service or procedure could be significantly less than other physicians in the same area.

If your fees for a particular procedure or service are at the national/local median, then 50% of all providers are charging more than you and 50% are charging less. Where you want to be is around the 75th percentile.

A comprehensive review of your fees at least once a year is important to make sure your fees are neither too low or too high. The only way to determine where your own fees fall within a range of fees is by comparing your fees to a comprehensive database of fees based on actual charges, not surveys.

Unfortunately, some practices still charge less than the Medicare allowable…and Medicare and private payers will be happy to process claims based on the lowest amount billed. These practices are leaving significant money on the table for each code affected by poor fee calculation. Using a comprehensive fee resource that provides usual, customary and reasonable (UCR) fees as percentiles plus Medicare allowables and RVUs eliminates the guesswork for fee setting that may result in this error.

Medical Fees 2017, published continuously since 1989, includes a comprehensive introduction and listings for over 8,500 CPT codes with expanded descriptions, fees at the 50th, 75th and 90th percentiles, plus Medicare fees and relative values (RVUs). Also includes geographic adjustment factors to help you fine-tune the data to your geographic area of practice.

Use Medical Fees 2017 to

  • Review your fee schedule against national and local statistical norms
  • Set fees for new or never before performed procedures
  • Maximize your payments from Medicare and private carriers
  • Challenge low allowances and payments by health insurance companies
  • Review managed care contracts to determine if payments are fair and reasonable

Save 50% off with coupon code FEE-SAVER-50 when ordering online.

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You Must Replace Your ICD-10-CM Coding Resources for 2017

The conversion to ICD-10-CM, which finally happened on October 1, 2015, was sort of like Y2K. While there were a lot of advance reports of providers not being ready, the transition went fairly smoothly. Many hospitals, clinics and insurance companies as a lot of providers had invested in planning, materials and training, which helped them over the hump.

Everyone now has actual ICD-10-CM coding experience and feedback in the form of delayed or denied claims that will ultimately result in better coding over time. Now it’s time to start planning for all the changes in the ICD-10-CM 2017.

Due to the two-year delay in implementation and the three-year freeze on introducing changes to ICD-10 there will be a lot of changes in ICD-10 2017. CMS and NCHS have continued to review and recommend changes to ICD-10 during the past three years…but were not allowed to implement them.

All of those changes, and a lot of new ones, will be in the ICD-10-CM 2017 edition. You could have handled the transition with a 2014, 2015 or 2016 edition of ICD-10-CM, but as of October 1, 2016 all of those will be out of date.

See all of the ICD-10-CM coding products and save 20% on your order. Input special offer coupon SAVE2017 when checking out.

Thank you for your support.

Jim Davis

Don’t put your practice at risk. Make sure you are using all of the current codes.

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Life After ICD-10-CM…What’s the Next Big Thing?

The conversion to ICD-10-CM, which finally happened on October 1, 2015, dominated the coding and compliance industry for the past three years. While diagnosis coding represents the justification for medical services and procedures, it is just one part of the coding process.

No matter how good your ICD-10-CM diagnosis coding is, it won’t matter if you are not using the most current CPT coding resources. There are hundreds of new, revised and deleted CPT codes every year. Medical services and procedures are paid based on the procedure code, not the diagnosis code. Yet many providers chose not to update procedure coding references during the period that the ICD-10 implementation was delayed.

Using current CPT (procedure) and ICD-10-CM (diagnosis) codes protects your reimbursement and also reduces the potential for audit liability.  Using expired codes results in claim delays, denials and may result in your patients having to pay more in out of pocket costs.

Don’t put your practice at risk. Make sure you are using all of the current codes.

 

 

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Mapping is the key to ICD-10

Now that CMS has officially issued another delay in the implementation date for ICD-10 to October 1, 2015, you may be tempted to relax and wait. Instead you should consider this new delay a gift…a gift of extra time to prepare for the transition.Mapping is the Key

The easiest way to learn how ICD-10 will impact your practice is to look at mapping first. Mapping is the process of converting ICD-9 codes to ICD-10 codes and vice versa. Mapping from ICD-10 back to ICD-9 codes is referred to as Backward Mapping. Mapping from ICD-9 codes to ICD-10 codes is referred to as Forward Mapping. Looking at mapping first will help you visualize the transition based on ICD-9 codes you already use.

The coding guidelines for ICD-10 are almost identical to the ICD-9 guidelines. The process of coding is the same, i.e. you look up a word or phrase in the index, go to the appropriate tabular section and pick the code. You already know how to do that. But what do the new codes look like? How do the ICD-10 and ICD-9 codes relate to each other? How many of the 65,000+ ICD-10 codes apply to your practice?

ICD-10 mapping will answer those questions and serve as an introduction to the ICD-10 coding system. You can use mapping resources to:

• Convert ICD-9-CM codes to ICD-10-CM

• Convert ICD-10-CM codes to ICD-9-CM

• Update diagnostic coding databases

• Revise your billing forms

• Create common code lists for training purposes

Mapping can be used by anyone who wants to convert coded data including: all payers; all providers; medical researchers; informatics professionals; coding professionals; software vendors; organizations needing to create mappings that suit their internal purposes; and others who use coded data.

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Be Prepared for “Dual Coding Systems”

We got close to the ICD-10-CM finish line but it was delayed once again. Unless there is yet more legislation to further delay or stop it, ICD-10-CM will become mandatory as of October 1, 2015. But don’t throw out your ICD-9-CM coding books yet…because you are going to need them. RE FOR DUAL CODING SYSTEMS 

While ICD-10-CM codes must be reported for all medical services provided on or after October 1, 2015, ICD-9-CM codes must be reported for all services provided before October 1, 2015, regardless of when the claim is filed. For example; you see a patient on September 15, 2015 but don’t file the insurance claim until October 20, 2015.  ICD-10-CM is now mandatory, but you must use ICD-9-CM for this claim due to the date of service. You see a patient in the hospital several times during the week prior to October 1, 2015 and you file claim forms for those visits using ICD-9-CM. You see the same patient, for the same conditions, several times after October 1, 2015. You file claim forms for those visits using ICD-10-CM. Questions, delays or denials from insurance companies regarding this series of claims could be for ICD-9-CM and/or ICD-10-CM and continue for months after the claims were filed. This is why you need to be prepared for “dual coding systems.”

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