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A relatively fast way to compare how the codes you most frequently use compare to the national average for other practices is to access Medicare’s Part B billing data. These data on physicians’ services and specialty-specific procedure code utilization are available for free on the Internet.
"This will permit you to view the number of times your specialty billed each Current Procedural Terminology [CPT] code. Using this information and a few simple calculations, you can determine the frequency with which your specialty billed Medicare for a particular CPT code within its family of codes," notes Brent Baker, a reimbursement specialist with the American College of Physicians-American Society of Internal Medicine (ACP-ASIM).
Follow these instructions from Baker, and you’ll be able to use Medicare’s on-line database to find out the frequency and distribution of your specialty’s billing of specific CPT codes. For instance, you can find the frequency and distribution of internists’ billing of established patient office visit codes. You can also use these figures, which represent national billing patterns, as a general guide when assessing your own billing patterns. Medicare carriers, for instance, use these physician billing profiles to find billing patterns outside the norm so they can flag practices for possible investigation.
Here’s how to get started with your computer search:
Table 1 provides a note on non-facility PE-RVU; disregard this information.
Table 2 is a specialty code description table that lists all the specialty designation codes. For example, the specialty designation code for internal medicine is "11" and the code for rheumatology is "66." You will use the two-digit number for your specialty to locate the relevant data in the utilization database.
Table 3 is a utilization table that contains utilization data per code for each specialty. The table, which contains a massive amount of information, has headings of: CPT (HCPCS) code; modifier, HCFA specialty code; facility indicator; and allowed service.
Follow these steps to determine the frequency and distribution of billings for a family of codes: