Several top-billed codes have seen a denials increase from 2001–2008, and health care providers should consider reviewing and updating their billing and coding criteria and related templates in order to avoid denials based on billing or coding errors. A recent analysis of statistics derived from the latest available CMS claims data shows that three of the top ten most common codes saw denial rates increase over the eight-year time frame.

The three codes seeing an increase in denials include: (1) 17003, a low-level dermatology service; (2) 95004, a common allergy test; and (3) 99213, the most commonly billed code for office/outpatient visits. One particularly noteworthy denial rate increase is the allergy test code, which has doubled from 8.4% in 2001 to 16.8% in 2008. The alarming increase in denials for allergy tests may be attributable to coding errors, such as using wrong diagnosis codes or leaving off modifier 25 for tests done on the same day as an unrelated office visit.

Source: Part B News 6/7/10