Steer Clear of the Top 5 Reasons for Unexpected Denials

If you are wondering why your practice is receiving an unexpected number of denials for certain codes, you may want to check out a recent study published in Physicians Practice which ranks the top five unexpected denials in various specialties. Data was collected by RemitDATA from May 1, 2014 – May 31, 2014 via electronic remittance claims service lines. Here were some of the results:

Top five most commonly unexpected denied procedures:

  1. 99213 Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused history; An expanded problem focused examination; Medical decision making of low complexity.
  2. 99214 Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A detailed history; A detailed examination; Medical decision making of moderate complexity.
  3. 36415 Collection of venous blood by venipuncture
  4. 97110 Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility
  5. 99232 Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: An expanded problem focused interval history; An expanded problem focused examination; Medical decision making of moderate complexity.

Be sure your claims are filed correctly by avoiding these top five reasons why those codes were denied:

  1. 18: Duplicate claim/service
  2. 16: Claim/service lacks information or has submission/billing error(s) which is needed for adjudication
  3. 97: The benefit is included in the payment/allowance for another service or procedure already adjudicated
  4. 96: Non-covered charges
  5. 29: The time limit for filing was expired

The data also captured the top five most commonly unexpected radiology denials. Code 71010 Radiologic examination, chest; single view, frontal received the most. For more information on the study read “5 Common Medical Practice Denials and Remedies.” May 2014.

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Michelle Dick
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Michelle Dick

Executive Editor at AAPC
Michelle A. Dick has been executive editor for AAPC for over seven years. Prior to her work at AAPC, she was editor-in-chief at Eli Research and Element K Journals, and disk ad coordinator, web designer/developer, and graphic artist at White Directory Publishers, Inc. Dick has a Bachelor of Science in Graphic Design from the State University of New York - Buffalo State and is a member of the Flower City Professional Coders in Rochester, N.Y.
Michelle Dick
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About Has 136 Posts

Michelle A. Dick has been executive editor for AAPC for over seven years. Prior to her work at AAPC, she was editor-in-chief at Eli Research and Element K Journals, and disk ad coordinator, web designer/developer, and graphic artist at White Directory Publishers, Inc. Dick has a Bachelor of Science in Graphic Design from the State University of New York - Buffalo State and is a member of the Flower City Professional Coders in Rochester, N.Y.

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