CPT 99213 billing error statistic

CPT Code 99213 (All Specialties)

Established Patient Office or Other Outpatient Visit services are a focus area for the FY 2010 Medical Review Strategy. Analysis of claims in the May 2009 sample period reveals there were 217 CERT errors. Of this number, 135 (62.21%) were for BETOS categories primarily reporting Evaluation and Management (E/M) procedure codes. Approximately 82% of the CERT errors for E/M codes were for incorrectly coded services. BETOS Category M1B - Established Patient Office or Other Outpatient Visit services had the second highest number of errors in comparison to the other E/M BETOS categories. Review of claims in the November 2009 sample period for BETOS Category M1B-Established Office Visits for the time frame of 04/01/2008 through 03/31/2009, revealed that established office visits accounted for 40% of the E/M CERT errors. Incorrectly coded services made up approximately 68% of the errors in this BETOS Category. CPT code 99213 comprised 21% of the incorrectly coded errors.

To prevent future improper payments for these services, Medical Review is utilizing both a direct and a widespread educational approach to those Part B services identified in the CERT errors. Enrollment records reveal there are approximately 90,000 providers who are able to bill for E/M services. To better identify the common billing and coding errors, Prepayment Service Specific Reviews will be utilized. Information obtained through these reviews will be utilized to further enhance and develop additional educational program