Benchmark of the Week: Modifier 55 denials, 2005 vs. 2009

Why This Topic Matters

It highlights a claim type that is especially vulnerable to denial and shows how documentation and contractor-specific requirements can influence payment outcomes for post-operative care billing.

Article Sections

1. Overview of modifier 55 denial patterns

   Introduces the article’s focus on denial rates for claims involving modifier 55 and places the topic in the broader context of modifier-based denials.

2. Comparison of 2009 results with 2005

   Summarizes the comparison of denial rates across selected high-utilization procedures and notes how the article frames changes over time.

3. Breakdown of selected procedures

   Reviews the procedures highlighted in the analysis and describes how their denial trends differed within the dataset.

4. Takeaways and documentation notes

   Discusses the main operational concerns raised by the analysis, including post-payment review, contractor expectations, and form-based reporting of care dates.