decisionhealth Newsletters, Part B News - 2013 Issue 1 (January)
Benchmark of the Week: Top-denied services billed with mods. 57 and 25
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Article Overview
This article summarizes benchmark charts on denial rates for evaluation and management services linked to surgery and additional procedures, using CMS claims data from 2010 to 2011. It is intended for coding and billing professionals who want to understand broad denial trends, utilization patterns, and the kinds of services most often associated with these modifier-related reviews.
Why This Topic Matters
Understanding denial patterns around modifier-linked E/M services can help coding, billing, and compliance teams gauge where claims review attention may be needed. The article highlights which service categories drew the most denials and why this type of benchmark data is relevant to documentation and claim management.
What You Will Learn
- How benchmark charts are used to compare denial and utilization patterns for E/M services.
- Which broad service categories were most commonly reviewed alongside surgery- and procedure-related modifiers.
- How denial trends differed between the two modifier-related service groups over the 2010–2011 period.
- Why documentation quality matters in claims involving E/M services connected to surgical decision-making.
Who Should Read This
- Medical coders
- Coding auditors
- Billing staff
- Compliance professionals
- Practice managers
- Physician office staff
Codes Discussed
Code Ranges Discussed
Modifiers Discussed
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