Comparative Billing Reports

CBR201703 Statistical Debriefing

CBR201703

The following is a description of the tables used in CBR201703, Sudomotor-Function Testing. There are links that will open the excel files that contain state and national statistics used in the analysis of referring Part B providers for CBR201703.  All of the analyses in this Comparative Billing Report (CBR) include only the Current Procedural Terminology (CPT®) code 95923. CBR201703 includes claims with dates of service from October 1, 2013 to September 30, 2016. These analyses are based on the latest version of claims available from the Integrated Data Repository as of February 8, 2017. Examples of each table can be found in the CBR201703 sample.

 

Summary of Your Referrals of CPT® Code 95923

Table 1 provides a summary of your referrals of CPT® code 95923 by date of service. The total allowed charges, allowed services, and distinct beneficiary count are included for each year. In addition, an overall “Total” row is included summarizing the utilization for the three-year period. Please note that the totals may not be equal to the sum of the rows due to rounding. Also, the number of beneficiaries are unduplicated counts for each row and the total. A beneficiary receiving this procedure in multiple years would be counted in the beneficiary count in each applicable row; however, this beneficiary would be counted only once in the total row.

 

Percentage of Services without Diagnosis Codes that Support Medical Necessity

Table 2 provides a statistical analysis of the percentage of services without diagnosis codes that support medical necessity. The diagnostic tests are reimbursed only when they are medically necessary and are used to diagnose and/or treat a specific condition or disease. This metric was designed to focus on providers who are referring this specific test at rates above their peers, using the diagnoses defined in the LCDs referenced in this document. Since this analysis encompasses time periods for ICD-9 and ICD-10 diagnosis codes, the ICD-9 diagnosis codes converted from the ICD-10 list are also included with the list of diagnoses. All diagnosis codes submitted with the claim were searched for these codes. The percentage of services without diagnosis codes that support medical necessity is calculated by taking the number of services without the indicated diagnoses divided by the total number of services and then multiplying by 100. Each provider’s percentage is compared to his/her state and the nation using chi-square test at the alpha value of 0.05.

 

To view the percentage of services without diagnosis codes that support medical necessity for each state and the nation, please select the following link: CBR201703 Percentage of Services without Diagnosis Codes that Support Medical Necessity.xls.

 

Percentage of Services Rendered by Providers Who are Not Neurologists

Table 3 provides a statistical analysis of the percentage of services rendered by providers who are not neurologists. Specialized training and expertise in autonomic disorders are required by the rendering provider in order to use the FDA approved devices required to bill CPT® code 95923. Since this knowledge must have been acquired within the framework of an accredited residency, fellowship program, or extensive continued medical education activities most common to neurologists, this metric focuses on those providers that refer this procedure to rendering providers who are not defined as neurologists on their claims. Although a provider of any specialty can acquire the necessary training needed, rendering providers of specialties other than neurology may not have the extensive training and/or certification required to perform and interpret this test. The percentage of services rendered by providers who are not neurologists is calculated by taking the number of services rendered by providers who are not neurologists divided by the total number of services and then multiplying by 100. Each provider’s percentage is compared to his/her state and the nation using chi-square test at the alpha value of 0.05.

 

To view the percentage of services rendered by providers who are not neurologists for each state and the nation, please select the following link: CBR201703 Percentage of Services Rendered by Providers Who are Not Neurologists.xls.

 

Percentage of Beneficiaries Receiving Multiple Services (Over 3-Year Period)

Table 4 provides a statistical analysis of the percentage of beneficiaries receiving multiple services. Sudomotor-function testing is performed to confirm or exclude a specific autonomic disease. Repeat testing is only necessary if there is a change in clinical status or in response to a therapeutic intervention. Although repeat testing is allowable, the majority of beneficiaries would not benefit from multiple tests. This metric was designed to identify potential overutilization of this service. The percentage of beneficiaries receiving multiple services (over 3-year period) is calculated by taking the number of beneficiaries receiving multiple services divided by the total number of beneficiaries and then multiplying by 100. Each provider’s percentage is compared to his/her state and the nation using chi-square test at the alpha value of 0.05.

 

To view the percentage of beneficiaries receiving multiple services (over 3-year period) for each state and the nation, please select the following link: CBR201703 Percentage of Beneficiaries Receiving Multiple Services (Over 3 Year Period).xls.

 

Percentage of a Referring Provider’s Beneficiaries Who Received Sudomotor-Function Testing

Table 5 provides a statistical analysis of the percentage of referring provider’s beneficiaries who received sudomotor function testing. Due to the increase in billing for sudomotor-function testing, this metric was designed to identify potential overutilization and improper use of this service. The percentage of a referring provider’s beneficiaries who received sudomotor-function testing (CPT® code 95923) is calculated by taking the number of beneficiaries referred by the provider who received code 95923 divided by the total number of beneficiaries referred by the provider for any Medicare Part B procedure and then multiplying by 100. Each provider’s percentage is compared to his/her state and the nation using chi-square test at the alpha value of 0.05.

 

To view the percentage of a referring providers beneficiaries who received sudomotor-function testing for each state and the nation, please select the following link: CBR201703 Percentage of Referring Providers Beneficiaries Who received Sudomotor Function Testing.xls.