Comparative Billing Reports

CBR201704 Statistical Debriefing

CBR201704

CBR201704 Statistical Debriefing:

The following is a description of the tables used in CBR201704, Transitional Care Management (TCM). There are links that will open the excel files that contain state and national statistics used in the analysis of rendering Medicare Part B providers for CBR201704. All of the analyses in this Comparative Billing Report (CBR) include only the Current Procedural Terminology (CPT®) codes 99495 and 99496. CBR201704 includes claims with dates of service from January 1, 2016 to December 31, 2016. These analyses are based on the latest version of claims available from the Integrated Data Repository as of April 6, 2017. Examples of each table can be found in the CBR201704 sample CBR.

 

Transitional Care Management CPT® Codes and Abbreviated Descriptions

Table 1 of CBR201704 lists each of the CPT® codes covered in this CBR with the abbreviated descriptions.

 

Summary of Your Utilization of CPT® Codes 99495, 99496

Table 2 provides a summary of your utilization of the procedure codes included in this CBR. The total allowed charges, allowed services, and distinct beneficiary count are included for each procedure code. In addition, an overall “Total” row is included. Your percentages are calculated from your utilization of the procedure codes. 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 both CPT® codes within this time period 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 Corresponding Discharge Records

Table 3 provides an analysis of the percentage of services without a corresponding discharge record. TCM services should be billed within 7 or 14 days of the discharge date. For this analysis, discharge dates submitted in Medicare Part A were selected if they were billed within 30 days of a TCM service. This measure was designed to identify TCM services which do not have a corresponding discharge record. The percentage of services without corresponding discharge records is calculated by taking the number of services without a corresponding discharge record divided by the total number services, and then multiplying by 100. Each provider’s percentage is compared to his/her state and the nation using the chi-square test at the alpha value of 0.05.

 

To view the percentage of services without a corresponding discharge record for each state and the nation, please select the following link: CBR201704 Percentage of Services without Corresponding Discharge Record.

 

Percentage of Services Billed with CPT® Code 99496

Table 4 provides an analysis of the percentage of services billed with CPT® code 99496. CPT® code 99496 is the higher level TCM code that requires medical decision making of high complexity, while CPT® code 99495 requires medical decision making of at least moderate complexity. This analysis is designed to compare each provider’s usage of the higher level TCM code to that of his/her peers. The percentage of services billed with CPT® code 99496 is calculated by taking the number of services with CPT® code 99496 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 the chi-square test at the alpha value of 0.05.

 

To view the percentage of services billed with CPT® code 99496 for each state and the nation, please select the following link: CBR201704 Percentage of Services Billed with CPT Code 99496.

 

Percentage of CPT® Code 99495 Services Billed After 14 Days of Discharge Date

Table 5 provides an analysis of the percentage of CPT® code 99495 services billed after 14 days of the discharge date. CPT® code 99495 requires medical decision making of at least moderate complexity and a face-to-face visit within 14 days of discharge; and the claim should be billed on the date of the face-to-face visit. This measure is only calculated on TCM services where a discharge date has been identified within 30 days prior to the TCM service. TCM services without a discharge date identified from the Medicare Part A claims database are excluded from this analysis. The percentage of CPT® code 99495 services billed after 14 days of the discharge date is calculated by taking the number of CPT® 99495 services billed after 14 days of the discharge date divided by the total number of services billed with CPT® code 99495, and then multiplying by 100. Each provider’s percentage is compared to his/her state and the nation using the chi-square test at the alpha value of 0.05.

 

To view the percentage of CPT® code 99495 services billed after 14 days of the discharge date for each state and the nation, please select the following link: CBR201704 Percentage of CPT Code 99495 Services Billed After 14 Days of Discharge Date.

 

Percentage of CPT® Code 99496 Services Billed After 7 Days of Discharge Date

Table 6 provides an analysis of the percentage of CPT® code 99496 services billed after 7 days of the discharge date. Use of CPT® code 99496 requires medical decision making of high complexity and a face-to-face visit within 7 days of discharge; and the claim should be billed on the date of the face-to-face visit. This measure is only calculated on TCM services where a discharge date has been identified within 30 days prior to the TCM service. TCM services without a discharge date identified from the Medicare Part A claims database are excluded from this analysis. The percentage of CPT® code 99496 services billed after 7 days of the discharge date is calculated by taking the number of CPT® 99496 services billed after 7 days of the discharge date divided by the total number of services billed with CPT® code 99496, 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 CPT® code 99496 services billed after 7 days of the discharge date for each state and the nation, please select the following link: CBR201704 Percentage of CPT Code 99496 Services Billed After 7 Days of Discharge Date.