Comparative Billing Reports

CBR201705 Statistical Debriefing

CBR201705

The following is a description of the tables used in CBR201705 Anesthesia Services for Lower Endoscopic Procedures. 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 CBR201705. All of the analyses in this Comparative Billing Report (CBR) include only the Current Procedural Terminology (CPT®) code 00810. CBR201705 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 13, 2017. Examples of each table can be found in the CBR201705 sample.

 

Modifiers Frequently Used with Anesthesia Services

Table 1 of CBR201705 lists the modifiers that are frequently used with anesthesia services, and a brief description of each modifier.

 

Summary of Your Utilization of CPT® Code 00810

Table 2 provides a summary of your utilization of the procedure code included in this CBR. The total allowed charges, allowed services, and distinct visit and beneficiary counts are included for the procedure code.

 

Average Number of Time Units Appended per Visit

Table 3 provides an analysis of the average number of time units appended per visit. A visit is defined as a single date of service by beneficiary. The total number of visits should be equivalent to the total number of services since the provider should combine the time associated with procedures performed on the same day and bill only for the CPT® code with the highest base value. Multiple services per visit should only be reported in cases where modifier 76 is appended for repeat procedures. The average time units appended per visit is calculated by taking the total time units divided by the total number of visits. Each provider’s average is compared to his/her state and the nation using the t-test at the alpha value of 0.05.

 

To view the average number of time units appended per visit for each state and the nation, please select the following link: CBR201705 Average Number of Time Units Appended per Visit.xls.

 

Percentage of Visits Billed without an Allowed Colonoscopy Claim

Table 4 provides an analysis of the percentage of visits billed without an allowed colonoscopy claim. Medicare Part B claims were searched for colonoscopy services CPT® codes 45300-45398, G0105, and G0121. Any beneficiary that did not have an allowed service for one of these CPT® codes on the date of service of the anesthesiology service, was flagged as a visit without an allowed colonoscopy service. The percentage of visits without an allowed colonoscopy claim is calculated by taking the number of visits without a colonoscopy divided by the total number of visits, 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 visits billed without an allowed colonoscopy claim for each state and the nation, please select the following link: CBR201705 Percentage of Visits Billed without an Allowed Colonoscopy Claim.xls.

 

Percentage of Visits with Modifier AA

Table 5 provides an analysis of the percentage of visits with modifier AA, signifying that the service was personally performed by a physician. The national and state percentages of visits appended with modifier AA is based only on those claim lines where the rendering NPI’s specialty is a physician. All claim lines with a specialty of ‘32’, ‘43’, ‘50’, ‘80’, ‘97’ were removed from calculations of the peer percentages; however, the individual provider (regardless of the specialty) was compared to those peer values. The percentage of visits appended with modifier AA is calculated by taking the number of visits with modifier AA divided by the total number of visits, 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 visits with modifier AA for each state and the nation, please select the following link: CBR201705 Percentage of Visits with Modifier AA.xls.