In Part One of this post, we discussed how to interpret some of the data from the Chiropractic Comparative Billing Report issued recently by Medicare to 5000 DC’s around the USA as well as made some proactive suggestions for improvement.
In this installment, we will discuss the data from the remainder of the Comparative Billing Report (Figure 2 and 3) as well as how to draw some conclusions from the CBR data about your practice.
Explanations of Figure 2/Table 2 Data
The data illustrated in these tables/graphs directly deals with the number of “distinct” diagnosis codes used for the sample of patients examined in the Comparative Billing Report. As with all data in the CBR, it is then compared to your chiropractic peers on a state and national level.
Since subluxation diagnosis codes are required by Medicare (in Dx Position #1) in order to make your claim eligible for payment, the data in Table 2/Figure 2 excludes the diagnosis of subluxation. In other words, these graphs illustrate your usage of diagnosis codes other than the subluxation series.
Specifically, the graphs indicate how many distinct diagnosis codes other than subluxations you utilized on the patients in your sample obtained in the CBR, which was determined over a one year period of time.
For example, let’s say you treated a patient in the sample for a total of 15 visits in the one year time period reviewed. If your initial diagnosis was cervical subluxation (Dx position 1)and neck pain (Dx position 2) and you treated the patient for 15 visits over the course of this year, all related to this initial diagnosis, then the number of “distinct” diagnosis codes for this patient would equal 1. On the other hand, if you started care with the above scenario and on visit 5, the patient injured themselves and you gave them a new diagnosis, the number of “distinct” diagnosis codes would now equal 2 and so on.
What Table 2/Figure 2 Says About You
A careful look at your individual numbers for table 2 will reveal some useful details about how you care for your patients. Simply put, this figure indicates how often you update or change your diagnosis codes for each beneficiary.
The national average (according to CBR data) is greatest in the category of billing only 1-2 diagnose codes per patient in 2009. If your numbers are lower than the national average, you basically rarely or never change diagnosis codes.
While it may be possible that all of your patients have significantly serious problems for which you treat them over the course of a year time span (and therefore, it may not be appropriate to change dx codes); it is also possible that your statistically significant difference from the national average may indicate incorrect usage.
Explanations of Table 3/Figure 3 Data
The third category examined by the CBR is related to the top 5 (most frequently billed) diagnosis codes you billed over the course of a year time span. By itself, this does not appear to be very revealing. However, consider the fact that most Medicare carriers have a diagnosis codes “hierarchy” which indicates that certain codes are suggestive of longer vs shorter duration of care.
When examining the national data in this light, it is easy to see a possible “disconnect” in usage. Three of the 5 most frequently billed diagnosis codes nationally are shorter duration codes (cervicalgia, lumbalgia, pain in the thoracic spine). In other words, DC’s using those codes frequently should also be giving short term duration care.
By examining your diagnosis code selection in your top 5, you can easily see the message that you may be communicating to Medicare, especially in comparison to your peers.
In the next installment, we will discuss how to integrate all of this data to help you achieve the primary goal of the Chiropractic Comparative Billing Report: to help you improve your billing patterns and comply with Medicare guidelines.
