Most Common Pediatric Codes

I am doing some research into the most common pediatric codes in order to set up a spread/worksheet for use during an insurane negotiation.  Lots of “consultants” routinely make the mistake of suggesting that you look at your top 10 or, more daringly, top 20 or 30 codes when comparing reimbursement between two plans.

That’s stupid  Flat out stupid.

First, there are too many plans who do P4P, for example, which affects your bottom line considerably.  Second, and more importantly, your top 10-30 codes may not actually explain enough of your income to make the comparison valid.  What proof?

According to my pediatric data (which, for 2007 alone, is about 10 million procedures and hundreds of millions of $$), the top 10 codes account for only about 50% of the practice income. The top 30?  73%.  That’s right – if you look only at your top 30 codes, you’re leaving 25% of the equation unaccounted for.

Usually, I like looking at revenue on a per-visit basis, but there are plenty of circumstances when it makes sense to break things down on a code-by-code basis, especially when comparing competing offers from the same plan.  So what are the top 30 codes from PCC customers.  Here is some practice management gold:

CPT Code % of Total Units % of Total Deposits
99213 14.6% 22.5%
90471 19.7% 24.5%
90466 24.3% 25.8%
90472 27.9% 26.7%
90465 31.2% 28.2%
87880 34.2% 29.3%
99214 37.2% 35.7%
99392 39.4% 41.1%
99391 41.6% 45.7%
90669 43.4% 48.7%
99393 45.1% 53.0%
90633 46.8% 54.3%
90716 48.3% 57.1%
90700 49.8% 58.0%
99213-25 51.3% 60.1%
99173 52.6% 60.3%
99394 53.9% 63.6%
99212 55.0% 64.8%
90713 56.2% 65.5%
90658 57.3% 65.9%
81002 58.3% 66.0%
90680 59.3% 67.6%
90649 60.3% 70.7%
90734 61.2% 72.8%
99051 62.1% 73.0%
81000 63.0% 73.1%
36416 63.8% 73.2%
85018 64.6% 73.2%
85025 65.3% 73.5%
92551 66.0% 73.7%
99000 66.7% 73.7%

Where else but here can you find such awesome data?!

Gotta’ run.

0 replies

Leave a Reply

Want to join the discussion?
Feel free to contribute!

Leave a Reply