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.