Frequency distributions of CPT codes for outpatient visits 99201 to 99215 were compared between NMHCs, CMS, and MGMA; and between individual centers and aggregate NMHCs.
Figures 2 and 3 illustrate the distribution of new and established patient office visit codes, respectively, for NMHCs, CMS, and MGMA.
Comparisons among national data: NMHCs, MGMA, and CMS.
NMHCs (for every one new patient visit there were 10 established patient visits) compared to a 1:19 ratio for MGMA NPs, and a 1:16 ratio for MGMA FPs.
Comparisons between individual NMHCs and NMHC aggregate national data.
For new patients (see Figure 4), Center A did not use 99202 (a lower resource-intensive code) compared to 8% found in national NMHCs data.
All new patients at Center C were the two lowest-level codes - 99201 (62%) and 99202 (38%)--compared to only 8% (99201) and 34% (99202) at national NMHCs, respectively.
Unfortunately, NMHCs struggle to remain in business for a variety of reasons, including underdeveloped business practices.
Until now, NMHCs had only data from CMS and MGMA for comparison with coding patterns in individual centers.
Among NMHCs, office visit codes compose the majority of E&M codes.
Comparisons of NMHCs with other national data found that for new patients, NMHC coding distributions fell in between CMS and MGMA providers and were more similar to MGMA physicians than other providers.
Based on analysis of the three NMHCs, reasons for variations in coding patterns included population-specific differences, undercoding, overcoding, and lack of sound business practices.