Knowledge Expansion

CPT-level benchmarking: The new standard

Insight Article

Benchmarking & Forecasting

Coding & Documentation

Andrew Hajde CMPE
Throughout the years I spent managing large groups of medical practices across many different specialties, I was asked specific CPT volume questions by physicians, healthcare leaders and hospital administrators on what other "typical" providers are doing.

For example, a cardiologist asked me how many cardiac catheter CPT codes the average interventional cardiologist bills per year, while an orthopedic surgeon inquired about how many hip replacements the average hip/knee ortho doctor performs annually. 

At the time I worked for a large organization that had other practices of the same specialty throughout the country, so we would often reach out to our peers to find the "average" or "median" data that was being requested. This generally resulted in a comparison on a very small scale compared to the number of physicians nationwide. 

We even considered utilizing data from the Centers for Medicare & Medicaid Services (CMS) or other specialty-specific associations to find the answer. The problem with the CMS data is that it is for a very specific segment of the patient population, mainly those 65-and-older. As for data from associations, it often didn't allow you to drill down to the CPT level or the provider sample size was too small.

This is where the 2019 MGMA DataDive Procedural Profile comes in. It allows organizations, hospitals, practices and administrators to use benchmarking data for their clinicians down to the CPT code level to see what's billed for providers of virtually any specialty. 

Not only can you find typical CPT code average volume, you can also see exactly what is being billed for a typical clinician and the associated volumes of each code. You can see what specialties are expanding their services, such as CPTs that were traditionally performed by dermatologists or plastic surgeons expanding into other specialties, or even the volumes of each type of new and traditional surgical procedure a heart surgeon or other specialist is performing. You can even filter this data by ownership type, geographic location and many other factors to see the specific segment you want.

Since this data is composed of patients of many different age ranges and insurances types (commercial and federal), it will give you the best data to benchmark against for any individual CPT or the full E/M bell curve beyond what CMS data alone can offer.

Take your productivity and benchmarking to the next level with the MGMA Procedural Profile and get the answers you have wanted and needed for your physicians or practice leaders. To learn more about or to obtain this dataset, complete the form on this page.

About the Author

Andrew Hajde
Andrew Hajde CMPE
Assistant Director, Association Content MGMA Englewood, Colorado

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