Are your doctors undercoding for CPT? Find out with MGMA DataDive

We just released our last dataset of the year, and it’s new data that hasn’t been available for several years now: the 2019 MGMA DataDive Procedural Profile.

The Procedural Profile data was created with the intent of giving us a CPT coding profile by specialty.

With the ability to view the data for all CPT codes, by CPT chapter, sub-chapter and by individual CPT code, MGMA has taken the guesswork out of performance expectations. Now we can see the difference in coding between low-producing and high-producing physicians, giving us a path to increasing the productivity for low-producing providers.

The Procedural Profile data also allows us to review level coding to ensure physicians aren't leaving money on the table by undercoding. The justification for adding new service lines may also be found in the coding profile of the physician specialties.

Using the Evaluation and Management (E/M) chapter and narrowing down to the office outpatient established patients, we can get to a bell curve of the distribution of the Level 1 through 5 coding.

And unlike other data publicly available, the MGMA bell curve will not be based solely upon Medicare patients. The ranking within the Procedural Profile data is unique due to the close relationship to the MGMA DataDive Provider Compensation dataset. Instead of providing percentile rankings, MGMA provides a coding profile based on the provider’s ranking for either total compensation, collections or work RVUs (wRVUs).

Applying the wRVU benchmark and the top quartile filter, you now have a CPT coding profile of a physician producing wRVUs above the 75th percentile from the 2019 MGMA DataDive Provider Compensation dataset.

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If you switch the quartile filter to the bottom quartile, you’re now able to look at a coding profile for the low-producing physician. Doing both low- and high-quartile physician profiles provides the path needed to move low-producing physicians toward higher production goals.

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The ‘View By’ option further allows you to cut the data for reordering by either percent of volume or based upon individual CPT code.

The ‘Limit data by’ filter allows you to apply even further limits on the data for a variety of specifications, including:

• Demographic classification
• Geographic section
• Number of full-time-equivalent (FTE) physicians
• Practice type
• Organization ownership 

The Procedural Profile dataset also can export any of the tables into either a PDF or an Excel file.

If you have any questions, please feel free to reach out to the MGMA Data Solutions department at either 877-275-6462, ext. 1895, or survey@mgma.com.