What is the Pediatric E&M Code Distribution Benchmark?

The Pediatric E&M Code Distribution Benchmark measures the volume of each of the established Sick Visit codes an entity performs over a period of time. The intent of the code descriptions as they are written is to provide the framework for a bell-curve distribution of codes (with the 99213 at the peak), but many practices are overly 99213-centric, leading to a skewed curve and reduced reimbursement.

This measurement provides a useful tool for measuring the coding knowledge of an individual or group of physicians. It is also used to measure productivity and even the reimbursement potential of a practice.

For a more detailed analysis of this issue (and a direct link to a benchmark calculator), read PCC's essay, Why Your Coding Pattern Costs You $45,000 a Year.

What is the Pediatric Benchmark for the E&M Code Distribution?

Please note that PCC clients take advantage of PCC's practice management system for pediatricians, Partner, and PCC's practice management expertise. As a result, the FACF values above are likely to exceed the natural average of your practice.

How do I calculate the E&M coding distribution for my practice?

For a significant period of time (we recommend a year, in order to cover an entire seasonal fluctuation), use your computer system to calculate the total number of each of the 99211 through 99215 codes and divide them by the sum of all 99211 through 99215 codes.

PCC clients can calculate this number at any time using the PCC Benchmark feature of srs.