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Specialty expertise

Every specialty fails differently

Cardiology loses money on component splits. Behavioral health loses it to credentialing delays. Podiatry loses it to the routine foot care exclusion. Generic billing catches none of it.

12–18% denials

Cardiology

Interventional, diagnostic and device monitoring billing.

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9–14% denials

Dermatology

Medical versus cosmetic, lesion coding, and Mohs billing.

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14–22% denials

Orthopedics

Surgical global periods, arthroscopy bundling and DME.

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10–16% denials

Mental & Behavioral Health

Time-based session coding, panels and credentialing.

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11–17% denials

OB-GYN

Obstetric global packages, gynecologic surgery and screening.

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8–13% denials

Pediatrics

Well-child visits, immunizations and developmental screening.

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8–12% denials

Family Medicine

Preventive care, chronic care management and E/M accuracy.

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9–14% denials

Internal Medicine

Complex chronic disease, care management and risk adjustment.

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10–16% denials

Anesthesia

Base plus time units, medical direction and concurrency.

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15–24% denials

Pain Management

Injection procedures, frequency limits and prior authorization.

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12–18% denials

Physical Therapy

Timed units, the 8-minute rule and authorization tracking.

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10–16% denials

Gastroenterology

Screening versus diagnostic, endoscopy and anesthesia coordination.

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10–16% denials

Radiology

Technical/professional splits, contrast studies and imaging authorization.

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11–17% denials

Urgent Care

Walk-in E/M, in-house procedures and real-time eligibility.

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12–18% denials

Neurology

Diagnostic testing, infusion therapy and complex E/M.

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13–20% denials

Oncology

Buy-and-bill drugs, infusion hierarchy and treatment authorization.

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10–16% denials

Ophthalmology

Medical versus vision routing, injections and surgical globals.

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14–21% denials

Podiatry

Routine foot care rules, Q modifiers and diabetic supplies.

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13–20% denials

Chiropractic

Manipulation coding, the AT modifier and maintenance-care rules.

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11–17% denials

Urology

Cystoscopy bundling, in-office procedures and hormone therapy.

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11–17% denials

ENT & Otolaryngology

Endoscopy, audiology coverage and allergy immunotherapy.

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10–16% denials

Nephrology

ESRD monthly capitation, vascular access and CKD management.

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12–19% denials

General Surgery

Global periods, modifier discipline and assistant surgeon billing.

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14–21% denials

Wound Care

Debridement depth, skin substitutes and serial documentation.

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16–24% denials

Durable Medical Equipment

Written orders, face-to-face rules and modifier discipline.

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