tci Medicare Compliance & Reimbursement - 2007 Issue 5

PHYSICIANS: Good Documentation Is The Key To Surviving An Audit

The bell curve won't shield you from modifier 25 scrutiny.Myth: If you bill mostly 99213s and keep your evaluation & management (E/M) billing within the "bell curve," you'll avoid the heat for using the 25 modifier (Significant, separately identifiable evaluation & management by the same physician on the same day of the procedure).Truth: The HHS Office of Inspector General (OIG) and other federal watchdogs are sniffing claims with the 25 modifier, regardless of coding level, says Devona Slater with Auditing for Compliance and Education in Leawood, KS. Some providers believe that they can fly under the...

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