Talk Ten Tuesdays

OIG Getting Under the Skin of Dermatologists: E&M Services and Modifier 25

June 22, 2021 Timothy Powell, CPA | Laurie M. Johnson MS | Shannon Deconda | Terry A. Fletcher | Dennis Jones Episode 466
Talk Ten Tuesdays
OIG Getting Under the Skin of Dermatologists: E&M Services and Modifier 25
Show Notes

Are you monitoring the 2021 U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) Work Plan? 

The watchdog agency is watching you. They’re auditing claims for evaluation and management (E&M) services performed on the same day as minor surgical procedures that have been documented with Modifier 25. 

The backstory: in 2019, about 56 percent of dermatologists' claims with an E&M service also included minor surgical procedures (such as lesion removals, destructions, and biopsies) on the same day. This may indicate abuse, wherein the provider used Modifier 25 to bill Medicare for a significant and separately identifiable E&M service when only a minor surgical procedure and related preoperative and postoperative services were supported by the beneficiary's medical record. Nationally recognized professional coder, educator, and auditor Terry Fletcher will return to the Talk Ten Tuesdays broadcast for its next edition to report the lead story. 

The live broadcast will also feature these other segments:

  • Coding Report: Laurie Johnson, senior healthcare consultant with Revenue Cycle Solutions, LLC, will have the Talk Ten Tuesdays Coding Report, along with the broadcast’s weekly Listeners Survey. 

  • Tuesday Focus: Homework: Many auditors and coders are working from home these days, and home has raised new obstacles and some new advantages to our daily routines. How to bring the home practicality into the coding and auditing work world will be Shannon DeConda, founder of the National Alliance of Medical Auditing Specialist (NAMAS). 

  • News Desk: Timothy Powell, compliance expert and ICD10monitor national correspondent, will anchor the Talk Ten Tuesdays News Desk.

  • Point of View: Dennis Jones, Patient Financial Services Administrator at Montefiore Nyack Hospital, will substitute for co-host Erica Remer, MD.