Practice Management Alert

The OIG is focusing on modifier 59, and so should you.With payers scrutinizing claims submissions for separate and distinct services, thanks to the OIG's reported error rates relating to modifier 59 use, you can't afford to make avoidable modifier 59 (Distinct procedural service) mistakes on your claims. Denials due to incorrect modifier 59 use cost your practice time and money, but perhaps even more critical is the red flag those claims wave at auditors. Good news: You can avoid these claim errors and prevent possible paybacks by using these two tips.Tip 1: Determine Separate RegionsPull a sample of your modifier 59 submissions and verify that the claims properly represent a distinct procedural service. Fifteen percent of the OIG's audited claims using modifier 59 had procedures that weren't distinct because "they were performed at the same session, same anatomical site, and/or through the same incision," says Daniel R. Levinson, inspector general, [...]