CMS urges carrier crackdown on abuse of modifier 79

Why This Topic Matters

The topic matters because postoperative billing patterns can draw payer scrutiny, and practices need to understand the compliance focus around modifier 79 and related documentation expectations without assuming all repeat services are payable separately.

Article Sections

1. CMS and OIG review of modifier 79 abuse

   Summarizes the Medicare program’s concern about possible misuse of postoperative billing patterns and the carrier review actions CMS wants to see. It also references the role of an OIG report in prompting scrutiny.

2. Postoperative use concerns in practice settings

   Discusses how modifier 79 issues may arise in specialty practices, with attention to documentation and billing patterns in surgical follow-up care. The section also notes the kinds of postoperative services that can draw attention.

3. Example and utilization data

   Provides an example referenced by a Medicare bulletin and cites utilization information related to one procedure code. This section illustrates the type of scenario discussed in the article.