decisionhealth Newsletters, Coder Pink Sheets - 2014 Issue 11 (November)
Compliance issues: Use of modifiers 59, 91 for urine drug screens under scrutiny by OIG
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Article Overview
This article covers Medicare billing compliance issues related to urine drug screens, including OIG enforcement activity, settlements, and scrutiny of claim patterns in pain management and laboratory settings. It is aimed at coders, compliance staff, and billing teams who work with drug testing services and related guidance from Medicare and the Correct Coding Initiative.
Why This Topic Matters
The topic matters because drug screen billing is under active review by enforcement agencies and payers, and improper claim patterns can create significant compliance risk for providers and labs.
What You Will Learn
- How OIG enforcement is affecting urine drug screen billing scrutiny
- Why Medicare claims for drug testing attract compliance review
- What general resources and guidance sources are referenced for compliance monitoring
- How payer and coding-policy changes can affect billing review workflows
Who Should Read This
- Medical coders
- Compliance officers
- Billing managers
- Pain management practices
- Clinical laboratories
- Revenue cycle professionals
Codes Discussed
Modifiers Discussed
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