OIG spotlights modifier -25 in recent Work Plan item

Why This Topic Matters

The topic matters because same-day E/M and procedure claims are a common audit focus, and practices that report these services need to understand documentation, medical necessity, and payer-policy review to reduce denials and compliance risk.

Article Sections

1. Minor procedures

   Introduces the general context for same-day E/M reporting with minor procedures and discusses how procedure global periods are being examined by CMS.

2. Correct use of modifier -25

   Covers the general concept of separately identifiable E/M services, documentation expectations, and how same-day reporting is described at a high level.

3. Incorrect use of modifier -25

   Describes broad situations in which same-day E/M reporting may not be supported and mentions resources used to determine what is included in a procedure.

4. Prevention

   Reviews internal auditing, monitoring, pre- and post-payment review concepts, and process risks that can affect claim accuracy.

5. Authoritative documents

   Summarizes the types of payer and policy documents that may govern claim review and audit decisions.

6. Reimbursement

   Addresses payer policy review, denial analysis, contractual considerations, and monitoring for underpayment or processing issues.