E/M Coding Alert - 2009 Issue 7
FACET JOINT COMPLIANCE: Physicians Overbilled Facet Joint Injections by $96 Million, OIG Says
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Article Overview
This article discusses Medicare compliance concerns surrounding facet joint injection billing and the CMS/OIG review that found widespread improper payment issues. It is aimed at physicians, coders, billers, and compliance staff who need a general understanding of how the article frames billing oversight, carrier processing concerns, and the categories of CPT and modifier guidance discussed.
Why This Topic Matters
Facet joint injection claims can be vulnerable to billing errors, payer processing problems, and compliance scrutiny. The article is relevant to practices that want to understand the general types of coding and claims-handling issues highlighted by CMS and the OIG.
What You Will Learn
- Why facet joint injection billing drew Medicare compliance attention
- What types of claims-processing issues were highlighted for these services
- How the article frames the role of CPT add-on reporting and modifier use
- Which broad billing scenarios the article says require extra attention
Who Should Read This
- Physicians
- Medical coders
- Medical billers
- Practice managers
- Compliance staff
- Revenue cycle professionals
Codes Discussed
Modifiers Discussed
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