General Surgery Coding Alert - 2018 Issue 6
Auditing: Avoid Audit Agony with This Modifier Advice
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Article Overview
This premium article explains an audit-focused review of evaluation and management claims tied to procedures with 0-, 10-, and 90-day global periods. It is aimed at coding and billing professionals who need to understand the compliance concerns, the audit context, and the general modifier guidance discussed in the article without relying on the full text.
Why This Topic Matters
Claims involving E/M services and procedures can draw audit attention when global period rules are implicated. Understanding the article helps readers recognize the compliance risk areas discussed by the RAC and the broader billing context for these claims.
Article Sections
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RAC review and audit focus
Introduces the audit context and the types of claims under review. It frames the compliance concerns discussed in the article.
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Three audit scenarios involving global periods
Summarizes the separate categories of claims being scrutinized across different global period lengths. The section provides the general subject matter for the modifier discussion that follows.
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Questions on modifier use in an example case
Walks through a case-based discussion centered on an E/M service and a same-day procedure. The section uses questions to explore the broader modifier concepts addressed in the article.
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Caution and audit follow-up
Concludes with a short note about automated review, documentation support, and next steps in the audit process. It emphasizes the article's compliance and audit management focus.
What You Will Learn
- How audit reviews can involve E/M services billed around procedures with global periods
- What general modifier topics are discussed in the context of same-day and perioperative services
- Why documentation and claim support matter in an audit setting
- How the article frames compliance concerns for coding and billing staff
Who Should Read This
- Medical coders
- Coding auditors
- Billing staff
- Revenue cycle professionals
- Compliance staff
- Physician practice managers
Codes Discussed
Modifiers Discussed
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