General Surgery Coding Alert - 2018 Issue 3
Compliance: What's On the RAC Hot List? E/M Codes Billed With Procedures
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Article Overview
This article explains a compliance topic for medical coders and billing staff: how recovery audit contractor attention can affect evaluation and management claims billed alongside procedures. It discusses general audit concerns, the role of global periods, and the use of common modifiers in broad scenarios so readers can assess whether the article is relevant to their coding and billing workflow. The piece is aimed at practices that submit professional claims and want to understand audit risk areas and response considerations.
Why This Topic Matters
Claims involving evaluation and management services and procedures are frequent audit targets, and misunderstanding global-period billing can lead to denials, repayment demands, or compliance exposure. The article is relevant for teams that handle physician billing, audits, and documentation support.
Article Sections
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Audit focus on E/M services billed with procedures
Introduces the compliance issue and the audit attention on evaluation and management services billed in proximity to procedures. It frames the general global-period context discussed in the article.
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3 Questions Show the Appropriate Use of Modifiers
Presents a scenario-based discussion used to review modifier application in relation to same-day or related-service billing. The section organizes the article’s broad coding guidance into a question-and-answer format.
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What If You Do Get a Letter from Your RAC About this?
Summarizes general steps to consider after receiving an audit letter and emphasizes timely response and supporting documentation. It also discusses the broader audit process and how practices may respond.
What You Will Learn
- How the article frames RAC audit interest in evaluation and management claims billed with procedures.
- What general billing and compliance issues are associated with global periods.
- How the article organizes its discussion of modifier use in broad scenario form.
- What to expect if an audit letter is received and the article’s general response themes.
Who Should Read This
- Medical coders
- Physician billing staff
- Compliance staff
- Practice managers
- Revenue cycle professionals
Codes Discussed
Code Ranges Discussed
Modifiers Discussed
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