tci Medicare Compliance & Reimbursement - 2012 Issue 8
Billing: CMS to Institute Payment Edits for E/M Services During Global Periods
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Article Overview
This article explains a set of CMS billing edits scheduled to begin in July and describes the general areas they affect, including E/M services during surgical global periods, untimed therapy billing, pulmonary diagnostic testing, IV hydration reporting, and claims involving two surgeons. It is aimed at medical coders, billing staff, compliance teams, and providers who need to understand where CMS is tightening claims review and what kinds of documentation and modifier issues are being targeted.
Why This Topic Matters
The article matters because it highlights CMS efforts to reduce improper payments through new edits that can affect common billing workflows across surgery, therapy, diagnostics, and infusion services. Readers can use it to identify which claims areas may face closer scrutiny and why documentation and modifier reporting are becoming more important.
What You Will Learn
- Which broad claim categories CMS plans to edit starting in July
- Why global-period E/M services are being reviewed more closely
- How untimed therapy billing is being targeted by new edits
- What general documentation concerns apply to pulmonary diagnostic testing with E/M services
- How initial IV hydration billing is being scrutinized
- Why claims involving two surgeons and related modifier reporting are receiving attention
Who Should Read This
- Medical coders
- Billing staff
- Compliance teams
- Physicians and surgeons
- Practice administrators
Codes Discussed
Code Ranges Discussed
Modifiers Discussed
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