Recovery Audit Contractors: Discontinued Procedure Modifiers Find Spot on RAC’s To-Do List

Why This Topic Matters

Claims involving discontinued procedures can be vulnerable to audits and payment adjustments if the modifier selection and supporting documentation are not aligned with the setting and circumstances. Understanding the article helps coding teams recognize the type of Medicare review involved and the broader documentation expectations discussed by the author.

Article Sections

1. Audit focus and background

   Introduces the Medicare recovery audit issue and the general claim type under review. Provides context on the role of recovery auditors in Medicare claim review.

2. Check This Example

   Presents a clinical billing scenario involving a discontinued procedure and the setting-specific considerations that follow. The example is used to frame the coding discussion that comes later.

3. Always Submit Documentation

   Summarizes the article’s discussion of supporting records for discontinued procedure claims. Emphasizes the documentation themes reviewed in the article.