Medicare Compliance & Reimbursement - 2016 Issue 3
E/M Self-Audits: Remember Modifier 25 When Conducting Self-Audits
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Article Overview
This article explains a compliance-focused review of E/M self-audits, emphasizing why modifier misuse can attract payer scrutiny and why documentation matters when a same-day procedure and evaluation and management service both appear in the record. It is relevant for coders, auditors, compliance staff, and practices reviewing office visit reporting habits and modifier use in routine audit preparation.
Why This Topic Matters
Improper modifier use can trigger payer audits and create documentation risk. The article highlights why self-audits should examine whether the record supports reporting a same-day E/M service alongside another procedure or service.
What You Will Learn
- Why modifier misuse is a common audit concern
- How self-audits can help identify documentation gaps
- What kinds of same-day E/M reporting situations draw scrutiny
- Why coding teams review modifier use carefully
Who Should Read This
- Medical coders
- Auditors
- Compliance staff
- Physician practices
- Revenue cycle teams
Codes Discussed
Modifiers Discussed
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