Avoid OIG Scrutiny

Why This Topic Matters

The article helps readers recognize which billing practices were being targeted for review so they can better assess compliance risk and document appropriately. It is relevant to organizations that perform diagnostic testing, submit surgery claims, or handle modifier-driven claim separation issues.

Article Sections

1. Shore up diagnostic test, modifier -59 claims in 2004

   Introduces the article’s focus on OIG scrutiny affecting diagnostic testing and modifier-based claim handling. It frames the compliance concerns that follow for surgery practices and billing staff.

2. Apply Modifier -59 With Caution

   Discusses the article’s primary modifier compliance topic and the broader concern about bypassing NCCI edits. It also addresses documentation and audit readiness in general terms.

3. Be Alert to Other Focus Areas

   Summarizes additional 2004 OIG focus areas relevant to surgeons and coders, including evaluation and management reporting, care plan oversight, and incident-to billing.