tci Part B Insider - 2019 Issue 2

Enforcement: Modifier 59 Case Highlights Risks of Unbundling

Organization receives $12.5 million settlement for modifier 59 abuses. Now that you’ve mastered all the latest ICD-10 and CPT® updates, you might think your 2019 compliance is complete — but, that’s not the case. A recent filing of false claims allegations suggests that repeatedly being lax about how you report modifier 59 (Distinct procedural service) claims could spell disaster for your practice. Context: Last month, the Department of Justice (DOJ) settled with founder and owner Emil DiIorio, MD and his Philadelphia-based organization, Coordinated Health Holding Company, LLC (Coordinated Health), for false orthopedic surgery claims submitted to...

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