tci Part B Insider - 2008 Issue 21

MODIFIER 59 COMPLIANCE: OIG Revisits Recommendation to Institute Edits

OIG found 40 percent error rate on modifier 59 claimsWhen the OIG talks, not everyone listens, according to a new report.The OIG makes hundreds of recommendations each year, advising practices and carriers to tighten up documentation, correct their modifier use, or implement other programs. On May 30, the OIG released its 86-page -Compendium of Unimplemented OIG Recommendations,- which revealed that practices have ignored many OIG suggestions.Case in point: In 1996, the OIG found a 40 percent error rate on claims that contained modifier 59 (Distinct procedural service) and encouraged carriers to institute a claims edit that...

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