Modifier 25... The OIG Hasn't Lost Its Edge  

Don't think the Office of Inspector General (OIG) has lost interest in modifier 25.

Hardly. The OIG plans to continue monitoring claims for use of this particular modifier due to a reputation that raises a red flag. The modifier identifies a separate service for billing so its presence in claims naturally attracts OIG attention, especially when claims in which it was used has resulted in millions of dollars in improper payments.

In 2001, according to the 2006 OIG work plan, Medicare allowed over $23 billion for evaluation and management services. Of that amount, approximately $1.7 billion was for evaluation and management services billed with modifier 25.

Modifier 25 appended to a CPT code distinguishes services provided by the same physician on the same day of service; it shows the evaluation and management work provided and reported separately went above and beyon...