Ophthalmology and Optometry Coding Alert

MACs looking for 'red flag' to halt additional global period pay. Billing for additional services during a global surgery period is always tricky, but now you can expect special scrutiny for modifier 79 claims. After the Office of Inspector General (OIG) got wind of fraudulent surgery billing with modifier 79 (Unrelated procedure or service by the same physician during the postoperative period), CMS contractors have been on the hunt for modifier 79 abuse. Action plan: Implement our expert tips below to keepyour 79 claims clean. Obey Global Package Model The starting point for clean modifier 79 claims is not breaching the global surgical billing concept. Once you understand the global package rules, you'll know when you have an exception that warrants an additional claim with an appropriate modifier. Know what's included: The global package includes the preoperative visit the day before surgery, intraoperative services, postsurgical complications handled in the office, [...]