Orthopedic Coding Alert

Question: I recently heard that the Office of Inspector General plans to focus on incident-to claims in 2008. Is that accurate?

Arkansas Subscriber

Answer: In September, the Office of Inspector General (OIG) for the Department of Health and Human Services (HHS) released its 2008 Work Plan, which did indicate that the agency will scrutinize claims for incident-to services administered to Medicare patients. According to the Work Plan, the OIG will examine the qualifications and appropriateness of the staff members who perform incident-to services.

The OIG will also zero in on claims for diagnostic x-ray services performed in emergency departments, as well as durable medical equipment (DME) and power wheelchair claims.

And don't forget to button up your claims for E/M services performed during global surgical periods. The OIG plans to determine whether "the number of E/M services provided during the global surgery period has changed since the global surgery fee concept was developed in 1992."

See the entire OIG Work Plan at http://oig.hhs.gov/08/Work_Plan_FY_2008.pdf.

-- Reader Questions and You Be the Coder were reviewed by Heidi Stout, CPC, CCS-P, director of orthopedic coding services at The Coding Network LLC; and Bill Mallon, MD, orthopedic surgeon and medical director at Triangle Orthopaedic Associates in Durham, N.C.