Part B Insider (Multispecialty) Coding Alert

Published on Sat Apr 11, 2009 PDF

" As most practices know, E/M services are included in the global packages of most major surgeries. But what happens if you bill the surgery without performing that included E/M? A new OIG report suggests that you might have to get used to less surgical pay if you are failing to perform E/Ms.

On April 20, the OIG released its report, Nationwide Review of E/M Services Included in Eye and Ocular Adnexa Global Surgery Fees for Calendar Year 2005, which noted that out of 300 global surgeries that the OIG reviewed, 240 of the surgeries did not include a qualifying E/M, even though surgeons were paid for these E/M services via the global surgical payment. This resulted in $97.6 million in overpayments to surgeons.

As a result, the OIG recommends that CMS either adjust the number of E/M services included in eye surgeries, or change the fee schedule amounts to reflect the unperformed E/M services.

To read the OIG report, visit www.oig.hhs.gov/oas/reports/region5/50700077.pdf.