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Pediatric Coding Alert

Audit Areas:

2 Actions Protect Your E/M, Incident to, Observation Care Services from Paybacks

Private payer auditors will be targeting these pediatric practice error areas. If you think as a pediatric practice you can ignore the OIG's 2011 Work Plan, be prepared for payback requests from your major payers. Myth: As a pediatric practice, you don't have to pay attention to the services and procedures listed in the plan. Truth: Although the Office of Inspector General's annual work plan recommends audit areas for Medicare contractors to focus on, private payers will include the high error items noted on the plan in their audits as well. To avoid having to pay back thousands in unsubstantiated or improperly coded services and procedures, do an internal audit so that you can bring your practice into compliance. Focus on these top error areas: Support Unrelated Postop E/Ms With Modifier 24 Some minor procedures, for instance, wart removal (17110, Destruction [e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement], of [...]

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