The Office of Inspector General (OIG) Work Plan now includes a new 2021 project: Auditing Dermatology Claims for E&M Services on the Same Day as Minor Surgical Procedures.

As reported by the OIG, Medicare only covers Evaluation & Management (E/.M) visits on the same day as a minor procedure if a surgeon performs a significant and separately identifiable E/M service that is unrelated to the decision to perform the minor surgical procedure.

As reported by the OIG, Medicare only covers Evaluation & Management (E/.M) visits on the same day as a minor procedure if a surgeon performs a significant and separately identifiable E/M service that is unrelated to the decision to perform the minor surgical procedure.

Why is this topic selected for OIG Audit?

In 2019, the OIG found that approximately 56 percent of dermatologists’ claims with an E/M service also included minor surgical procedures (such as lesion removals, destructions, and biopsies) on the same day. This may indicate abuse whereby the provider used modifier 25 to bill Medicare for a significant and separately identifiable E/M service when only a minor surgical procedure and related preoperative and postoperative services are supported by the beneficiary’s medical record.

Through investigation, the OIG will determine whether dermatologists’ claims for E/M services on the same day of service as a minor surgical procedure complied with Medicare requirements.

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Source: The American Institute of Healthcare Compliance