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00731  Anesthesia for upper gastrointestinal endoscopic procedures, endoscope introduced proximal to duodenum; not otherwise specified ...

OIG Reports Hospital Billing Issues - Adding Modifier 59 for RHC when Heart Biopsy is performed on the same day


In one of the recent reports, the Office of Inspector General (OIG) cites significant issues in which hospitals are making coding errors on Medicare claims. Correct coding of claims is important for hospitals to avoid improper payments, which can lead to recoveries of overpayments. The Centers for Medicare & Medicaid Services (CMS) encourages hospital billing and coding personnel to review the OIG reports and take steps to avoid the problems identified in those reports. It is also very important that claims submitted are supported by documentation in the beneficiary's medical records. 

In the report, “Hospitals Nationwide Generally Did Not Comply with Medicare Requirements for Billing Outpatient Right Heart Catheterizations with Heart Biopsies,” the OIG analyzed claims to determine if hospitals were correctly reporting modifier -59 for RHCs and heart biopsies. The OIG found that in billing for outpatient RHCs with heart biopsies, hospitals often use modifier -59 inappropriately, which leads to significant overpayments and overpayment recoveries on claims for these services. 

For detail information on OIG audits & findings, visit: https://oig.hhs.gov/oas/reports/region1/11300511.pdf

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