NewsAn $850,000 DOJ settlement over alleged misuse of modifier 25 serves as a reminder that sometimes modifier misuse rises to something more than a coding dispute and can put you in False Claims Act jeopardy. Kevin P. Mulry spoke with Part B News regarding this topic:
Kevin Mulry, a former assistant U.S. attorney and a partner with Farrell Fritz in New York City and Uniondale, N.Y., says practices can get sloppy about this. For example, “when there are injections that that are administered to a patient periodically — that’s an area where a practice may add 25 but if they can’t justify it, that’ll be a problem,” Mulry says. “Each patient’s chart should show some specific reason aside from the initial service for using 25 — if it appears to be a default choice, you have a big problem.”
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Part B News | $850K for misusing modifier 25? Tighten up on policy… (decisionhealth.com)