General Question for the Week of April 26, 2021

General Compliance Question of the Week


From a claims perspective, what are some red flags when reviewing infusion and injection claims?


Two areas to watch are:

  • The total number of units reported – If more than one unit is reported, review the encounter to verify that the appropriate number of units have been charged.
  • Use of modifiers – If modifiers are reported for an infusion, compare the line item to other charges on the claim to ensure appropriate modifier use.

Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.