| The OIG’s recent audit of dermatology providers highlights a critical compliance checkpoint: billing of evaluation & management (E/M) services on the same day as minor surgical procedures.
Key Takeaways
- The audit found that many dermatology claims combined same-day E/M services with minor surgical procedures despite Medicare’s global-surgery and coding rules.
- Under Centers for Medicare & Medicaid Services (CMS) policy, when a minor procedure (with a 0- or 10-day global period) is performed, the decision-making and evaluation that led to that procedure are generally bundled into the payment for the procedure, unless the E/M service is significant and separately identifiable.
- The audit clearly signals that dermatology practices (and by extension other specialties performing minor procedures) are under scrutiny for possible improper billing when these services are not appropriately separated.
Why This Matters for Compliance Officers
- Billing missteps in this area may trigger audits, payment recoupment or provider sanctions.
- Even if your facility or practice isn’t dermatology-specific, the same principles apply to any specialty combining same-day E/M visits and minor procedures.
- Establishing robust documentation, clear workflows for when an E/M is truly “separate” from the procedure decision/visit, and internal audit controls around the use of Modifier 25 is essential.
- It’s not sufficient to simply append a modifier, compliance must ensure the medical record clearly supports: (a) the E/M was above/beyond the usual pre-/post-operative work of the procedure, and (b) the issue addressed was distinct from the surgical decision-making.
Action Items for Your Compliance Program
- Review recent claims where same-day E/M + minor procedures were billed, analyze whether modifier 25 was used and whether documentation supports a distinct E/M service.
- Update physician/provider education and documentation guidelines: clarify when same-day E/M is appropriate, and when it is not.
- Audit your internal “bundling” controls: Do coders/billers check for minor procedure global periods, same-day E/M presence, appropriate modifier use, and documented justification?
- Monitor for changes in CMS/OIG policy and guidance (similar audits are occurring across other specialties) so your practice stays ahead of enforcement actions.
In short: While the OIG’s audit concluded that many dermatology providers generally met Medicare requirements, the review underscores that same-day E/M services paired with minor surgical procedures remain an enforcement focus. For compliance officers, now is the moment to ensure your policies, claims review workflows and documentation standards are solid.
The OIG report is accessible here: https://oig.hhs.gov/reports/all/2025/dermatology-providers-generally-met-medicare-requirements-for-evaluation-and-management-services-performed-on-same-day-as-minor-surgical-procedures/
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