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About Course

Format: On-Demand Webinar
Presenter: Edna Maldonado, CPC, ACS-UR
Time: You can access the webinar anytime
Duration: 60 minutes
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Modifier 59 is the most frequently used modifiers and also complex and confusing to properly use. This webinar will provide a well round explanation on the proper use of modifiers. Explain the difference of informational and payment modifiers. Our speaker will also go over the two sets of modifiers for Category I and HCPCS Level Modifiers. Improper use of Modifier 59 not only results in denied claims but also create risk of huge fines and penalties.

Expert Edna Maldonado will review the nuances of correctly utilizing modifier 59 and also help you better identify distinct procedural services to help you get reimbursed more. She will also help you to master the complex Modifier 59 unbundling, different payment and informational modifiers.

Learning Objectives

  • Describe coding information to use in everyday practice
  • Understand proper use of modifiers to communicate with carriers
  • Identify CAT I and HCPCS Modifiers
  • Know the reimbursement differences when modifiers are used
  • Review current documentation to determine changes that need to be made

Areas Covered in the Session

  • Differences of Opinion
  • Objectives
  • Two Types of Modifiers
    • HCPCS Level 1 – Developed by the AMA
    • HCPCS Level 2 – Developed by the CMS
  • Why use a modifier?
  • Modifiers
    • Evaluation and Management Services
    • Surgery/Procedures
  • Modifiers For E/M Services
  • Modifier 24
  • Modifier 25
  • Medical Necessity?
  • Determining Correct Use
  • Modifier 57
  • Modifier Guidelines/Usage
  • Payment Modifiers
    • Modifier 22 – Increased Procedural Service
    • Modifier 50 – Bilateral procedure
    • Modifier 51 – Multiple procedures
    • Modifier 52 – Reduced services
    • Modifier 53 – Discontinued Procedure
    • Modifier 62 – Co-surgeons
    • Modifier 78 – Unplanned return to the operating/procedure Room by the same physician or other qualified
      health care Professional following initial procedure for a related Procedure during the postoperative
      period
    • Modifier 80 – Assistant Surgeon
    • Modifier 81 – Minimum Assistant Surgeon
    • Modifier 82 – Assistant Surgeon when qualified
  • Assistant Surgeon
  • Informational Modifiers
    • Modifier 58 – Staged or Related procedure or service by the same physician other qualified health care
      professional during the postoperative period
    • Modifier 76 – Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional
    • Modifier 77 – Repeat Procedure by Another Physician or Other Qualified Health Care Professional
    • Modifier 79 – Unrelated procedure or service by the same physician or other qualified health care
      professional during the postoperative period
  • Bundling Modifier 59
    • Modifier 59 – Distinct procedural service
  • Modifier 59
  • Subset Modifiers to Modifier 59
    • XE: Separate Encounter, a service that is distinct because it occurred during a separate encounter
    • XS: Separate Structure, a service that is distinct because it was performed on a separate
      organ/structure
    • XP: Separate Practitioner, a service that is distinct because it was performed by a different
      practitioner
    • XU: Unusual Non-Overlapping Service, the use of a service that is distinct because it does not overlap
      usual components of the main service
    • Example of Proper use 59/XS
  • HCPCS Modifiers – AS, JW, JZ

Suggested Attendees

  • Coders – Beginners, Intermediate and Professionals
  • Billers
  • Physicians
  • Nurses
  • Providers
  • Administrators
  • APPs
  • Residents
  • Claims Adjusters
  • Reimbursement Staff
  • Medical Officers
  • Clinic Managers
  • Insurance Company Claims Reviewers
  • Insurance Payers
  • Payment Policymakers
  • Denial Resolution Team

About the Presenter

Ms. Edna R. Maldonado is a Certified Professional Coder (CPC), Board of Medical Specialty Coding & Compliance (ACS-Urology) and AHIMA ICD-10-CM Trainer. Edna R. Maldonado, CPC, is a bilingual health care management professional that has specialized in urology coding, billing, and training for over 30 years. Her training skills are unmatched, and she has used them to train several coders new to urology to staff AUA’s Coding Hotline. She has also trained and prepared coders for the CPC coding examination. Her leadership extends beyond training, she has also assisted new coders with goal setting, and she has mentored several coders who have moved on to higher positions in urology coding.

Ms. Maldonado’s ambition and drive has elevated her to an expert level in the field of urology coding. She holds herself to the highest standards of professionalism and confidence. She is dedicated to representing her organization and herself in a stellar light by always providing superior results. She is currently the Chair for the Practice Administration Work Group (PAWG) for the AUA, serving as Co-Course Director for the two-day annual Coding Seminar held by the AUA. Ms. Maldonado is an AAPC Officer for her Local Chapter, Frederick, MD.

Ms. Maldonado’s career in urology began in 1990 at Florida Urology Partners (formerly known as Town & Country Urology) where she was hired to manage a busy urology practice by the original owner, Servando Sanchez, M.D. During her time there, Ms. Maldonado was an effective leader with creative skills in interpersonal communications, organizational techniques and problem solving that she used to motivate and to cultivate a diverse staff of eleven. Her time there prepared her for a great opportunity to relocate and join a premier urologic association, providing invaluable support to the urologic community-the American Urological Association (AUA).

Since joining the AUA in 2010, Ms. Maldonado has become a respected and renowned expert in the field of urology coding. She has developed a multitude of urology coding training materials and training techniques for teaching urology coding. As a urology coding trainer, Ms. Maldonado has developed, designed, and recorded content for urology coding CDs, webinars, and virtual training. As an instructor, Ms. Maldonado has been a lead faculty member for urology coding courses including 30 two-day coding seminars, 27 customized coding seminars and over6 conference coding courses.

Snippet From Our Previous Session

Course Content

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  • Webinar Link + Handouts PDF
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