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