Learning Objective:

• Understand the difference between payment and informational modifiers
• Learn the NCCI guidelines on the appropriate use of modifiers
• Be able to apply the correct modifier(s) based on the specific circumstances
• Learn how to properly resolve NCCI edits including a breakdown of -59 and associated -X modifiers
• Proper use of modifier -25, especially in the office or outpatient setting
• Understanding the -57/-54 combination

Areas Covered in the Session

• Purpose of Modifiers
• Types Of Modifiers
  • Payment Modifiers
  • Informational Modifier
• CPT/HCPCS Modifiers
• Modifiers And Reimbursement
• Tips for Modifier Usage
• Steps to Applying Modifiers Correctly
• Hot Topic Modifier
• Modifiers 24/25
  • CMS Guidelines for Modifier 24
  • CMS Guidelines for Modifier 25
• Modifier 59
  • CMS Guidelines for Modifier 59
  • AMA Guidelines for Modifier 59
• Modifiers X{EPSU}
• Modifiers JW & JZ
• Surgery Modifier
• NCCI
• Modifier 22
• Modifiers 50/51
  • Modifier 50: Bilateral Procedure
  • Modifier 51: Multiple Procedures
• Modifiers 58/78
• Modifiers 76/ 77
  • CMS Guidelines for Modifier 76 and Modifier 77
  • AMA Guidelines for Modifier 76 and Modifier 77
• Example for All Modifiers
• Resources

Suggested Attendees

• Coders
• Billers
• Auditors
• Physicians and non-physician practitioners
• Nurses
• Medical Officers
• Compliance Officers
• Clinic Managers
• Insurance company claims reviewers
• Insurance payers
• Payment policymakers
• Denial resolution team

About the Presenter