Modifier 59, 57, 25 & 24 – New Changes and Reimbursement Guidelines for Modifiers

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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

Presenter Biography:

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This is a Live Virtual session.

A new way of immersive learning that allows you to engage live with our instructor and peers providing you with the flexibility to juggle the new work-life balance.

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