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2023 CMS Surgical Modifiers Compliance and Reimbursement Guidelines

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Surgical modifiers have been in existence for many years but continue to be somewhat confusing. This program will Identify specific surgical documentation that will help support use of modifiers, decrease denials and reduce risk of audits. The Correct Coding initiative (CCI) plays a major role in reporting multiple procedures. Discussion of CCI principles will help you understand how to navigate CCI reporting issues. We will review different categories of modifiers such as modifiers that identify multiple providers working on a global surgery encounter, modifiers to support billing additional procedures and modifiers that may increase or reduce payments. We will discuss tips for reporting modifier -22, modifier -59, modifiers 78, 58 and 79 to ensure maximum reimbursement with handy quick reference grid.

Learning Objectives:
  • Review monetary issues with modifiers
  • Understand Unbundling issues and the use of modifier -59 versus modifier -51
  • Know what types of procedures may require a modifier
  • Understand “decision for surgery”
  • Who can bill for preoperative services
  • Understanddocumentation to help support use of a specific modifier
  • Correct reporting and charges for reduced or incomplete procedures
  • Correct reporting of modifiers -58, -78, and -79
  • Reduce risk associated with improper use of modifiers
  • Payment for multiple providers
Areas Covered in the Session:
  • Preoperative care
  • Correct coding initiative and modifier -59 or modifiers XE, XS, XP, XU
  • Modifier reporting in the post operative period
  • Modifiers -22, -52 and -53
  • Modifier -51 versus -59
  • Multiple procedure reductions for endoscopic procedures versus non-endoscopic procedures
  • Modifiers for multiple providers and payment issues
  • Live Q&A session
Suggested Attendees:
  • Providers
  • Office managers
  • Physicians
  • Physicians coders
  • Billers
  • Auditors
  • Practice managers
  • Denial resolution teams
  • Revenue and Claim specialist
Presenter Biography:

Jan Rasmussen, PCS, ACS-OB, ACS-GI, – As a healthcare consultant Jan has more than 35 years of experience in physician billing, reimbursement, and compliance. Jan is currently the owner of Professional Coding Solutions, a healthcare consulting firm. She has been a Certified Professional Coder (CPC) since 1992 with active membership in the American Academy of Procedural Coders (AAPC). As a member of the AAPC, Jan previously served on their Advisory Board as the liaison to the AMA, has been a speaker for the AAPC annual conference as well as contributing to the development of AAPC’s independent study and university education programs and proficiency tests. In 1994, she was honored by AAPC as Networker of the Year. Jan was also a Regional Governor for the American College of Medical Coding Specialists (ACMCS) serving as Chair of the Ethics committee and a member of the Examination committee.

In her role as a physician consultant, she has participated in physician coding and documentation reviews including OIG government PATH and Campus audits, and designed and conducted physician coding seminars nationwide. She has been a guest speaker for several conferences sponsored by United Communications, Inc/ Decision Health, AAPC as well as Coding Institute Specialty Conferences.

In previous consulting positions she was responsible for developing and conducting seminars for basic, intermediate, and advanced ICD-9-CM and CPT, teaching physician guidelines as well as special seminars for OB/ Gyn, Orthopedics, Urology, Gastroenterology, General Surgery, ENT, Cardiology, Emergency Medicine and Evaluation and Management. In her role as an educator, she has been teaching E/M documentation and auditing to both physician and coding audiences since 1992 when RBRVS was first implemented.

Jan has also worked for several major health insurance payers in Wisconsin, was a coding advisor to the WPS Medicare Carrier Advisory Committee, and served as the coding and reimbursement coordinator for a 37-provider, staff model HMO clinic. As the coding and reimbursement coordinator, Jan was responsible for physician office, hospital, surgical, and nursing facility coding charge ticket development, fee development, reimbursement analysis, claims analysis, and physician education.


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TESTIMONIALS

“Jim Sheldon-Dean’s insights on privacy and security were very much helpful to our team, it was great to learn from an instructor like him. Appreciate!”–CHRISTINE JACOB MD, CDI SPECIALIST

“This program on HIPAA did a great job providing actionable concepts in a way that updated our team and me, I now know how I will implement the concepts because I already did it in their online seminar, it was easy to ask questions from the speaker at the end of my 60 minutes course.” –MELISSA PRESTON, HEALTH INFORMATION MANAGEMENT STAFF

“The workshop was very insightful and made absolute sense in terms of the regulations and their compliance. I am thankful for having the opportunity to attend.”–BARBARA CAPRIOTTY, REHABILITATION DIRECTOR

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