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Modifiers Matter: A Modifier Overview for
Presenter
Leesa A. Israel
Follow us :
Learn Some Common Pitfalls for Each Modifier and How to
Overcome or Avoid Them
Disclaimer
I am a writer, a coder, and an auditor, not an attorney.
Although the information has been carefully researched
and checked for accuracy and completeness, the
presenter and Audioeducator.com carry no
responsibility or liability with regards to errors,
omissions, misuse, or misinterpretation.
CPT®
is registered trademark of the American Medical
Association.
Agenda:
 Uncover why it is critical to understand how to use modifiers.
 Get to know what modifiers actually do and review the different types of
modifiers.
 Look at different individual CPT®
modifiers that you will use in your practices:
 Modifier 24
 Modifier 25
 Modifier 57
 Modifier 59
 Modifier 22
 Modifiers 50/LT/RT
 Modifier 51
 Modifier 52
 Highlight the HCPCS modifiers you’ll use, such as QW and Q5/Q6.
 Go through specialty-specific examples for each modifier.
 Take a look at some pitfalls for each modifier and how to overcome or avoid
them.
 Modifier 53
 Modifier 58
 Modifier 78
 Modifier 79
 Modifiers 26/TC
 Modifier 54/55/56
 Modifier 62
 Modifiers 80/81/82
Modifiers Can Make or
Break Your Claim
Assigning the proper procedure code for
services your physician provides is often
only half the battle. If you’re not
appending the proper modifier — or if
you’re assigning the wrong modifier —
you risk miscoding and denials.
Modifiers allow you to:
 Indicate that a service or procedure
was altered in some way, but the
main code descriptor has not
changed.
Use modifiers to …
 Provide the payer with additional
information
 Help explain clinical situations
 Break bundles
 Capture deserved extra payment
If you don’t know how to use
modifiers, you could be:
 Fraudulently billing
 Violating bundling rules
 Wasting time on unnecessary
appeals
 Losing deserved reimbursement
 Raising audit red flags
To see the complete presentation
check the below link:
http://www.audioeducator.com/coding-updates/modifier-
matter-10-14-2014.html

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Modifiers Matter: A Modifier Overview for All Physician Practices

  • 1. Modifiers Matter: A Modifier Overview for Presenter Leesa A. Israel Follow us : Learn Some Common Pitfalls for Each Modifier and How to Overcome or Avoid Them
  • 2. Disclaimer I am a writer, a coder, and an auditor, not an attorney. Although the information has been carefully researched and checked for accuracy and completeness, the presenter and Audioeducator.com carry no responsibility or liability with regards to errors, omissions, misuse, or misinterpretation. CPT® is registered trademark of the American Medical Association.
  • 3. Agenda:  Uncover why it is critical to understand how to use modifiers.  Get to know what modifiers actually do and review the different types of modifiers.  Look at different individual CPT® modifiers that you will use in your practices:  Modifier 24  Modifier 25  Modifier 57  Modifier 59  Modifier 22  Modifiers 50/LT/RT  Modifier 51  Modifier 52  Highlight the HCPCS modifiers you’ll use, such as QW and Q5/Q6.  Go through specialty-specific examples for each modifier.  Take a look at some pitfalls for each modifier and how to overcome or avoid them.  Modifier 53  Modifier 58  Modifier 78  Modifier 79  Modifiers 26/TC  Modifier 54/55/56  Modifier 62  Modifiers 80/81/82
  • 4. Modifiers Can Make or Break Your Claim Assigning the proper procedure code for services your physician provides is often only half the battle. If you’re not appending the proper modifier — or if you’re assigning the wrong modifier — you risk miscoding and denials.
  • 5. Modifiers allow you to:  Indicate that a service or procedure was altered in some way, but the main code descriptor has not changed.
  • 6. Use modifiers to …  Provide the payer with additional information  Help explain clinical situations  Break bundles  Capture deserved extra payment
  • 7. If you don’t know how to use modifiers, you could be:  Fraudulently billing  Violating bundling rules  Wasting time on unnecessary appeals  Losing deserved reimbursement  Raising audit red flags
  • 8. To see the complete presentation check the below link: http://www.audioeducator.com/coding-updates/modifier- matter-10-14-2014.html