Presentation of proper coding and usage of modifiers (Level I and Level II)
Have trouble knowing what modifier to use and how use will impact your claim? Take a look at the presentation "The In's and Out's of Coding with Modifiers", which explain modifiers for you! Hope you enjoy!
A Facility-Focused Guide to Applying Modifiers Corectly.pptxHealth Catalyst
This webinar is a review of how to appropriately assign frequently misapplied CPT and HCPCS modifiers. Older modifiers and newly added modifiers, that were effective January 1, 2023, will be covered. This webinar is focused on modifiers that should be used on the facility side. While some of these modifiers can also be used on the professional side, this presentation does not focus on assigning modifiers on the professional side. For information regarding applying modifiers on the professional side, please see part one of this series--A Physician-Focused Guide to Applying Modifiers Correctly.
A Facility-Focused Guide to Applying Modifiers Corectly.pptxHealth Catalyst
This webinar is a review of how to appropriately assign frequently misapplied CPT and HCPCS modifiers. Older modifiers and newly added modifiers, that were effective January 1, 2023, will be covered. This webinar is focused on modifiers that should be used on the facility side. While some of these modifiers can also be used on the professional side, this presentation does not focus on assigning modifiers on the professional side. For information regarding applying modifiers on the professional side, please see part one of this series--A Physician-Focused Guide to Applying Modifiers Correctly.
Clinical Documentation Guidelines for ICD-10-CMPamela Marasco
How Do You Rate Yourself as an Adopter of Change? Assess your willingness to implement new clinical documentation standards for ICD-10-CM. Improve your practice for clinical documentation to ensure proper selection of ICD-10-CM Coding Guidelines. Because EVERYTHING IS CHANGING!
US Healthcare Reimbursement for MedTech & Digital HealthLevi Shapiro
Overview of the US healthcare reimbursement framework as it relates to MedTech and Digital Health companies by David Farber, Senior Partner, King & Spalding law firm. Includes Introduction FDA Approval vs. Reimbursement; Different Standards; Clinical Evidence Needed; The Three Keys to Reimbursement Coverage; Coding; Payment; What’s New for 2019 Reimbursement for MedTech; AI Solutions Tips for Successful Reimbursement
The following information was taken from Chapter 2 of Buck's Step-by-Step Medical Coding, 2019 Edition. The book is cited on the last slide of the presentation. All information is relevant as of 2019. Any updates after November 2019 will not be in this presentation. This presentation was created through Canva.
This process is complicated and depends on rules that are specific to payers and to the states in which a provider is located. Effectively, a claims appeal is the process by which a provider attempts to secure the proper reimbursement for their services.
Clinical Documentation Guidelines for ICD-10-CMPamela Marasco
How Do You Rate Yourself as an Adopter of Change? Assess your willingness to implement new clinical documentation standards for ICD-10-CM. Improve your practice for clinical documentation to ensure proper selection of ICD-10-CM Coding Guidelines. Because EVERYTHING IS CHANGING!
US Healthcare Reimbursement for MedTech & Digital HealthLevi Shapiro
Overview of the US healthcare reimbursement framework as it relates to MedTech and Digital Health companies by David Farber, Senior Partner, King & Spalding law firm. Includes Introduction FDA Approval vs. Reimbursement; Different Standards; Clinical Evidence Needed; The Three Keys to Reimbursement Coverage; Coding; Payment; What’s New for 2019 Reimbursement for MedTech; AI Solutions Tips for Successful Reimbursement
The following information was taken from Chapter 2 of Buck's Step-by-Step Medical Coding, 2019 Edition. The book is cited on the last slide of the presentation. All information is relevant as of 2019. Any updates after November 2019 will not be in this presentation. This presentation was created through Canva.
This process is complicated and depends on rules that are specific to payers and to the states in which a provider is located. Effectively, a claims appeal is the process by which a provider attempts to secure the proper reimbursement for their services.
Modifiers for Otolaryngology: Best Practices for Reimbursement SuccessAudioEducator
Otolaryngology coding and billing expert Barbara J. Cobuzzi provides a 1-hour audioconference on Modifiers for Otolaryngology: Best Practices for Reimbursement Success.
Modifiers List in Medical Billing and CodingNick Johnson
A CPT Modifier is a two-position alpha and alpha-numeric code used to identify certain situations that require the basic value of a procedure to be either enhanced or diminished. A modifier provides the means by which a service or procedure that has been performed can be altered without changing the procedures code. Modifying circumstances include. CPT Modifiers are an important part of the managed care system or medical billing.
A service or procedure that has both a professional and technical component. (26 or TC)
A service or procedure that was performed more than once on the same day by the same physician or by a different physician. (76 or 77)
A bilateral procedure service that was performed. (50)
A distinct procedure service. (59)
What Are CPT Modifiers And Why Medical Billing Companies Use Them?Jessica Parker
CPT modifier may describe whether multiple procedures were performed, why that procedure was necessary, where the procedure was performed on the body, how many surgeons worked on the patient, and lots of other information that may be critical to a claim’s status with the insurance payer.
Webinar - A Physician-Focused Guide to Applying Modifiers CorrectlyHealth Catalyst
This webinar is a review of how to appropriately assign frequently misapplied CPT and HCPCS modifiers. Older modifiers and newly added modifiers, that were effective January 1, 2023, will be covered. This webinar is focused on modifiers that should be used on the professional side. While some of these modifiers can also be used on the facility side, this presentation does not focus on assigning modifiers on the facility side. Stay tuned for part two of this series which will cover a facility-focused guide to applying modifiers correctly.
Webinar - A Physician-Focused Guide to Applying Modifiers Correctly Health Catalyst
This webinar is a review of how to appropriately assign frequently misapplied CPT and HCPCS modifiers. Older modifiers and newly added modifiers, that were effective January 1, 2023, will be covered. This webinar is focused on modifiers that should be used on the professional side. While some of these modifiers can also be used on the facility side, this presentation does not focus on assigning modifiers on the facility side. Stay tuned for part two of this series which will cover a facility-focused guide to applying modifiers correctly.
Understanding ASC Coding and Billing
Medical Billers and Coders (MBC) offer complete transparency and control of the ASC revenue cycle along with key analytics, actionable insights, recommendations, and proven strategies. Such offerings will maximize the ASC’s efficiency, profitability, and physician disbursements. To know more about Ambulatory Surgical Center (ASC) medical billing and coding services contact us at 888-357-3226/info@medicalbillersandcoders.com
Click Here: https://www.medicalbillersandcoders.com/blog/understanding-asc-coding-and-billing/
#ASC #ambulatorysurgicalcentermedicalbilling #ascrevenuecycle #medicalbillingandcodingservice #ascbilling #medicalbillersandcoders #MBC #medicalbillingservices
2011 CMS Physician Quality Reporting System (PQRS): Teaching Doctors of Chiropractic How to Report on Measures Related to Quality Patient Care by Tony Hamm, American Chiropractic Association
How to Use Modifiers 59, 25, 91If you run a healthcare organization from a small physician's office to a large hospital, your billing department uses codes to document procedures, medication and techniques used to treat clients. Entering the wrong code...
CPT coding for pain management is really a hectic task and outsourcing it to a reliable medical coding company helps you earn more while focusing on your core processes
How to Use Modifiers 59, 25, 91If you run a healthcare organization from a small physician's office to a large hospital, your billing department uses codes to document procedures, medication and techniques used to treat clients. Entering the wrong code...
Compliance and Implementation Strategies for CMS Physician Final Rule 2023Conference Panel
Each summer, CMS (Centers for Medicare & Medicaid Services) releases its proposed physician payment and coding change guidelines for the upcoming year. After gathering feedback from the physician community, CMS published the final rule on November 1, 2022, which either confirmed or modified issues from the initial proposal. The provider comments have the potential to influence CMS to deviate from its original guidelines. It is of utmost importance for healthcare providers and their staff to be aware of the specific items that will be implemented in 2023 and those that CMS has decided not to move forward with. The aspects of the proposed rule that were not implemented for 2023 may signal issues that are still under consideration for 2024. Notably, this year brings significant changes to Evaluation and Management (EM) services, as well as prolonged services, necessitating a complete overhaul in coding practices outside of the office setting. Additionally, there are new criteria for determining prolonged services for Medicare patients. Being well-informed about these updates will be crucial for providers to navigate the evolving landscape of Medicare reimbursement and ensure optimal patient care.
Register,
https://conferencepanel.com/conference/cms-physician-final-rule-2023
Similar to The In's and Out's of Coding with Modifiers (20)
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
1. The ‘In’s and Out’s of Coding with ModifiersThe Key to Proper Reimbursement Tara Ritter, CPC, CPC-H, CPC-I Approved PMCC Instructor Owner of A+ Coding Institute (678) 684-8855 www.apluscodinginstitute.com apluscodinginstitute@gmail.com
2. Today’s Agenda What are modifiers? Why are they used? Modifier Categories Is your practice compliant?
4. What are modifiers? Modifiers are two digit codes appended to a CPT code that indicate that a service or procedure has been altered by a specific circumstance, but has not changed in its basic definition
5. Three Levels of HCPCS Codes and Modifiers(Healthcare Common Procedural Coding System) Level 1 - CPT, Physician’s Current Procedural Terminology (Live in the CPT Manual) Level 2 - HCPCS National Codes (Live in the HCPCS Manual) Level 3 - Local Codes assigned and maintained by individual state Medicare Carriers Eliminated by HIPAA as of Dec 31, 2003
6. Modifiers denote that… A service or procedure has both a professional and technical components A service or procedure was performed by more than one physician A service or procedure has been increased or reduced Only part of a service was performed A service or procedure was provided more than once A bilateral procedure was performed Unusual events occurred
7. Examples: 31237-50 (procedure done bilaterally) 99214-25 (office visit and procedure on same day) 33208-62 (two surgeons of differing specialties doing same procedure together)
9. Modifiers are used for a variety of reasons, including: Claims can be incomplete or inaccurate without a modifier Coding to the highest level of specificity requires modifier use Appropriate use of modifiers get services reimbursed that might otherwise be denied Allows for proper reimbursement (increased or decreased) based on the procedure/service circumstances …and to avoid hearing your physicians say…. Why Do We Use Them?
12. MODIFIER CATEGORIES Global Package Modifiers CCI or Bundling Modifiers Evaluation and Management Only Modifiers Number of Surgeon Modifiers “Other” Modifiers
14. What is the “Global” Period? Also known as the global surgical package CMS and AMA have the same definition Per CPT Guidelines, the following services are always included in addition to the operation per se: local or topical anesthesia subsequent to the decision for surgery, one related E/M encounter on the date immediately prior to or on the date of procedure (including history and physical) immediate postoperative care writing orders evaluating the patient in the post-anesthesia recovery area typical postoperative follow-up care
15. Examples of Services Included in the Global Period Removal of staples 10 days after a surgical procedure A visit with a patient prior to surgery to answer any last minute questions A post-operative visit in the office to check on wound healing
16. Services NOT Included in Global Package: Initial consultation or evaluation by the surgeon to determine the need for surgery Services of other physicians unless a transfer of care has been arranged Visits unrelated to patient’s surgical diagnosis Treatment for the underlying condition or an added course of treatment that is not part of normal recovery from surgery
17. Services NOT Included in Global Package: Diagnostic tests and procedures Staged or clearly distinct surgical procedures during the post-op period Treatment for post-op complications requiring a return to the OR A more extensive procedure when a less extensive procedure fails
18. Services NOT Included in Global Package: Supplies, such a surgical trays, splints and casting materials when certain surgical services are performed in the physician’s office Immunosuppresive therapy for organ transplants Critical Care services unrelated to the surgery for a critically injured patient Pre-op evaluations outside of the global surgical period Without a modifier, these service will not get paid!!!!!!!
20. Modifier -24 Unrelated E/M Service by Same Physician During a Postoperative PeriodAppend to E&M Code Only Used when a physician provides a surgical service related to one problem and then during the postoperative period provides an E&M service unrelated to the problem requiring the surgery Diagnosis code selection is critical to indicate the reason for the additional E&M service. Modifier Category: E/M Only and Global Package
21. Modifier -24 Example: Patient came in for post-operative visit. He is 12 weeks s/p diskectomy. During the exam, pt c/o severe headaches with visual changes, preceded by an aura. The physician performs an expanded problem focused exam. His impression is migraine with medical decision making of low complexity. Report: CPT Code 99213 [24] Level 3, established patient office visit
22. Clinical Examples for Modifier -24 Appropriate Use: Patient 80 - days s/p TURP. Reports to the office of the surgeon who performed the procedure complaining of right flank pain and abdominal pain. Diagnostic work-up reveals a kidney stone. Report 992XX-24 with diagnosis code for the kidney stone Inappropriate Use: Patient returns for complaining of fever and wound tenderness in the global period of her C-Section Report 99024 post-op visit
23. Modifier -25Significant, Separately Identifiable E/M by the Same Physician on the Same Day of the Procedure or Other ServiceAppend to E&M Code Only Indicates that on the day of a procedure or other service, the patients condition required an additional E&M service above and beyond the usual pre and post-op care associated with the procedure performed. E&M Service elements must be clearly documented to justify that a visit took place beyond the elements necessary to perform the procedure Modifier Category: E/M Only, Global Package and CCI
24. Modifier -25 EXAMPLE: An established patient is seen by the physician to evaluate his general osteoarthritis, benign HTN and NIDDM. While examining the patient, the physician determines that an arthrocentesis of the patient’s knee joint needs to be performed. REPORT: CPT Codes 9921X-25 & 20610
25. Clinical Example for Modifier -25 Appropriate Use: Procedure: Excision, rt. arm lesion Visit- Established Pt concerned about changes to a lesion on right arm. History taken, examination of arm and additional body areas for new and suspicious lesions performed. Physician decides to remove lesion. Inappropriate Use: Patient presents for scheduled removal of lesion on right arm. Exam of arm to determine status of lesion performed and a general determination of the patient’s status prior to excision.
26. Modifier -26Professional ComponentAppend to procedure code Certain procedures are a combination of a physician component and a technical component. When physician component is reported separately, add -26 to the CPT code to identify that the physician’s component only is being billed. EXAMPLE: A 72 year old woman comes to the Emergency Room complaining of chest discomfort. The physician orders a complete 2D echocardiography using the hospital equipment. The physician provides the written interpretation. REPORT: CPT Codes: 93307-26 Modifier Category: Global Package
27. Modifier -26 For use by physicians when utilizing equipment owned by a hospital/facility Interpretations must be separate, distinct, written and signed Not all procedures have a professional/technical split! Refer to Medicare Fee Schedule to determine what procedures are eligible for this modifier Common Services billed with -26: Radiology, Stress Tests, Heart Catheterizations
28. Modifier -54Surgical Care OnlyAppend to Procedure Code Physician service to the patient was only the intra-operative procedure. The physician is paid a portion of the global package. Another physician(s) will perform the Pre-operative and Post operative care There should be an agreement for the transfer of care between physicians Do not use with procedure codes having a zero day global period Do not use -54 if physician is a covering physician (locum tenens) or part of the same group as the surgeon who performed the procedure Modifiers 54 should only be appended to the surgical procedure codes Procedure codes with modifier 54 will be paid a percentage of the allowable charge. The percentage paid is variable and based on the Medicate Physician Fee Schedule See Intra-op column, by CPT code, for the percentage of the allowed amount to expect for reimbursement Modifier Category: Global Package
29. Modifier -55Post Operative Management OnlyAppend to Surgical Procedure Code Modifier 55 is reported when one physician performed the postoperative management only; another physician performed the surgical procedure. Modifier 55 is appended to the surgical code. The physician is paid a portion of the global package Modifiers 55 should only be appended to the surgical procedure codes Procedure codes with modifier 55 will be paid a percentage of the allowable charge. The percentage paid is variable and based on the Medicate Physician Fee Schedule See Post-op column, by CPT code, for the percentage of the allowed amount to expect for reimbursement Modifier Category: Global Package
30. Modifier -56 Pre Operative Management OnlyAppend to Surgical Procedure Code Modifier 56 is reported when one physician performed the preoperative care and evaluation and another physician performed the surgical procedure. Modifier 56 is appended to the surgical code. The physician is paid a portion of the global package Modifiers 56 should only be appended to the surgical procedure codes Procedure codes with modifier 56 will be paid a percentage of the allowable charge. The percentage paid is variable and based on the Medicate Physician Fee Schedule See Pre-op column, by CPT code, for the percentage of the allowed amount to expect for reimbursement Modifier Category: Global Package
31. Split Surgical Care Clinical Examples -54 Surgical Care Only A neurosurgeon travels to a rural location to perform a craniotomy for drainage of an intracranial abscess. He assessed the patient the day before surgery, and performed the procedure. Follow-up care was performed by a local surgeon. The neurosurgeon would report 61321-54 -55 Pre Operative Care Only Pre operative evaluation was performed and decision was made to have the intra-operative procedure and post operative care done else where. Internist does pre-op work-up on a patient having a laporoscopic cholecystectomy by a general surgeon who travels to the area monthly. Internist would bill 47562-56 -56 Post Operative Care Only While on vacation in Vail, Anna had a skiing accident. A local Orthopedist in Vail did the Pre operative and Intra-operative procedure and the patient went home. NYU physician provides all post-op care, and bills by adding a -55 to the surgical procedure code.
32. MODIFIER -57DECISION FOR SURGERYAppend to E/M Code Only The purpose of this modifier is to report an E/M service on the day before or on the day of major surgery (90 day global period) which results in the initial decision to perform the surgery. NOTE: For minor surgical procedures, see -25 vs. -57 Modifier 57 is appended to the appropriate level of E/M CPT code Modifier 57 should not be appended to any code other than an E/M code Without using this modifier on the E/M code the E/M will be denied as “included in the Global period of the surgical procedure EXAMPLE: Patient comes to the emergency department with sudden onset of acute abdominal pain. Gyn physician evaluates patient & determines that patient has twisted ovarian cyst. Physician admits patient to OR for right salpingo-oophorectomy. REPORT: CPT Code 99223-57 & 58720 Modifier Category: E/M Only and Global Package
33. Modifier -58Staged or Related Procedure by the Same Physician during the Postoperative PeriodAppend to Surgical Procedure Code The purpose of this modifier is to report the performance of a procedure or service during the postoperative period for one of the following circumstances: planned or staged more extensive than the original procedure therapy following a surgical procedure This modifier is used to report a staged or related procedure by the same physician during the postoperative period of the first procedure Modifier 58 is used only during the global surgical period for the original procedure Modifier Category: Global Package
34. Modifier -58 Modifier 58 should not be reported when treatment of a problem requires return to the operating room Modifier 58 should not be used for staged procedures when the code description indicates “one or more visits or one or more sessions.” Without the modifier, the third-party payer could reject the claim because the surgery occurred during the post-op period
35. Modifier -58 Clinical Examples Example #1: 32 year old woman with breast cancer undergoes a mastectomy one week ago. Today, she is scheduled to have breast implants placed Report: 19342-58 Example #2: Sternal debridement performed for mediastinitis and it is noted that a muscle flap repair will be needed in a few days to close the defect Report: 15734-58 since muscle flap planned at time of initial surgery
36. Modifier -76Repeat Procedure by same physicianAppend to Procedure Code Repeat Procedure by the Same Physician; use when it is necessary to report repeat procedures performed on the same day Appropriate Usage: • On procedure codes that cannot be quantity billed • Report each service on a separate line, using a quantity of one and append 76 to the subsequent procedures • The same physician performs the services Inappropriate Usage: • Appending to a surgical procedure code • Appending to each line of service • Repeat services due to equipment or other technical failure • For services repeated for quality control purposes Modifier Category: Global Package
37. Modifier -76 Medicare considers two physicians, in the same group with the same specialty performing services on the same day as the same physician For all procedure codes that cannot be quantity billed always use a quantity of “1” To avoid denials, bill all services performed on one day on the same claim For repeat clinical diagnostic laboratory tests, use modifier 91 if the service can not be quantity billed
38. Example: A second radiology service performed on the same day Two subsequent services, with no original service
39. Modifier -77Repeat Procedure by Another PhysicianAppend to Procedure Code Repeat Procedure by a Different Physician; use when it is necessary to report repeat procedures performed on the same day Appropriate Usage: • A different physician performs the repeat services Inappropriate Usage: • Appending to a surgical procedure code • Appending when the repeat procedure is performed by the same physician • Appending to E/M codes Example: A PCP performs a chest x-ray in his office and observes a suspicious mass. He sends the patient to a Pulmonologist who, on the same day, repeats the CXR. The Pulmonologist should submit their claim with the and provide documentation to support the need for a repeat CXR. Modifier Category: Global Package
40. Modifier -78Unplanned return to the operating/procedure room by the same physician following initial procedure for a related procedure during the postop period Append to Procedure Code The purpose of this modifier is to report a related procedure performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure) and requires use of the operating/procedure room. Modifier 78 should not be used if a complication does not require use of the operating/procedure room. Modifier 78 may be used to report procedures performed on the same day (usually in emergency situations) Example: Pt. brought to recovery room S/P abdominal surgery. Dressings became saturated, vital signs were unstable. Pt. brought back to OR for exploration post-op hemorrhage. Report: CPT Codes 35840 [78] Modifier Category: Global Package
41. Modifier -79Unrelated Procedure/Service by same MD during the post-op periodAppend to Procedure Code The purpose of this modifier is to report services during the postoperative period that are unrelated to the original procedure. The procedure must be performed by the same physician, and modifier 79 is appended to the procedure code Claim should be submitted with a different diagnosis and documentation should the different diagnosis and support medical necessity Example: A repair of femoral hernia [49550 (90 day global)] is performed on Jan. 5th. On Feb. 12th, the same physician performs an appendectomy. Report: CPT Code: 44950 [79] Modifier Category: Global Package
43. Modifier -22Unusual Procedural ServicesAppend to procedure code Indicates that procedure was more complicated or complex Alerts payers to unusual circumstances or complications during a procedure Increased work effort of 30-50% Must be accompanied by an Operative Report with letter explaining additional time required to support modifier -22 use Modifier Category: “Other”
44. Modifier -22 Operative/Procedure Note Key Terms: Increased risk; difficult; extended; complications; prolonged; unusual findings; unusual contamination controls; hemorrhage, blood loss over 600cc, unusual findings, etc. Additional physician work due to complications or medical emergencies may warrant use of -22 Documentation must support the substantial additional work and the reason for the additional work (i.e., increased intensity, time, technical difficulty of procedure, severity of patient’s condition, physical and mental effort required) Overuse can trigger an audit, if you find yourself consistently using modifier -22, chances are you are using the wrong CPT
46. Modifier -23Unusual AnesthesiaAppend to Anesthesia Code Only Used to report a procedure which normally requires either local or no anesthesia, must be done under general anesthesia due to unusual circumstances Reserved for use by Anesthesiologists Only Example: Child or adult unable to cooperate with procedure - requires anesthesia i.e. CT, MRI, XRT. The anesthesiologist should report the appropriate anesthesia code (00010-01999) with modifier -23 Modifier Category: “Other”
47. -23 Unusual Anesthesia Use the code once on the basic service procedure code Claim must be accompanied by documentation and cover letter by physician explaining the need for general anesthesia Not for use by the Anesthesiologist Do not use for local anesthesia
48. Modifier -32Mandated ServicesAppend to Procedure Code Attach modifier 32 to mandated consultation &/or other services Usually mandated by courts, government agencies or an insurance entity Modifier Category: “Other”
49. Modifier -47Anesthesia by SurgeonAppend to Surgical Procedure Code Only Regional or general anesthesia provided by surgeon may be reported by adding -47. Not to be used with local anesthesia Do not use CPT modifier 47 on anesthesia procedures codes 00100 through 01999, or 99143 through 99145 CPT codes for use with CPT modifier 47 are 10021 through 69990 Not for use an Anesthesiologist Not covered by Medicare Modifier Category: “Other”
50. Modifier -50Bilateral ProcedureAppend to Procedure Code Used to report bilateral procedures that are performed at the same operative session Bilateral means: (bi = two, lateral = side; both sides) Modifier 50 is used to report diagnostic, radiology and surgical procedures Modifier 50 should only be applied to services and/or procedures performed on identical anatomic sites, aspects, or organs (arms, legs, eyes, breasts) Modifier Category: “Other”
51. Modifier -50 Modifier -50 is not applicable to: Procedures that are bilateral by definition. Procedures with descriptions including the terminology as “bilateral” or “unilateral” When removing a lesion on the right arm and one on the left arm (RT/LT should be used) Modifier -50 can be appended to codes with a bilateral indicator of “1” or “3” on the Medicare Physician Fee Schedule
52. Modifier -50Reporting Bilateral Procedures on the Claim Form Medicare requires the bilateral procedure to be reported on a single line with -50; however, private payers may require the procedure to be reported on two separate lines, appending -50 on the 2nd line (check with the individual payer for their bilateral billing policy) Reimbursement is subject to 100% of the allowable charge for the first side and 50% of the allowable charge for the second side (150% of allowed amount) Example: Physician removes a foreign body from each of a patient’s ears without anesthesia
53. Modifier -50Reporting Bilateral Procedures on the Claim Form Do not report modifier -50 on the same line with modifiers RT/LT Example: Correctly billed for bilateral procedure Submit either Modifier 50 orModifiers LT and RT
54. Modifier -51Multiple ProceduresAppend to Procedure Code Used when multiple procedures, other than E/M services, performed at the same session by the same provider Reimbursement is subject to 100% of the allowable charge for the primary code and 50% of the allowable charge for each additional surgery code EXAMPLE: Patient presents for removal of a malignant lesion on the face with complex repair of the defect REPORT: Line 1: 11641 Paid at 100% of Allowed Line 2: 13152-51 Paid at 50% of Allowed Modifier Category: “Other”
55. Modifier -51 The surgical procedure with the highest allowable amount is considered the primary (first) procedure. Medicare uses the RVU for this determination, which can be found on the Physician Fee Schedule Do not use -51 on the primary procedure, only on the secondary procedures (order procedures by RVU; highest to lowest) Do not use -51 on procedures with a “+” or “Ø” symbol indicated in the CPT Manual (See Appendix D and E) These codes can also be identified on the Medicare Physician Fee Schedule with a Multiple Procedure Indicator of “3”
56. Modifier -52Reduced ServicesAppend to Procedure Code This modifier is used to report a service or procedure that is partially reduced or eliminated at the physician’s election Modifier 52 is not used to report an elective cancellation of a procedure before surgical preparation in the operating suite Modifier 52 should not be used if the procedure is discontinued after administration of anesthesia The presence of modifier -52 will reduce the payment of the service. Depending upon the payer, the payment reduction percentage can vary, usually, the payment reduction is 50% Modifier Category: “Other”
57. Modifier -53Discontinued ProcedureAppend to Procedure Code Used to indicate that a surgical or diagnostic procedure was started but discontinued, due to extenuating circumstances that threaten the patient’s well-being This modifier is used to report services or procedures when discontinued after anesthesia is administered to the patient This modifier is not used to report an elective cancellation of a procedure or prior to the patient’s anesthesia induction and/or surgical preparation in the operating suite; including situations where cancellation is due to patient instability Modifier 53 should not be used when a laparoscopic or endoscopic procedure is converted to an open procedure. Modifier 53 should not be appended to E/M codes. Modifier Category: “Other”
58. Modifier -53 Differs from modifier -52 because in that a life-threatening condition precipitates the terminated procedure when modifier -53 is reported EXAMPLE: A 50 year old woman complaining of acute rectal bleeding. She was given a bowel prep, administered at home, and returned for a total diagnostic colonoscopy. The procedure proceeds in the normal fashion, however the patient suddenly develops an erratic heart beat and the physician elects to discontinue the procedure
59. Modifier -63Procedure Performed on Infants less than 4kgAppend to Specific Surgical Procedure Codes Only Procedures performed on neonates and infants up to a present body weight of 4kg may involve significantly increased complexity and physician work Unless otherwise designated, should only be appended to services in 20000-69999 code series. Should not be appended to E&M, Anesthesia, Radiology, Path/Lab, Medicine sections WARNING:CPT lists, in Appendix F, codes that are exempt from use of modifier -63. There is not a used symbol for modifier -63 exempt codes, like there is for modifier -51 exempt codes (Ø). Check parenthetical notes under CPT codes for “patients under the age of 1 year”, as well as Appendix F, before appending modifier -63. Modifier Category: Other
61. What is CCI or NCCI? CMS developed the National Correct Coding Initiative (NCCI) to promote national correct coding methodologies and to control improper coding leading to inappropriate payment in Part B claims. The CMS developed its coding policies based on coding conventions defined in the American Medical Association's CPT manual, national and local policies and edits, coding guidelines developed by national societies, analysis of standard medical and surgical practices, and a review of current coding practices NCCI (National Correct Coding Initiative) edits, which are released by CMS quarterly, define when two procedure HCPCS/CPT codes may not be reported together except under special circumstances. If an edit allows use of NCCI-associated modifiers, the two procedure codes may be reported together if the two procedures are performed at different anatomic sites or different patient encounters Edits can be viewed @: http://www.cms.gov/NationalCorrectCodInitEd/01_overview.asp
62. Modifier -59Distinct Procedural ServiceAppend to Procedure Code The purpose of this modifier is to identify procedures or services that are not usually reported together but appropriate under the circumstances. This may represent the following: A different session or patient encounter A different procedure or surgery A different site or organ system A separate incision or excision A separate lesion A separate injury (or area of injury in extensive injuries) Modifier -59 should only be used if no other modifier more appropriately describes the relationships of the two or more procedure codes (i.e. RT/LT, T1-T0, etc.) Modifier 59 should not be appended to an E/M code Modifier Category: CCI
63. Modifier -59 and NCCI Modifier -59 is an important NCCI associated modifier that is often used incorrectly. For the NCCI its primary purpose is to indicate that two or more procedures are performed at different anatomic sites or different patient encounters From an NCCI perspective, the definition of different anatomic sites includes different organs or different lesions in the same organ. However, it does not include treatment of contiguous structures of the same organ. For example, treatment of the nail, nail bed, and adjacent soft tissue constitutes a single anatomic site. Treatment of posterior segment structures in the eye constitute a single anatomic site
64. Modifier -59 and NCCI Use of modifier -59 to indicate different procedures or surgeries does not require a different diagnosis for each HCPCS/CPT coded procedure/surgery Example: An arthroscopic synovectomy was performed on the right knee for localized synovitis and a diagnostic arthroscopy was performed on the left knee for chronic pain syndrome Report: 29875 & 29870 – 59 Note: The diagnosis for both CPT codes will be “chronic pain syndrome CMS issued an article on modifier -59 which can be found at: http://www.cms.gov/NationalCorrectCodInitEd/Downloads/modifier59.pdf
65. Modifier -59 Clinical Examples Example #1: Column 1 Code/Column 2 Code 11055/11720 CPT Code 11055 - Paring or cutting of benign hyperkeratotic lesion; single lesion CPT Code 11720 – Debridement of nail(s) by any method(s); 1-5 Modifier -59 is: 1) Only appropriate if procedures are performed for lesions anatomically separate from one another or if procedures are performed at separate patient encounters 2) Don’t report CPT codes 11055-11057 for removal of hyperkeratotic skin adjacent to nails needing debridement Example #2: Column 1 Code/Column 2 Code 17000/11100 CPT Code 17000 – Destruction, all benign or premalignant lesions other than skin tags or cutaneous vascular proliferative lesions; first lesion CPT Code 11100 – Biopsy of skin, subcutaneous tissue and/or mucous; single lesion Modifier -59 is: 1) Only appropriate if procedures are performed on separate lesions or at separate patient encounters
66. Modifier -59 Clinical Examples Example #3: Column 1 Code/Column 2 Code 38221/38220 CPT code 38221 - Bone marrow; biopsy, needle or trocar CPT code 38220 - Bone marrow; aspiration only Use of -59 modifier should be uncommon but appropriate for these circumstances: 1) Different sites - contralateral iliac crests; iliac crest and sternum 2) Different incisions - same iliac crest 3) Different encounters Example #4: Column 1 Code/Column 2 Code 93529/76000 CPT Code 93529 – Combined right heart catheterization and left heart catheterization through existing septal opening (with or without retrograde left heart catheterization) CPT Code 76000 – Fluoroscopy (separate procedure), up to one hour physician time, other than 71023 or 71034 (e.g., cardiac fluoroscopy) Modifier -59 is: 1) Only appropriate if the fluoroscopy service 76000 is performed for a procedure done unrelated to the cardiac catheterization procedure.
68. How to Determine if Multiple Surgeons Are Allowed To determine whether the services of more than one surgeon may be submitted to Medicare with CPT Modifiers 62, 66, 80, 81, 82 or AS, refer to the Medicare Physician Fee Schedule database (MPFSDB): Access the database directly from the CMS Web Site at www.cms.gov/apps/physician-fee-schedule/overview.aspx/ Select Physician Fee Schedule Search from the left area of the Web page Screen defaults to current year. Under Type of information, select Payment Policy Indicators, then ‘next’ On the ‘select field options’ screen, select ‘Next’ Enter the procedure code and select ‘All Modifiers’, then click ‘Submit’ Refer to the column heading applicable: ‘Co Surg’, ‘Team Surg’ or ‘Asst Surg’
69. Modifier -62Two surgeonsAppend to Surgical Procedure Code Two surgeons (each in a different specialty) work together to perform a specific procedure If two surgeons (each in a different specialty) are required to perform a specific procedure, each surgeon bills for the procedure, and both surgeons need to report the same surgery code with the modifier 62. Example: Transphenoidal Hypophesectomy Neurosurgeon and ENT both report 61548-62 WARNING: If one surgeon bills with a modifier “-62,” and one surgeon bills with no modifier, the payer may deny or suspend the claim with the modifier for review. Coordination of billing is key to proper reimbursement for each surgeon! Modifier Category: # of Surgeons
70. Modifier -62 Global surgery rules apply to each of the physicians participating in a co-surgery Documentation of the medical necessity for two surgeons is required for certain services identified in the Medicare Physician Fee Schedule Reimbursement is at 62.5% of the global surgery fee schedule amount for each co-surgeon The following Co-Surgeon indicators found on the Medicare Physician Fee Schedule identify services for which two surgeons, each in a different specialty, may be paid: 0 = Co-surgeons not permitted for this procedure 1= Co-surgeons may be paid if supporting documentation is supplied to establish medical necessity 2 = Co-surgeons permitted. No documentation is required if two- specialty requirement is met
71. Modifier -62 Appropriate Use: Arthrodesis using anterior interbody technique, thoracic level. Thoracic surgeon performs a thoracotomy, exposes and later closes the site Orthopaedic surgeon performs the arthrodesis Both surgeons should use CPT Code: 22556-62 Inappropriate Use: Oncology surgeon performs a radical mastectomy. At same operative session the plastic surgeon then performs breast reconstruction. In this case, the surgeons are performing 2 distinct services and each uses separate CPT codes and -62 is not required
72. Modifier -66Surgical TeamAppend to Surgical Procedure Codes Only Highly complex procedures requiring concomitant services of several physicians, often of different specialties plus other highly skilled, specially trained personnel, various types of complex equipment Example: Transplants Separation of conjoined twins Each participating physicians uses the -66 modifier Modifier Category: # of Surgeons
73. Modifier -66 Global surgery rules apply to each of the physicians participating in a team surgery. The Medicare Physician Fee Schedule identifies certain services submitted with a “-66” modifier, which must be sufficiently documented to establish that a team was medically necessary. All claims for team surgeons must contain sufficient information to allow pricing “by report.” The following indicators, according to the Medicare Physician Fee Schedule, identify services for which team surgeons may be paid: 0 = Team surgeons not permitted for this procedure. 1 = Team surgeons may be paid if supporting documentation is supplied to establish medical necessity of a team. Paid by report. 2 = Team surgeons may be paid. Paid by report. Reimbursement is typically determined “By Report.”
74. Modifier -80Assistant SurgeonAppend to Surgical Procedure Codes Only Submit CPT modifier 80 to identify the services of a surgical assistant This modifier may only be submitted with surgery codes Physician assistants, nurse practitioners and clinical nurse specialists must not submit this modifier. See HCPCS Modifier AS Use of the modifier will result in a payment of 16% of the allowed amount Global surgery rules do not apply Modifier Category: # of Surgeons
75. Modifier -81Minimal Assistant SurgeonAppend to Surgical Procedure Codes Only Modifier -81 specifies “minimal” assistant surgeon, but neither CPT nor CMS provides definitive guidelines to help physicians and coders distinguish a minimum assistant from a “regular” assistant as described by modifier -80. This absence of clarity causes payers to interpret modifier -81 differently This modifier may only be submitted with surgery codes Physician assistants, nurse practitioners and clinical nurse specialists must not submit this modifier. See HCPCS Modifier AS Use of the modifier will result in a payment of 16% of the allowed amount Global Surgery rules do not apply Modifier Category: # of Surgeons
76. Modifier -82Assistant surgeon (when qualified resident surgeon not available)Append to Surgical Procedure Codes Only Submit CPT modifier 82 when the assistant at surgery service was provided by an MD and there was not a qualified resident available This modifier may only be submitted by teaching hospitals Payment is not made for a first assistant when the service is provided in a teaching hospital that has a training program related to the particular surgical procedure and a qualified resident is available. But if the teaching hospital has no qualified resident available or no teaching program related to the particular medical specialty required for the procedure, or if the primary surgeon has an across-the-board policy of not using residents, Medicare will cover the services of a PA first assistant Modifier Category: # of Surgeons
77. Modifier -ASPhysician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgeryAppend to Surgical Procedure Codes Only Modifier “AS” is for assistant at surgery services provided by a Physician Assistant (PA) or Nurse Practitioner (NP) This modifier may only be submitted with surgery codes Not for use by Physicians Use of the modifier will result in an 85% payment of 16% of the allowed amount Modifier Category: # of Surgeons
78. Modifiers -80, -81, 82 and -AS The following indicators, according to the Medicare Physician Fee Schedule, identify services for which assistant surgeons may be paid: Indicator 0 = Payment restriction for assistants at surgery applies to this procedure. Supporting documentation describing the medical necessity for an assistant must be submitted with the claim Indicator 1 = Statutory payment restriction for assistants at surgery applies to this procedure. Assistants at surgery will not be paid Indicator 2 = Payment restriction for assistants at surgery does not apply to this procedure. Assistants at surgery may be paid Indicator 9 = Concept does not apply (the most likely explanation is that the procedure is not a surgery)
79. Assistant Surgeon Modifiers Which One Do I Use? Quick Reference for Choosing Assistant Surgeon Modifier CPT Modifier -80, assistant at surgery:This includes MD, DO, and DPM provider types and is an assistant surgeon providing full assist to the primary surgeon CPT Modifier -81, minimal assistant at surgery:This includes MD, DO, and DPM provider types and is an assistant surgeon providing minimal assistance to the primary surgeon. This modifier may be used when more than one assistant is involved or if one person assists during a portion of the surgery. This modifier is not intended for use by non-physician assistants (e.g., RN, PA) CPT Modifier -82, assistant at surgery when a qualified resident surgeon is not available to assist the primary surgeon:This used by teaching hospitals and includes MD, DO, and DPM provider types HCPCS Level II modifier -AS, a non-physician assistant at surgery:This would include PA, CNS, CRNFA, RNFA, NP, LPN, DDS, DMD, and surgical technician provider types, subject to contract eligibility
81. HCPCS Level II Modifiers Alpha or alphanumeric Provide additional information just like CPT modifiers Found in HCPCS Manual Can be used on Level I CPT codes and/or Level II HCPCS codes
82. HCPCS Level II Modifiers HCPCS Modifiers are very descriptive and should be reviewed for applicability before assigning modifier -59 Example: A patient has a lesion removed from the left breast and a biopsy of a lesion of the right breast In this instance, assign 19120 with modifier -LT and 19100 with modifier -RT. This is because, according to CMS, when another already established modifier is appropriate, it should be used rather than modifier 59. Only if no more descriptive modifier is available should modifier 59 be used
83. Examples of HCPCS Modifiers -LT: LEFT SIDE (USED TO IDENTIFY PROCEDURES PERFORMED ON THE LEFT SIDE OF THE BODY) -RT: RIGHT SIDE (USED TO IDENTIFY PROCEDURES PERFORMED ON THE RIGHT SIDE OF THE BODY) -GA: WAIVER OF LIABILITY STATEMENT ON FILE -RR: RENTAL (USE THE 'RR' MODIFIER WHEN DME IS TO BE RENTED)
84. Is your practice in compliance? QUICK SELF TEST FOR COMPLIANCE PRACTICES IN YOUR OFFICE
85. A Quick Self-Test for Compliance Practices in Your Office Does your office review all pertinent documentation prior to appending a modifier? Do you monitor the activities of your billing office or service with respect to modifier usage? Do you randomly cross-check all billings performed by your office or service to be certain that claims submitted with modifiers are accurate and appropriate?
86. Compliance Test cont.. Do you make sure the staff is educated and updated on Medicare and Medicaid program changes? Are services billed to Medicare and Medicaid thoroughly documented? Are new billing employees and new physicians oriented on modifier reporting policies?
88. A Quick Self-Test for Complaint Practices in Your Office Do you allow your billing office or service to assign modifiers and subsequently report services on claims without conducting an intermittent review of claims? Does your billing office or service have carte blanche permission to correct and/or change codes for services that you have performed?
89. Is there evidence of inappropriate overpayment by the payer when a modifier is used? Does your billing office or service answer all Medicare and Medicaid inquiries regarding your services and claims on your behalf without your knowledge? Compliance Test cont..