Modifiers Jeffrey D Lehrman, DPM, FASPS, CPC

Transcription

1 Modifiers Jeffrey D Lehrman, DPM, FASPS, CPC Board of Directors, ASPS Board of Directors, APWCA Diplomate, ABFAS Advisor, APMA Coding Committee Advisor, APMA MACRA Task Force Expert Panelist, Codingline Fellow, AAPPM

2 Disclosures Consultant: American Podiatric Medical Association Musculoskeletal Transplant Foundation Smith & Nephew Advanced Wound Management Molnlycke Endo Pharmaceuticals Wounds A.I. Bako Diagnostics Orpyx Medical Technologies AmerX Modulated Imaging Speaker s Bureau: Organogenesis AmerX Smith & Nephew Advanced Wound Management BSN Medical Advanced Wound Care Division Stockholder: Talar Medical Medical/Scientific Boards: Bako Diagnostics Principal: Lehrman Consulting, LLC

3 T 4 T 3 T 2 T 1 TA LT

4 T 5 T 6 T 7 T 8 T 9 RT

5 22 Modifier - Increased Procedural Services Op Report must support the substantial additional work and the reason for the additional work Increased intensity Increased time Technical difficulty of procedure Severity of patient s condition Physical and mental effort required Should not be appended to an E/M service Procedures Only!

6 22 Modifier - Increased Procedural Services Two documents required to support the claim. 1) An operative report 2) A narrative indicating how the service differs from the usual Legit examples Non-Legit examples

7 25 Modifier Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service

8 50 modifier Bilateral Procedure

9

10 Bilateral Keller 50 Modifier

11

12 Bilateral Keller CPT modifier One unit No Laterality modifiers Bill twice normal

13 Bilateral 2 nd Metatarsal Condylectomy

14 Bilateral 2 nd Metatarsal Condylectomy

15 Bilateral 2 nd Metatarsal Condylectomy CPT RT CPT LT 59 mod

16 59 modifier Distinct Procedural Service Documentation must support Different session, Different procedure or surgery Different site or organ system Separate incision or excision Separate lesion Separate injury (or area of injury in extensive injuries) Not ordinarily encountered or performed on the same day by the same individual.

17 X Modifiers Medicare only? XE - Separate Encounter: A service that is distinct because it occurred during a separate encounter. XP - Separate Practitioner: A service that is distinct because it was performed by a different practitioner. XS - Separate Structure: A service that is distinct because it was performed on a separate organ/structure. XU - Unusual Non-Overlapping Service: The use of a service that is distinct because it does not overlap usual components of the main service.

18 Coding During Global E/M 24 modifier Procedure 58 modifier 78 modifier 79 modifier

19 24 Modifier Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period

20 79 modifier Unrelated Procedure or Service by the Same Physician During the Postoperative Period

21 78 modifier Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period

22 58 modifier Staged or Related Procedure or Service by the Same Physician During the Postoperative Period

23 57 modifier Decision for Surgery

24 FX Modifier Payment Reduction For The Technical Component for X- Rays Taken Using Film Effective 01/01/2017 Applies to Medicare only

25 FY Modifier Payment Reduction For The Technical Component for X-Rays Taken Using Computerized Radiography (CR) Applies to Medicare only

26 Thank You!!

27 Modifiers Jeffrey D Lehrman, DPM, FASPS, CPC Board of Directors, ASPS Board of Directors, APWCA Diplomate, ABFAS Advisor, APMA Coding Committee Advisor, APMA MACRA Task Force Expert Panelist, Codingline Fellow, AAPPM