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 Twitter: @DrLehrman
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
T 4 T 3 T 2 T 1 TA LT
T 5 T 6 T 7 T 8 T 9 RT
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!
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
25 Modifier Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service
50 modifier Bilateral Procedure
Bilateral Keller 50 Modifier
Bilateral Keller CPT 28292 50 modifier One unit No Laterality modifiers Bill twice normal
Bilateral 2 nd Metatarsal Condylectomy
Bilateral 2 nd Metatarsal Condylectomy
Bilateral 2 nd Metatarsal Condylectomy CPT 28288 RT CPT 28288 LT 59 mod
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.
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.
Coding During Global E/M 24 modifier Procedure 58 modifier 78 modifier 79 modifier
24 Modifier Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period
79 modifier Unrelated Procedure or Service by the Same Physician During the Postoperative Period
78 modifier Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period
58 modifier Staged or Related Procedure or Service by the Same Physician During the Postoperative Period
57 modifier Decision for Surgery
FX Modifier Payment Reduction For The Technical Component for X- Rays Taken Using Film Effective 01/01/2017 Applies to Medicare only
FY Modifier Payment Reduction For The Technical Component for X-Rays Taken Using Computerized Radiography (CR) Applies to Medicare only
Thank You!!
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 Twitter: @DrLehrman