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Modifiers

Modifiers

Modifier 59

4 Uses of Modifier 59 That Are Appropriate (And 2 That Aren’t)

Whether or not you have a solid understanding of the National Correct Coding Initiative (NCCI) edits, you are likely very familiar with modifier 59 and the X modifiers, which allow you to report two procedures at the same time. What many practices don’t know, however, is that payers are waiting for you to misuse these […]
Published Date: July 26, 2023
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Modifier 25

Cigna Delays Plan Requiring Medical Records With Modifier 25

UPDATE: Cigna has delayed the requirement described below, and it will no longer take effect on May 25. The company has not yet indicated when it will go into place, so keep an eye on the Healthcare Training Leader website for more information as this story develops. When you perform a minor procedure along with […]
Published Date: May 23, 2023
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Modifier 58

Modifier 58 vs 78: Boost Pay-up for Post-Op Procedures

Using modifier 58 to code post-operative procedures can prevent payer denials and decreased reimbursement for services – but you must use it correctly. When coding post-op procedures, most problems occur because of the similarities between two key modifiers: Modifier 58 – staged or related procedure or service by the same physician during the postoperative period, […]
Published Date: March 10, 2022
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Billing modifier 62

Step-by-Step Tips to Head Off Modifier 62 Overpayments

The January 2021 updated OIG Work Plan makes it clear that the Office of the Inspector General (OIG) is paying attention to surgical modifier 62. The Work Plan states.billing modifier 62. “…we plan to audit a sample of claim line items specifically where different physicians billed for the same co-surgery procedure code, for the same […]
Published Date: March 17, 2021
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Using modifier 25

Key to Using Modifier 25? Separate History and Exam

With the new 2021 E/​M guidelines in effect, payers and auditors have made it clear that they’ll be closely scrutinizing E/​M claims more than usual—this includes the modifiers appended to them as well. One of the murkiest modifiers continues to be 25 (a significant, separately identifiable evaluation and management service by the same physician or […]
Published Date: March 11, 2021
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Shoulder unbundling errors

Head Off Revenue Losses Due to Shoulder Unbundling Errors

You don’t want to miss billing an allowed shoulder procedure and leave thousands of dollars on the table. But it’s imperative that you avoid shoulder unbundling errors – or your repeated billing of included charges can land you with costly denials, and accusations of abuse or fraud. It’s critical that you know when to legally […]
Published Date: November 2, 2020
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New CMS Telehealth Rule: Speed Cashflow, Update Billing

Just when you thought you got your head semi-wrapped around Medicare telemedicine rules, they go and throw it out the window! On March 30, CMS issued an Interim Final Rule and released new guidance on how to code and bill for rapidly evolving telehealth services. Before you file another claim, here are the three sweeping […]
Published Date: March 31, 2020
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Solve Your 5 Biggest Modifier 59 Problems by Focusing on ‘Separate’

If you’re using Modifier 59 to get paid for multiple procedures, auditors are watching you. Modifier 59 has been on the OIG’s (Office of the Inspector General) radar for a while now, and because of consistent misuse and abuse, it will likely stay that way. Modifier 59 allows you to unbundle — separately report and […]
Published Date: July 29, 2019
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Modifier 51 over 59

When To Use Modifier 51 over 59

When would I use modifier 51 instead of modifier 59? If you would have asked me that question 10 years ago, I would have told you not to use a 51 modifier because it causes bundling reimbursement. But 51 is now in your CPT book for when you are doing skin or endoscopic procedures. There […]
Published Date: September 25, 2017
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