You can’t afford to keep putting modifier 59 on every multiple code claim. Insurers have taken notice of this improper use and started invoking huge penalties.
Yes, doing your due diligence to determine if modifier 59 is appropriate takes time. But with the right strategies and practical advice, you can keep your practice out of hot water.
Carriers, Plans Increasing Modifier Monitoring
Consistent misuse and abuse of modifier 59 – $320m in claims errors – has put it on the Office of the Inspector General’s (OIG) watch list. Your carriers are actively monitoring your modifier usage and over reporting and misreporting this modifier will trigger an audit.
Anthem BlueCrossBlueShield has seen so much modifier misuse that they have rolled out prepayment claim audits in 14 states since June 2019. Nurses and coders are performing clinical reviews to check that the National Correct Coding Initiative (NCCI) edits allow using the modifier and that the scenario supports its use.
Act Now to Protect Your Practice From Penalties
Your only defense is to take action, and the Expert Report Modifier 59 from expert coder and educator Kim Garner Huey, MJ, CHC, CPC, CCS-P, PCS, CPCO, is the answer. Here are just a few of the practical strategies you’ll receive in this step-by-step expert report:
- How to use CCI edits to ensure modifier 59 is allowed
- Quick ways to tell when you should instead use modifier 25
- What the X modifiers mean and when to apply them
- How to always use modifier 59 as the last resort
- Spot when to switch to modifier 51 and 50 to stop modifier misuse
- Audit-proof documentation phrases to justify your modifier usage
- And so much more…
Don’t risk severe penalties and payment delays, order this must-have expert report today and finally understand these complex and dangerous modifiers.
Note: PDF copy will be sent via email immediately after purchase. For Print copies, please allow 7 days for delivery.
Kim is an independent coding and reimbursement consultant, providing audit, training and oversight of coding and reimbursement functions for physicians. Kim completed three years of pre-medical education at the University of Alabama before she decided that she preferred the business side of medicine.
She completed a Bachelor’s degree in Health Care Management and went on to obtain certification through the American Academy of Professional Coders and the American Health Information Management Association.
Recognizing the important position of compliance in today’s world, she has also obtained certification as a Certified Healthcare Compliance Consultant and a Certified Healthcare Audit Professional. Kim is also an AHIMA-approved ICD-10-CM trainer and has recently earned a Master of Jurisprudence in Health Law.
For over twenty-five years, Kim has worked with providers in virtually all specialties, from General Surgery to Obstetrics/Gynecology to Oncology to Internal Medicine and beyond. She has spoken at the national conference for numerous organizations.