CMS Modifier 25 and 59 Reimbursement Guidelines: Don’t Bottleneck Your Payments

Description

Modifier 25 and 59 have a long history of confusion and misused by providers, coders, and auditors. These modifiers are one of the hardest modifiers to determine appropriate use. The term “significant, separately identifiable service” has been very subjective to different interpretations. The American Medical Association (AMA) recently indicated that more than one E/M service on the same day by the same provider may be reported with Modifier 25, leading to further confusion in the coding community. Modifier 25 has been on the payer’s radar for some time and continues to be a problem for payment.

This webinar will describe the nuances related to the usage of modifier 25 and 59. When billing for your level of service and services on the same day as a minor procedure. Using modifier 59 and distinctly documenting the two procedures using the right tools and knowing when it’s requirement and how to appropriately append them. With granular understanding of its usage, will create more opportunities for fluid revenue stream and understanding its usage.

Learning Objectives:

• Understanding how and when to use modifier 25 and 59
• Documentation requirements for when modifier 25 and 59 is most appropriate
• What is modifier 59 and what are the purposes?
• Understanding the Procedure-to-Procedure (P2P) files and knowing how to use them when understanding bundled payments or services which are inclusive for services
• Learn the NCCI guidelines on the appropriate use of modifiers
• Be able to apply the correct modifier(s) based on the specific circumstances
• Learn how to properly resolve NCCI edits including a breakdown of modifier 59
• Proper use of modifier 25, especially in the office or outpatient setting

Areas Covered in the Session:

• CMS rules and requirements for the usage of modifiers 25 and 59
• Key points of documentation when a procedure is needed
• Documentation requirements to receive both the EM and procedure when billing
• NCCI Procedure-to-Procedure (P2P) – what it means and how it should be used when billing for additional services which may be bundled in payment
• Inappropriate usage of modifier 25 will lead to inappropriate payments and becoming a target to payers which may lead to payback
• Documentation to support the use of Modifier 25 and 59
• Techniques to identify a significant and separately identifiable service in documentation
• Services that may require the use of Modifier 25 when performed on the same day as a related EM service
• Examples of correct and incorrect use of Modifier 25 and 59 based on different specialties
• Payer deviations on Modifier 25 and 59
• ?Live Q&A Session

Attendees:

• Physicians and Non-Physician Practitioners
• Qualified Health Care Professionals
• Coders
• Billers
• Auditors
• Nurses
• Practice Managers
• Medical Officers
• Compliance Officers
• Clinic Managers
• Insurance Company Claims Reviewers
• Insurance Payers
• Payment Policymakers
• Denial Resolution Team