This course explains the importance of applying modifiers to hospital outpatient claims and defines some of the most common modifiers (25, 50, 52, 59, 73, and 74) and their uses. It also describes the modifier 59 replacements (-XE, -XS, -XP and -XU). Specifically, this lesson will cover bilateral, separate procedure, distinct procedure, discontinued, and anatomical modifiers. This course may feature information on the use of medical and procedural codes, including CPT® codes as they relate to the subject matter presented. The goal of this course is to give revenue cycle and coding professionals an overview of the common modifiers used when submitting claims for hospital outpatient services.
This course explains the importance of applying modifiers to hospital outpatient claims and defines some of the most common modifiers (25, 50, 52, 59, 73, and 74) and their uses. It also describes the modifier 59 replacements (-XE, -XS, -XP and -XU). Specifically, this lesson will cover bilateral, separate procedure, distinct procedure, discontinued, and anatomical modifiers. This course may feature information on the use of medical and procedural codes, including CPT® codes as they relate to the subject matter presented. The goal of this course is to give revenue cycle and coding professionals an overview of the common modifiers used when submitting claims for hospital outpatient services.
“This program has been approved for 0.5000 continuing education unit(s) for use in fulfilling the continuing education requirements of the American Health Information Management Association (AHIMA). Granting prior approval from AHIMA does not constitute endorsement of the program content or its program sponsor.”
This activity is approved for 0.5000 contact hours.
“This program has been approved for 0.5000 continuing education unit(s) for use in fulfilling the continuing education requirements of the American Health Information Management Association (AHIMA). Granting prior approval from AHIMA does not constitute endorsement of the program content or its program sponsor.”
Outline:
Section 1: Introduction
About This Course
Learning Objectives
Section 2: Overview
Defining “Modifier”
Review
Level I and Level II Modifier Examples
Basic Modifier-Reporting Guidelines
When Not to Use Modifiers
Section 3: Modifiers 50, 52 and HCPCS Modifiers
Modifier -50
Modifier -50: Payment Implications
Review
Modifier 52: Reduced Services
Review
Section 4: Discontinued Services
Modifier 73: Discontinued Procedure Prior to Anesthesia
Modifier 74: Discontinued Procedure after Anesthesia
Additional Instructions for Coding Discontinued Services
Review
Section 5: Distinct and Separate Procedures
Modifier 59: Distinct Procedural Services
Using Modifiers 59, -XE, -XS, -XP, and -XU
Modifier 25: Significant, Separately Identifiable E/M Services
Review
Section 6: Valid OPPS Modifiers
Valid Outpatient Prospective Payment System Modifiers
Review
Section 7: Conclusion
Summary
Course Contributor(s)
References
Exam
Reviewer: Veronica Ziac, MBAJean Russell has over thirty years of healthcare and information system experience. Her areas of expertise include the Medicare outpatient prospective payment systems (APCs, and APGs), as well as ICD-10-CM/PCS training, Charge Description Master (CDM), admission status reviews, and outpatient coding and compliance. She is a frequent speaker at the national, state and local levels for HFMA and AHIMA professional groups. Jean has her Masters from the University of Houston in Biomedical Engineering; her Bachelors from Colgate University in Biology; and her RHIT from the independent study program through the American Health Information Management Association.
Disclosure: Jean C. Russell, MS, RHIT has no Relevant Financial or Non-Financial Relationship with ineligible companies to disclose.
Veronica Ziac, MBA has over twenty years of healthcare administration experience. Her areas of expertise include revenue cycle, information systems, population health and physician practice management. Most recently, she was the Director of Revenue Cycle Integrity at Cobleskill Regional Hospital. Prior to that, Veronica was the Chief Operating Officer for a large multispecialty hospital-based physician practice based in New York. Veronica has an MBA in Healthcare Administration from Union College and a bachelor’s degree from the University at Albany. She is a member of HFMA and MGMA and has been Certified in Healthcare Compliance (CHC) by the Healthcare Compliance Association.
Disclosure: Veronica Ziac, MBA has no Relevant Financial or Non-Financial Relationship with ineligible companies to disclose.
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