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 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.”
This activity is approved for 0.5000 contact hours.
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
Tamara has twenty-seven years of multi-specialized medical coding and Corporate Compliance experience. She is the founder of Abraham Medical Coach LLC, where she provides medical coding and healthcare compliance consulting services to healthcare organizations across the United States. In addition to consulting, Tamara prepares individuals to sit for their medical coding certification via her online course curriculum. She is an adjunct educator for a local community college based in Texas. Her area of instruction includes Introduction to Medical Law, Medical Terminology, ICD-10-CM and Procedural Coding. Tamara’s credentials include AAPC Approved Instructor, Certified General Surgery Coder and Certified Professional Coder with the Academy of Professional Coders Association (AAPC). She has authored three books specific to the medical coding industry. Disclosure: Tamara Abraham, AS, BA, CPC-I, CGSC, CPC has no Relevant Financial or Non-Financial Relationship with ineligible companies to disclose.
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