The Centers for Medicare and Medicaid Services (CMS) is establishing four new HCPCS modifiers to define subsets of the modifier -59, a modifier used to define a “Distinct Procedural Service.” Currently, providers use modifier -59 to indicate that a code represents a service that is separate and distinct from another service with which it would usually be considered to be bundled. Because modifier -59 is so broadly applicable, CMS is concerned that providers may be using it incorrectly to bypass National Correct Coding Initiative (NCCI) edits which are procedure to procedure edits intended to prevent unbundling and consequent overpayment to physicians and outpatient facilities.
Of course, there are instances when it would be appropriate to report modifier -59 to let CMS know that payment for both procedures is warranted but CMS believes this would occur less frequently than the reporting of modifier -59 would suggest. CMS believes that modifier -59 is commonly used and commonly abused. The primary issues associated the modifier -59 are that it is defined for use in a wide variety of circumstances, such as a use to identify different encounters, different anatomic sites, and distinct services. CMS believes that more precise coding options coupled with increased education and selective editing is needed and may help reduce the errors it’s seeing and the associated overpayment.
This conference by expert speaker Jugna Shah will help you understand CMS’ intent behind the use of the new modifiers and what each modifier is. Tips will be provided on how to test cases today to see which modifiers would be most applicable, and a discussion on who would assign the modifiers and the time it would take.
Who should attend? Health Information Management, Charge Master Manager, Billing Office Staff, Compliance, Revenue Cycle staff, and others
- Elin Baklid-Kunz
Jugna Shah, MPH, is the president and founder of Nimitt Consulting Inc. and specializes in working with hospitals, health systems, advocacy organizations, and international governments on regulatory and health care financing issues. In the U.S., Ms. Shah works with hospitals to manage the clinical and financial operations related to OPPS/APCs.
She also raises important payment system issues to Medicare and the APC Advisory Panel to improve the APC... More Info
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