Medical Billing Blog

NCCI Publishes Changes to Coding Modifier -59

Posted by Scott Shatzman on Mon, Sep, 08, 2014 @ 10:09 AM

The Medicare National Correct Coding Initiative (NCCI) published Procedure to Procedure edits
that seek to prevent unbundling of services and overpayment. The requirements state that if one code defines a subset of work of another code, the codes should not be reported separately, which would be considered double billing. The notice states that modifier -59 defines a “Distinct Procedural Service” which represents a service that is separate and distinct from another service with which it would usually be considered to be bundled.

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Proper Use of Modifier 59 Can Increase Revenue for Medical Practices

Posted by Ali Ziehm on Thu, Jun, 07, 2012 @ 13:06 PM

By Heather Lakner, CPC -- Modifier 59 can be used in appropriate circumstances to unbundle codes to make them separately payable under Medicare guidelines.  This can mean an increase in revenue for medical practices in circumstances when this modifier is appended correctly, with proper documentation to support its use.  Unfortunately, Modifier 59 is often used incorrectly.  Many billers will append it to a service to override an edit, but this can set up their medical practice for a substantial audit risk if it is applied incorrectly, or if cirumstances in the patient’s medical record do not clearly indicate that its use is appropriate.  

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Include Documentation With Medical Billing Of Modifier 22

Posted by Ali Ziehm on Thu, Apr, 26, 2012 @ 12:04 PM

Karyn Shatzman, CPC, CGSC--Did you ever work really hard on something, above and beyond the normal circumstances, only to find out that you get no additional compensation for what you have accomplished?  This happens to physicians all the time when they do medical billing for increased procedural services.  The CPT book gives you a description of a service that is rendered by a physician.  The American Medical Association, who writes the CPT, sets guidelines for that procedure code.  What happens if that surgery that typically takes two hours to perform suddenly takes six hours?  Maybe there were adhesions that the physician had to dissect for hours before they could even start the intended surgery.  Payment schedules based on RVU’s do not take these circumstances into consideration, so modifier 22 was created.

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Tips For Use Of Modifier 58 and Modifier 78 In Medical Billing

Posted by Ali Ziehm on Thu, Mar, 08, 2012 @ 12:03 PM

By Christine Moore, CPC, CGSC--Even though Modifier 58 and Modifier 78 have similar meaning and wording, there are a few tips that will help in choosing the correct global period modifier when billing claims.

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Using Modifiers To Maximize Reimbursement in Medical Billing

Posted by Barry Shatzman on Mon, Oct, 24, 2011 @ 15:10 PM

Want More Cash?  Better Pay Attention To Your Modifiers! It’s extremely difficult, especially when you combine the CPT modifiers with Medicare’s ever-changing regulations, to use modifiers accurately for a provided/ordered service. Therefore, if you’re not up to date on your modifier coding practices, you’re not only at risk of losing deserved pay, but it could also slow down your cash flow! To avoid this, take a look at our top four tips about modifiers.

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