Catalog Number : cra1632
Title : The "-59" and "-25" Modifiers
Speaker : Duane Abbey

Webplay Recording Date : 9-24-2015
Webplay Price : $ 125 for two weeks viewing

Webinar Overview: 

Will the RACs investigate the use of the "-25" and "-59" modifiers? Is there a clear guidance from CMS concerning the use of the "-25" and "-59" modifiers? To answer these questions and more, come join us at this informational Webinar.

Webinar Objectives:

• To carefully review the definitions of both the "-59" and "-25" modifiers
• To review the National Correct Coding Initiative coding policies
• To appreciate the physician and hospital use of the "-59" and "-25" modifiers
• To understand the use of the "-59" and "-25" modifiers for APCs
• To review the OIG findings and compliance concerns for the use and non-use "-59" and "-25" modifiers
• To review the general and specific policies inherent in the NCCI guidelines
• To appreciate the compliance issues surrounding hospital use of these modifiers
• To understand the difference between absolute bundling and relative bundling with the "-59" modifier
• To recognize special compliance issues for using the "-25" modifier for ED services involving surgeries
• To appreciate possible RAC activities with the "-59" and "-25" modifiers
• To understand how the process of statistical extrapolation works

Target Audience:

Billing and Claims Transaction Personnel, Chargemaster Coordinators, Financial Analysts, Compliance Personnel, Physicians, Internal Auditing Staff and Other Interested Personnel

A few of the Topics that will be covered:

• Overview of Modifiers
  • "-59" Modifier
  • "-25" Modifier
  • Differences Between Physician and Hospital Utilization
  • Hospital vs. Physician NCCI Edits
• The "-59" Modifier
  • Definition and Description in CPT
  • How This Modifier Is Used
  • Process for Developing and Including the "-59" Modifier on Claims
  • Compliance Overtones – Payment Modifier
  • Coding, Billing and Chargemaster Policies and Procedures
  • Editing Software
• The "-25" Modifier
  • Definition and Description in CPT
  • Relationship to Evaluation and Management t (E/M) Codes
  • How This Modifier Is Used
  • CMS Guidance on Use/Non-Use of This Modifier Under APCs
  • Process for Developing and Justifying Use of "-25" on Claims
  • Special Issues for the Emergency Department (ED)
  • Special Issues for Provider-Based Clinics
• Compliance Issues
  • Auditor Use of Statistical Extrapolation
  • OIG Pronouncement on Use of the "-59" and "-25" Modifiers
  • Audit Procedures for Proper Use
  • Recovery Audit Contractor (RAC) Involvement
• Case Studies and Exercises
• Sources for Further Information

Attendance Certificate:

Upon attending this course you will receive a 1.5 Contact Hour Attendance Certificate. There is usually a reciprocal agreement between state associations to allow these to count for each state. If you have any questions, please ask your state association.

Full tuition is refunded immediately on request if the participant has not been sent the program materials and instructions. Once the instructions (including access codes) have been sent, a full refund will be issued only after the program runs and it is verified that the participant did not access the program.