Healthicity Blog

Modifier 59 is shockingly confusing for coders, auditors and physicians alike. It’s frequently misused, for example, it’s often added as prevention or recoupment of an insurance denial as a way to get additional procedures paid.

For those of you unfamiliar with coding and billing, modifier -59 is a two-digit numeric code modifier that can be appended to a CPT or HCPCS procedure code, for example, and will frequently bypass many payor edits.

“Time is on my side. Yes it is.” But knowing whether or not time is a factor to qualify for a particular level of E/M can lead to uncertainty. So when is time a factor?

The OIG has frequently reviewed chiropractic services over the last several years. Their most recent report was posted on their website on Aug. 18, 2017 and concluded that a Brooklyn chiropractor had a 100% error rate for claims over a two-year period worth about $672,000.

Sometimes, when I mention coding and documenting Transitional Care Management, coders and auditors will get a crazy look in their eye that can best be described as, “subtle fear.”

But don’t panic, it’s easier than you think!

Recently, I talked with Christopher Chandler, a senior consultant at a large medical group in the professional coding and reimbursements department. Christopher explained a whole slew of surgical coding misunderstandings like confusion about how ICD coding works with CPT coding and what to do with...

In this episode of Compliance Conversations, I sat down with Senior Consultant, Brenden O’Neil, who works in Intermountain’s professional coding and reimbursement department. O’Neil and I had a fascinating discussion on CPT codes and the complicated gray area of coding a laminectomy.

Healthcare fraud and abuse are hot topics right now, it’s more important than ever to get on top of new codes and keep your practice audit-ready. Knowledge is power. This handy list will help you update CPT codes and stay current. Educate providers and staff using the following auditing resources.