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.

As 2017 comes to an end, we’re all scrambling to wrap up a bazillion audits. ‘Tis the season for holiday cheer and audit anxiety, right?

The appropriate use of Modifier 25 can be a little tricky because the requirements are ultra-specific. On the one hand, Modifier 25 is really handy.

“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?

For this episode of Compliance Conversations, I sat down with Chad Peterson, a senior consultant at a large hospital, in their professional coding and reimbursement group. He educates physicians, mid-level providers/ advanced practice providers and even ancillary staff about E/M coding.

Compliance and coding are complicated.

Annually, the Centers for Medicare and Medicaid Services (CMS) publishes its Fee-For-Service (FFS) Improper Payment Report, a result of the accumulated totals of the Comprehensive Error Rate Testing (CERT) audits.

Evaluation and management (E/M) services are “visits performed by doctors to assess and manage a beneficiary's health,” according to the OIG’s website.