Modifiers Jeffrey D. Lehrman, DPM, FASPS, MAPWCA APMA Coding Committee Expert Panelist, Codingline APMA MACRA Task Force Fellow, American Academy of Podiatric Practice Management Board of Directors, ASPS Board of Directors, APWCA Twitter: @DrLehrman

TA T2 T1 T3 T4 LT

T6 T5 T7 T8 T9 RT

22 Modifier - Increased Procedural Services Op Report must support the substantial additional work and the reason for the additional work Increased intensity Increased time Technical difficulty of procedure Severity of patient’s condition Physical and mental effort required Should not be appended to an E/M service Procedures Only!

22 Modifier Two documents required to support the claim. 1) An operative report 2) A narrative indicating how the service differs from the usual Legit examples Non-Legit examples

25 Modifier Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service

50 modifier Bilateral Procedure

50 Modifier Bilateral Keller

Bilateral Keller CPT 28292 – 50 modifier One unit No Laterality modifiers Bill twice normal

Bilateral 2nd Metatarsal Condylectomy

Bilateral 2nd Metatarsal Condylectomy CPT 28288 – RT CPT 28288 – LT – 59 mod

59 modifier Distinct Procedural Service Documentation must support Different session, Different procedure or surgery Different site or organ system Separate incision or excision Separate lesion Separate injury (or area of injury in extensive injuries) Not ordinarily encountered or performed on the same day by the same individual.

Coding During Global E/M Procedure 24 modifier 58 modifier 78 modifier

24 Modifier Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period

79 modifier Unrelated Procedure or Service by the Same Physician During the Postoperative Period

78 modifier Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period

58 modifier Staged or Related Procedure or Service by the Same Physician During the Postoperative Period More extensive therapy

57 modifier Decision for Surgery

JW / JC Modifiers Effective 1-1-2017 Use with CTPs Bill product using 2 lines Units of CTP used: Q code X units – JC mod Units of CTP discarded: Q code X units - JW mod Line 1 + Line 2 = Total CTP product

FX Modifier Payment Reduction For The Technical Component for X-Rays Taken Using Film Effective 01/01/2017 Applies to Medicare only

Thank You!!

Modifiers Jeffrey D. Lehrman, DPM, FASPS, MAPWCA APMA Coding Committee Expert Panelist, Codingline APMA MACRA Task Force Fellow, American Academy of Podiatric Practice Management Board of Directors, ASPS Board of Directors, APWCA Twitter: @DrLehrman

Resources Kesselman, P., DPM. (September, 2013). Wound care billing update, Podiatry Management pg 53-59 LeGrand, M., RN, MA CCS-P, CPC., Changes in reporting wound débridement, http://www.aaos.org/news/aaosnow/jun11/managing2.asp CGS Medicare. (May 9, 2012). Documenting surgical debridement services – Measurements matter. https://www.cgsmedicare.com/ohb/pubs/news/2012/0512/cope18819.html, Noridian Medicare, Wound care and debridement – Provided by physician, NPP or as incident-to services, https://www.noridianmedicare.com/cgi-bin/coranto/viewnews.cgi?id=EFFZFZyyEpAJGDJCxK&tmpl=part_a_viewnews&style=part_ab_viewnews Fife, C.E., MD, FAAFP, CWS. The debridement dilemma returns,http://www.todayswoundclinic.com/debridement-dilemma-returns?page=4, National Government Services. National Government Services LCD for Debridement Services (L27373),http://apps.ngsmedicare.com/lcd/LCD_L27373.htm, Just Coding News. (August 8, 2012). Differentiate between types of wound debridement. JustCoding News: Outpatient