1. 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

2. TA T2 T1 T3 T4 LT

3. T6 T5 T7 T8 T9 RT

4. 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!

5. 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

6. 25 Modifier
Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service

7. 50 modifier
Bilateral Procedure

9. 50 Modifier
Bilateral Keller

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

12. Bilateral 2nd Metatarsal Condylectomy

14. Bilateral 2nd Metatarsal Condylectomy
CPT – RT CPT – LT – 59 mod

15. 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.

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

17. 24 Modifier
Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period

18. 79 modifier
Unrelated Procedure or Service by the Same Physician During the Postoperative Period

19. 78 modifier
Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period

20. 58 modifier
Staged or Related Procedure or Service by the Same Physician During the Postoperative Period
More extensive
therapy

21. 57 modifier
Decision for Surgery

22. JW / JC Modifiers
Effective
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

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

24. Thank You!!

25. 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

26. 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,
CGS Medicare. (May 9, 2012). Documenting surgical debridement services – Measurements matter
Noridian Medicare, Wound care and debridement – Provided by physician, NPP or as incident-to services,
Fife, C.E., MD, FAAFP, CWS. The debridement dilemma returns,
National Government Services. National Government Services LCD for Debridement Services (L27373),
Just Coding News. (August 8, 2012). Differentiate between types of wound debridement. JustCoding News: Outpatient