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

LT

TA T1

T2 T

3 T4

RT

T5

T6 T

7 T8 T

9

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 – 24 modifier

• Procedure – 58 modifier – 78 modifier – 79 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

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