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Course

Surgical Modifiers

Instructor

Faye Grile, CCS-P, CDIP, CPC, COC, CPCO, CPMA, CEMC

Description

Gain a deep understanding of Level I CPT modifiers and their impact on claim processing and reimbursement in surgical procedures in our course, "Surgical Modifiers." Discover the intricacies of Global Surgical Packages, Global Surgery Fees, and when modifiers like 25, 57, 58, 76, and 77 should be used. Delve into the significance of modifiers 78 and 79 for unplanned returns to the operating room and unrelated postoperative procedures. Learn how Modifier 24 affects E/M services during the postoperative period and its exceptions. Our course ensures you master the art of applying surgical modifiers accurately, preventing claim denials, and optimizing reimbursement.

Included Lessons:

  • What is a Surgical Modifier 
  • Definitions
  • Related, Staged, and Unplanned
  • Modifiers that Impact Surgical Reimbursement 
  • Organizational Impact 
CEUs available for the following credentials:

AAPC

COC, CPC, CPC-P, CANPC, CASCC, CCC, CCPC, CCVTC, CDEI, CDEO, CEDC, CEMC, CENTC, CFPC, CGIC, CGSC, CHONC, CIC, CIMC, COBGC, COPC, COSC, CPB, CPCD, CPCO, CPEDC, CPMA, CPMS, CPPM, CPRC, CRC, CRHC, CSFAC, CUC

AHIMA

CCA, CCS, CCS-P, RHIT, RHIA, CDIP, CHDA, CHPS

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Key Takeaways

By the end of this course, participants will have a comprehensive understanding of surgical modifiers, enabling them to navigate the complex world of medical billing and coding with precision and confidence. Key takeaways for this course include:

  • Understanding Modifier Types: Gain knowledge of Level I CPT modifiers and their role in accurately representing surgical procedures and services.
  • Global Surgical Packages: Learn about the concept of global surgery fees, encompassing pre-operative, intra-operative, and post-operative care, and their impact on billing and reimbursement.
  • Related, Staged, and Unplanned Procedures: Recognize the distinctions between procedures that are related, staged, or unrelated to the original surgery, and how this affects coding and reimbursement.
  • Organizational Impact: Recognize the significance of correctly selecting and using modifiers for accurate billing, preventing claim denials, and optimizing reimbursement.

Benefits of Taking this Course

  • Enhanced Coding Knowledge and Expertise
  • Continued Professional Development
  • Continued Education Units

FAQs

What is the difference between Modifier 57 and Modifier 78, and when should each be used?

Modifier 57 is used when a healthcare provider makes the initial decision to perform major surgery during the preoperative period of a surgical procedure with a 90-day global period. It indicates that an E/M service on the day before or the day of a major surgery led to the decision for surgery, which will take place within the next 24 hours.

Modifier 78, on the other hand, is applied when an unplanned return trip to the operating room is required during the post-operative period for a related procedure. This modifier signifies that the procedure performed during the return trip is related to the original surgery.

When should Modifier 24 be used, and what are the implications of using it for E/M services during the postoperative period?

Modifier 24 is used to indicate that an unrelated E/M service was provided by the same physician during a postoperative period. It is primarily used by surgeons when the E/M service is unrelated to the surgery that initiated the global surgical period.

Implications of using Modifier 24 for E/M services during the postoperative period differ for inpatient and outpatient settings:

  • Inpatient: Medicare typically does not allow separate payment for such visits, unless specific exceptions apply, such as immunotherapy management by the transplant surgeon or critical care for a burn or trauma patient. Documentation must establish that the visit was unrelated to the surgery.

  • Outpatient: If an E/M service claim is submitted with Modifier 24 and has a different diagnosis than the surgery that placed the patient in a global surgical period, separate payment for the E/M service is allowed. Otherwise, the visit is considered included in the global fee, and payment may be denied.

In both cases, it's crucial to ensure proper documentation supports the use of Modifier 24 to avoid payment issues and claim denials.

About our Medical Coding Courses

HIAlearn, powered by Health Information Associates (HIA)—a leader in medical coding and auditing for more than three decades—offers a comprehensive online education platform for medical coders. With a catalog of over 200 medical coding courses accepted by the American Health Information Management Association (AHIMA) for Continuing Education Units (CEUs) and a selection approved by the American Academy of Professional Coders (AAPC), HIAlearn caters to both beginners and experienced medical coders seeking to enhance their skills. The platform provides an array of training plans tailored to meet individual learning needs, from mastering challenging coding procedures to understanding broad conceptual frameworks within the coding world. Courses are available across various coding types including CPT, E/M, ICD-10-CM, ICD-10-PCS, and are designed to cater to different coder levels and coding specialties such as inpatient, outpatient, profee, and CDI. Additionally, HIAlearn offers a Coding Updates bundle to ensure coders are up-to-date with the annual changes in ICD-10-CM, ICD-10-PCS, CPT, and IPPS. Beyond individual learning, HIAlearn supports organizations with group discounts, promoting enhanced coding accuracy, efficiency, and compliance across teams. 

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Overview
Price
Price : $35.99
Courses
Courses : 1
CEUs
AHIMA CEUs : 1
CEUs
AAPC CEUs : 1
Code Type
E&ME&M