HCM Marketplace

AUDIOCONFERENCE ON CD OR AUDIO ARCHIVE

presented on January 16, 2008

Case study analysis of proper use of modifier -25

If CPT and Medicare guidance on modifier -25 confuses you and your staff, you’re not alone. Most physician practices struggle with this modifier on a daily basis because both sets of guidelines can be difficult to interpret. Learning the correct application of modifier -25 using actual case study scenarios will help practices identify key risk areas and ensure a plan for compliance.

Using modifier -25 to override the National Correct Coding Initiative Edits can lead to over-payments —which could trigger an audit. On the other hand, under-use of the modifier can lead to lost revenue, which can cut into your practice’s bottom line.

Learn the ins and outs of modifier -25 usage in a physician practice setting with industry experts Hugh E. Aaron, MHA, JD, CPC, CPC-H, and Robin B. Stickney, MD, JD during this live audioconference. They will discuss helpful case studies and scenarios where this modifier should and should not be used as well as provide supporting documentation for their rationale. You’ll also hear tips you can put to work right away to improve compliance. Plus, you’ll get our hit list of modifier -25 traps and how to avoid them.

TAKE A LOOK AT THE AGENDA

This program is tailored to meet the needs of physician practices. It will discuss modifier -25 relative to professional services.  The speakers will not discuss the use of modifier -25 relative to hospital facility services.

1. Analysis of CPT guidance on the use of modifier -25 in billing for physician and other professional services
   1. Major definitional requirements
   2. Application issues
2. Analysis of Medicare guidance on the use of modifier -25 in billing Medicare for physician and other professional services
   1. The general rule for use of modifier -25
   2. Documentation requirements
   3. Using modifier -57 in lieu of modifier -25
   4. Using modifier -25 in lieu of modifier -57
   5. Multiple Evaluation and Management (E/M) services
   6. E/M services with an Initial Preventative Physical Exam (IPPE) (i.e., “Welcome to Medicare” exam)
   7. E/M services with a non-covered preventative medicine service
   8. E/M services with drug administration
   9. Preoperative critical care services
   10. E/M services with inpatient dialysis
3. Case studies

A question and answer session follows the presentation
Note: This is an intermediate level program. Purchasers should have a basic understanding of CPT and Medicare coding guidelines, including a basic understanding of the proper use of modifiers.

LEARNING OBJECTIVES

• Explain the differences between the CPT definition and Medicare guidance related to the use of modifier -25 for physician and other professional services
• Properly use modifier -25 in billing for physician and other professional services
• Evaluate the compliance risks associated with the use of modifier -25 in billing for physician and other professional services

EARN CONTINUING EDUCATION CREDITS

This program has been approved for 2 continuing education units for use in fulfilling the continuing education requirements of the American Health Information Management Association (AHIMA). This program has prior approval of the American Academy of Professional Coders for 1.5 Continuing Education Units. Granting of this approval in no way constitutes endorsement by the Academy of the program, content or the program sponsor.

WHO SHOULD LISTEN

Anyone involved in coding and billing for physician and other professional services, including coders, billers, physicians and other clinicians, HIM directors, practice managers, compliance officers

MEET THE SPEAKERS

Hugh E. Aaron, MHA, JD, CPC, CPC-H, is HCPro's senior vice president for compliance and regulatory affairs/regulatory counsel. Aaron’s work focuses primarily on coding and billing accuracy with a particular emphasis on Medicare billing compliance. He was the original developer of the Certified Coder Boot Camp®–Original Version, the Medicare Boot Camp®--Hospital Version, and the Medicare Boot Camp® –Professional Services Version courses, now offered by HCPro. Aaron is an adjunct assistant professor of law at the University of Richmond School of Law and an affiliate assistant professor in the Department of Health Administration at Virginia Commonwealth University (Medical College of Virginia Campus).

Robin B. Stickney, MD, JD, is a senior consultant with St. Vincent Health, a division of Ascension Health, in Indianapolis. His medical career includes extensive practice and leadership experience in Emergency Medicine, Aerospace Medicine, Occupational Medicine and Family Medicine. He also was a practicing attorney for ten years, focusing primarily on Insurance Defense Litigation. In his current position, Dr. Stickney leads the Professional Services Coding and Documentation Compliance Program for all of the employed practitioners throughout St. Vincent Health.

YOUR MATERIALS PACKET

In addition to the expertise and advice presented during this audioconference, you'll also receive a proposed framework for how to correctly append modifier -25.

Purchase a CD or audio archive of the program and listen when you can. It's also a perfect training tool for new staff or as a refresher for veteran staff.

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