Modifier-59: Manage Pre- and Post-Payment Audits to Reduce Denials

AUDIO CONFERENCE ON CD OR AUDIO ON-DEMAND

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presented on June 23, 2009

A program for outpatient coders and HIM staff members

PROBLEM

Modifier -59 describes separate procedures at different times in the same day on the same patient. New coders and experienced pros alike have difficulty applying this modifier correctly. Inaccurate coding can lead to missed revenue opportunities as well as open the door to major compliance problems. With a wide range of auditors—including NCCI, RACs, CERT, MUEs, and the OIG—watching your back, you need to get it right.

SOLUTION

Coding and billing for second procedures is often legitimate, necessary, and should be taken seriously. Learning specific, common scenarios where modifier -59 can and should be used will increase your level of understanding about its application and help ensure appropriate usage. Strategies on how to prepare for an audit examining modifier -59 coding will help you further understand all that goes into appropriate use of the modifier as you attempt to minimize risk.

LEARN FROM US

HCPro's 90-minute audio conference, Modifier -59: Manage Pre- and Post-Payment Audits to Reduce Denials featuring expert healthcare consultants Susan E. Garrison, CHC, CHCA, PCS, FCS, CCS-P, CPAR, CPC, CPC-H (Magnus Confidential), and Peggy S. Blue, MPH, CPC, CCS-P (HCPro, Inc.). They illustrate specific case studies to show you the proper usage of modifier -59, and they explain how to appropriately document and audit your use of the modifier. In addition, the speakers provide practical tools and checklists, giving you a step-by-step blueprint to help you minimize incorrect modifier -59 use to prevent both denials and audits.

LEARNING OBJECTIVES

At the conclusion of this audio conference, you will be able to:

• Explain the risks of inappropriate usage of modifier -59
• Recognize the documentation necessary for billing the modifier appropriately
• Describe how to gather data and summarize a process for auditing modifier -59

AGENDA:

• Correct use of modifier -59 in the event of an audit
• NCCI edits
• MUEs
• CERT
• RACs
• Appropriate modifier use and interpretation
• Edit guidelines
• When you can and cannot bypass the edit
• Outpatient case studies
• Surgical (modifier -59 vs. modifier -51)
• Ancillaries
• Radiology
• Laboratory (modifier -59 vs. modifier -91)
• Others
• Auditing techniques to ensure appropriate modifier use
• Identifying cases to audit
• Knowing if the modifier was used (or not used) appropriately
• How to extrapolate to see a true picture of the overall use of modifier -59
• Who's responsible for the modifier and how to educate them
• Question and answer session

BONUS TOOLS

In addition to the expertise and advice presented during this audio conference, you'll also receive a slide presentation of the program materials and:

• Link to/Copy of Medicare Claims Review Program's pre- and post-payment booklet
• Copy of the OIG's report on modifier -59
• Link to/Copy of special edition on MLN Matters article on modifier -59
• Auditing checklist

CONTINUING EDUCATION

This program has been approved for 1 continuing education unit for use in fulfilling the continuing education requirements of the American Health Information Management Association (AHIMA). Credits expire June 23, 2010.

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. Credits expire on May 31, 2010.

MEET THE SPEAKERS

Susan E. Garrison, CHC, CHCA, PCS, FCS, CCS-P, CPAR, CPC, CPC-H, executive vice president, healthcare consulting services, Magnus Confidential (Atlanta, GA). Garrison has more than 25 years of experience in healthcare management, including the areas of documentation, coding, billing, and reimbursement for both outpatient hospital and physician services. She has conducted hundreds of engagements at hospitals across the country to improve hospital and physician compliance and reimbursement.

Peggy S. Blue, MPH, CPC, CCS-P instructor, Medicare Boot Camp® - Physician Services Version, and Certified Coder Boot Camp HCPro, Inc. (Marblehead, MA). Blue has more than 20 years of experience in the health insurance industry including extensive experience in the Medicare and TRICARE government programs. Prior to joining HCPro, she oversaw the development, implementation, dissemination, and reporting of information related to Medicare professional services training efforts for Highmark Medicare Services in Pennsylvania.

WHO SHOULD LISTEN?

Professionals employed by outpatient hospitals, including the following titles:

• HIM manager/staff
• Outpatient coder
• Billing manager/staff
• Patient financial services
• Ancillary services department
• Revenue cycle manager
• Compliance manager/staff
• Clinical documentation specialist

AUDIO ON-DEMAND

In addition to the regular purchase options for HCPro audio conferences, we are pleased to offer another option, audio on-demand. Audio on-demand allows you to download the program and play it back at your convenience through your computer or MP3 player. Purchase a CD or audio on-demand 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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