Modifier 25 & E&M Coding - 2023 Updates

Session 1 - Modifier 25 - How & When To Use It To Get Zero Denials?

Modifiers are a big part of billing, coding, and claims processing.  Modifiers allow us to share with insurance carriers’ information necessary to adjudicate claims for reimbursement.  Some modifiers are scrutinized more than others because of the frequency in which they are used, and/or the misuse of certain modifiers.  When reporting evaluation and management services, one modifier available to tell the story is modifier 25. It can only be used for sharing information related to codes 99202-99499.  It tells the insurance company that the visit is a separately and significantly identifiable service from a procedure(s) that is also performed on the same date of service that has a 00 or 10 day post-operative period assigned to it.  This is where the confusion comes in as to when it is or isn’t applicable. 

Webinar Objectives

The problem with modifier occurs when evaluation and management visit and procedure(s) are related.  According to the NCCI Policy Manual published by CMS, there has to be a very unrelated procedure(s) performed in order to correctly apply the modifier 25.  We will discuss not only different interpretations of this policy but will also look at real life examples for using Modifier 25 both right and wrong.  Evaluation and management services are the number 1 service performed in offices, hospitals, and other healthcare facilities.

Webinar Agenda

The real and full description of modifier 25 will be thoroughly reviewed to have a clear understanding of its purpose.  Even when you believe the modifier was assigned to an evaluation and management visit correctly, it is very common to receive a claim denial when it is reported with a procedure(s).  What you need to do to appeal that denial will be shared with proven results.

Webinar Highlights

• Full description of modifier 25
• When modifier 25 should not be used
• Documentation that is necessary to prove a modifier 25 is pertinent
• Understanding similar modifiers that can be used for evaluation and management services
• Process for the working of a denial
• Follow-up process to be certain clean claims are reimbursed

Session 2 - Evaluation and Management Coding in 2023-Are you under coding?

New changes in Evaluation and Management coding have a lot of providers still scratching their heads about whether they are coding appropriately. What makes up a level 2 visit, or a level 3 or even a level 4. With the new guidelines there are several changes that minimize the need for unnecessary documentation and increase the chance for you and your practice to get the coding right.

Our speaker will take a deep dive into the specifics of the coding guidelines, including what is needed to keep you safe from audit and the potential errors that can be watched for.

Elements of medical decision making will be explained at length, as this is the most misinterpreted section of the new guidelines. The number and complexity of problems addressed will be shown with several examples given. Tests and data reviewed will also be reviewed, explained, and gone through in detail. Risk, being wide in range, will also be wrapped up with several examples and using audit tools that will be provided to attendees, this will be show and explain this section with ease.

Criteria of time will also be discussed and why this can be of use in some circumstances. Our expert speaker will also touch on prolonged services with outpatient evaluation and management.

Webinar Objectives

Errors in outpatient office visit coding is and will continue to be one of the top reasons for payers to audit medical offices. Both under coding and over coding can get you in hot water. Be sure to join us in this valuable webinar to learn the tools and areas of the new guidelines to ensure you coding correctly. Don’t leave any money on the table!

What is a 99213 vs 99214? We will take a deep dive into the differences between these two codes. There are several instances that possible lack of documentation or information will change that coding in an instant. We want to help you identify areas of risk and be sure you and your providers are understanding all the appropriate value in their office visits.

Time based coding can be useful, especially for some providers. But there can be scrutiny around this coding, so join us for this must-see webinar about E&M coding to be sure you understand the rules.

Webinar Agenda

• Summary of changes
• Sections of Evaluation and Management coding in detail
• Examples of each section in detail
• Audit tools for success
• Questions

Webinar Highlights

• 99213 vs 99214
• Time coding
• Prolonged service coding
• Audit risk
• Under coding
• Over coding
• Increase revenue potential
• Documentation improvement

Who Should Attend

Coders, Billers, Denial Reps, Claim Adjusters, Case Managers, Medical offices, providers, office managers, administrators, billing managers, billing directors, auditors