Understand and Avoid Costly Mistakes for Modifiers 51, 52, 53, 58, 59, 25, 78 and 22

It’s important to understand modifier usage to avoid costly mistakes. Modifiers can also have significant impact on claims and payment. When used correctly, modifiers can positively affect reimbursement and offer a clear picture of the service performed.

Use Modifiers Correctly and Avoid the Potential for Abuse: Modifier 52 and Modifier 53

Modifiers identify circumstances or procedures that vary from the original code description. They alert the payer that something unusual has occurred. And, because modifiers address exceptions and not the rule, the potential for misuse or abuse of them is often significant.

Two Facts Increase Payment Success

“Coders who recognize two foundational truths about modifiers increase their reimbursement success,” Carol Pohlig, BSN, RN, CPC, who works in the department of medicine at the Hospital of the University of Pennsylvania, says.

“First, coders must recognize that not...

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