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Week 1 Modifiers (CPT/HCPCS Level II) Series Instructional Series — Transcript

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0:01[music]
0:07[music]
0:14[music]
0:23[music]
0:32Hello. Hello. Hello everyone.
0:36How are you?
0:38All right. So, I just need my team to
0:42tell me if my mic sounds nice.
0:47Hello. Hello. Hello. I see someone
0:49saying good morning.
0:51Hi, Vina.
0:54Thank you, Miss Mills. Miss Mill said,
0:56"Hey, I sound good. How is everyone?
0:58Thank you so much for coming." We didn't
1:01give everyone a lot of time to get here.
1:04We just kind of said, you know, let's do
1:06this. And we did. All right. So, welcome
1:11to something you all have been asking
1:13for. That's why we're doing it. We are
1:15going to talk about CPT and Hickpix
1:19level two modifiers. Now, this isn't a
1:22course, so it's less formal, and we're
1:25going to get into it. And yeah, it is
1:28going to be highly engaging. All right.
1:31So, I'm going to shout you all out in a
1:33moment, but I do want to shout out my
1:36team. I just want to say hello. Thank
1:38you so much, Mr. Sandep, Miss Mills, and
1:42you know what? I'm not quite sure who's
1:43all here, but I did see Miss Beth. I did
1:46see Miss Haley. Hi, Miss Haley. I saw um
1:52Star Wars girl. That's her intern. I saw
1:55Vina.
1:56If I missed anyone, please let me know.
2:02Mr. Sandep, I think I don't know who
2:03that person is, but it says AMCI Medical
2:06Coding. So, let me know. I see you, Miss
2:08Vina. Okay. So, I'll be shouting you all
2:10out all the way through and let's get
2:13into what are the goals of this class.
2:18Well, the goals we only have three.
2:19Number one, we're going to learn common
2:22CPT modifiers. Number two, we are going
2:25to learn about Hickpix level two
2:28modifiers, the common ones. And three,
2:32we're going to bring you one step closer
2:34to mastery. In fact, not only is our
2:38goal to enable you to master, by the end
2:42of this class, you will have mastered
2:46three modifiers and they're very
2:49important. So, let's get going.
2:52So, before we get started, I want to
2:55know what you know. Yes, we got a poll.
3:00All right, so in the chat, put your
3:02answer. How comfortable are you with
3:06coding CPT and Hickpix level two
3:09modifiers?
3:11A I'm confident. B I'm okay. C so
3:18D I need help. Or E, what are modifiers?
3:23Go ahead, put your answers in the chat.
3:43All right. So, we we you know, we we're
3:44little this this gives me a lot of um
3:48information.
3:50Hi, Linda. How are you?
3:56Okay. Okay. Okay.
4:00All right. So, good, good, good. So, we
4:02don't really have anyone that's like,
4:04I'm confident. All right. So, this is
4:06where you belong and I needed that.
4:09Okay. So, I want to begin this
4:11discussion by kind of giving you a
4:14little bit of context,
4:16right? You because we keep telling you
4:19what a modifier is. A modifier modifies
4:22a code, right? What does that mean?
4:25Well, let just listen to my little
4:29it's not a story, but
4:33give you listen to my little context.
4:35Okay? All right. So, let's say you've
4:39been dreaming about
4:41a vacation, a European vacation for
4:45years, right?
4:47So you go ahead, you save up your money,
4:52you, you know, work extra hours, you do
4:56overtime, you you don't, you know, you
4:58know, you bring your lunch, you know,
5:01you're saving. And your ideal vacation
5:04is you want to do a European vacation,
5:08you want to go Paris, you want to go to
5:10Italy, and you want to go to Greece. All
5:13three, right? So,
5:17you're going to do it. This is your
5:20bucket list. You're going to do it.
5:21You're going to get your passport.
5:23You're going to get your airline
5:24tickets. You got your itinerary. You're
5:26ready to go.
5:29So,
5:32when you take this trip and you plan
5:35this trip,
5:38there are going to be some things that
5:41you'll need to um
5:45do to accommodate the trip. All right?
5:47So, you're going to pack your clothes,
5:49right? You're going to arrive to the
5:51airport. So, you're all ready to go,
5:52right?
5:54And so you're telling everybody, I'm
5:56going on this European trip.
6:00And that's what you expect to do, right?
6:02Yeah, you're going to go on this trip,
6:03but just saying you're going on the trip
6:07doesn't mean
6:09that was your experience,
6:12right? Because just like things in life,
6:16things happen, right? So you could
6:19experience maybe um your flight to
6:23Paris. Let's say you're leaving from
6:24Dulles to Paris. Let's say it gets
6:27cancelled, right? And let's say midway.
6:32Let's say you're in some other country
6:35and you just kind of stuck, right? Let's
6:39say that
6:41your husband surprises you and say,
6:43"Hey, I'm going to join you."
6:46Let's say they lose your luggage, right?
6:50Let's say that something gets [snorts]
6:52taken from your luggage.
6:56Let's say that when you get to Italy,
7:01you get sick
7:05and then you got to make a detour. You
7:08got to cut your trip a little short. In
7:12fact, you might just want to go home.
7:19So, you did have some modifying
7:23circumstances to that European trip.
7:30Okay, coders, are you following me? that
7:34even though the trip may have taken many
7:37detours, whether they're good or bad,
7:39and there are some good detours,
7:42they had multiple modifying
7:46circumstances or modifying factors. Key
7:50word modifier,
7:53right? So, the trip, they still went on
7:56the trip,
7:59but they had those detours along the
8:01way. And just like that trip of a
8:05lifetime where these modifying factors
8:08changed the trip, it didn't change the
8:11fact that they went, but it changed,
8:14you know, there were some factors that
8:16kind of changed it. Surgery is the same
8:20way. There are incidents and
8:23circumstances that could modify surgery,
8:28but the surgery still happens and
8:31sometimes not.
8:34So, over the next four weeks,
8:38we're going to learn how to tell that
8:40whole story about surgeries by using
8:44modifiers.
8:48And we're going to begin week one
8:52with mastery of modifiers 22,
8:5852,
9:00and 53.
9:08Now, before we go any further, do you
9:11all know that a a um list of modifiers
9:17are in the front inside cover of your
9:20CPT
9:22manual?
9:24Are you all aware? And if you aren't,
9:27you know, I want everyone to pull out
9:29your CPT manual and open up the front
9:31inside cover. When I open mine, there's
9:35a page stuck to mine. So, I'm gonna pull
9:38it apart and I can see my modifiers at a
9:44glance. So, I want you all to get
9:46familiar with that. And also,
9:50these are just, you know, abbreviated
9:52definitions. Now, the full definitions
9:56are in the back in appendix A. So, if
10:00you just aren't sure and you're not
10:01clear and you need that full definition,
10:03you go to the back to appendix A and go
10:07grab that modifier definition.
10:12All right. Now, I still want to know
10:14what you know. You know, just by you
10:16saying, "Hey, I feel good." You know, I
10:19really want to know. So, I have a true
10:21false exercise for you.
10:26Now, someone's talking about hickpicks
10:27level two. We're not talking about that
10:29yet, but yes, thank you. Very, very
10:32good, Mia. All right, so we got some
10:35questions. I want to know what you know.
10:38Modifier 22 is reported when a procedure
10:41requires substantially greater physician
10:43work than is normally required. True or
10:47false?
10:50What say you?
10:54And feel free to answer. Don't wait
10:56until I finish reading it. If you want
10:58to answer it quickly, go right ahead
11:01because we are a couple of seconds
11:03delayed and um don't let me slow you
11:07down.
11:10Good that you know a couple of people
11:12said, "Hey, I'm going to put that answer
11:14in." Now, I'm not going to tell you if
11:15it's correct or not, but I will commend
11:18you for taking the you know, just go
11:21ahead, put your answer. We will not
11:23judge you here. no judgment zone. And
11:27the answer the answer is true. Number
11:30two, I'm going to pick up the pace
11:32everyone. So, if you can read it before
11:34me, that'll be great. Modifier 25 may be
11:37reported when a significant separately
11:40identifiable ENM service is performed on
11:43the same day as a procedure. True or
11:46false? What say you?
11:52And I know that some of these
11:56definitions don't really explain what it
11:58is, but I'm giving you this definition
12:00because that's the definition that they
12:03provide you with. But yes, believe me, I
12:06will explain them more in depth. And if
12:09you said true, outstanding. Next
12:12question. Modifier 26 identifies the
12:16professionals part of a service. True or
12:20false? What say you? Go ahead, put your
12:24answers in the chat. And you all are
12:26rocking it. All right. I see couture
12:29dream divas. I see you Karen T. I see
12:34you. Me Mia. I might not be saying your
12:36name right. And you know I know these
12:38are screen names so please forgive me.
12:40Be Frasier. I see you. Welcome. Welcome.
12:42Welcome. Sue Cabala. Welcome back.
12:47Welcome back. All right. Mima.
12:51Okay. Musically,
12:54you all are just doing an amazing job.
12:56Okay, Deborah and outstanding. The
12:58answer is true. Next question. Modifier
13:0232 is used when a procedure is mandated
13:05by a third party such as a court or
13:09insurance carrier.
13:14Mabe, I know I'm not saying your name
13:16correctly, but I'm going to say it.
13:19Outstanding.
13:21Thank you. Look at my interns. You all
13:23are rocking. I see you. Vina, Miss
13:26Haley, Miss There's Star Wars girl. I
13:30see you all. Hey, B Frasier.
13:33Okay, Linda. I see you.
13:37And I see you too, Lindsay. Good job,
13:41Orlica. Very good. I No, I'm probably
13:44not saying it correct. So, Sherry,
13:47outstanding. Go. You all said true. Way
13:50to go. Next. Modifier 47 is reported by
13:54the anesthesiologist to indicate
13:56anesthesia performed by the physician.
13:59True or false? Okay, Kimmy, I see you.
14:02Thank you.
14:05They are. They are. Rock and Beina
14:10Waka,
14:12your name is familiar.
14:17True or false? Yeah, you are like, I
14:20don't know about this one. True or
14:22false? True or false? Put your answers
14:23in the chat. Hi Melissa
14:26Sapphire. Yes, this is recorded and I
14:29will show you how to get it at the end.
14:31But while we're waiting, if you go to
14:33the YouTube channel and you click on our
14:35lives, all of our recordings from all of
14:38the lives can be found there. Good job.
14:41The answer is false. The key word is
14:44anesthesiologist.
14:47Modifier 47 is reported by the physician
14:50or the surgeon, never the
14:53anesthesiologist.
14:55Way to go. Way to go. And if you learn
14:57something, outstanding. Okay. Hey,
14:59Modifier 50 is used when a procedure is
15:02performed on both sides of the body
15:04during the same operative session. True
15:07or false?
15:11All right, Lily, you you're waiting to
15:14become an intern. You just come on over
15:17and talk to Miss Meals. She's right in
15:19the chat. Okay, look at all these great
15:22answers. Way to go, Sherry. Way to go,
15:25Mabe. Way to go. Way to go. Way to go,
15:27Mima. Melo, all these M's.
15:30[clears throat] The answer is true.
15:31That's right. We You know what? You all
15:34have this one down. Next. Modifier 51
15:38should always be appended on all
15:40multiple procedures performed during the
15:43same encounter. True or false? That's
15:47right. They're on fire.
15:50On fire.
15:56Okay. All right. So, Lily May, um,
15:59contact us again. Miss Mills, Lily May
16:01said, um, she filled out an application
16:05and she wants to be an intern. We'd love
16:08to have you. Okay,
16:14Couture, I see you. Okay, Sherry
16:22Lindsay. All right. I'm loving the fact
16:25that you answer. I'm not telling you the
16:27answer, but I love the fact. And you
16:29know what? Uh oh, look at that. Okay,
16:33something came up on my screen. All
16:34right, and the answer is false. And I'm
16:37going to tell you, here is something
16:39common knowledge. Whenever you're taking
16:41like multiplechoice exams, when you see
16:44this word all, every, never, just weigh
16:48it very, very carefully. When in doubt,
16:51rule against it. But if you know for a
16:54fact, then you go with what you know.
16:56All right? So very little is all. Never.
17:02Always. I'm not saying all the time, but
17:05I'm just saying very little. So modifier
17:0851 should always be appended on all
17:12multiple procedures. That's false
17:14because when you think about it,
17:15bilateral procedures, that's multiple
17:18procedures, right? So, you're not going
17:20to append a 51 on a bilateral procedure.
17:24All right, good job everyone. Hopefully,
17:26that was a aha moment. Okay, modifier 52
17:30is used when a physician intentionally
17:34reduces or partially performs a service.
17:38True or false? What say you?
17:42And if you don't know, take a guess.
17:44That's it. We're here to learn. And
17:46we're going to learn about modifier 52
17:48today.
18:05All right, we got those answers coming
18:06through and the answer is true. Yes.
18:10Okay. Modifier 53 is reported when a
18:12procedure is started but discontinued
18:15due to unforeseen circumstances or
18:18concern for patient safety. True or
18:21false? What say you? That's right. They
18:25are getting it. You are doing amazing.
18:30That's right, Miss Beth. Beth, I'm
18:31loving this participation.
18:34Come on, coders.
18:37What say you? Okay, I'm going to pick up
18:40the pace and I know your answers are in
18:42there. I'm I'm just a little lagged. And
18:44the answer is true. Modifier 53 is used
18:49for discontinued procedures. All right.
18:52Modifier 58 is used when a patient
18:55returns unexpectedly to the operating
18:58room for related procedure during the
19:00post-oper operative period. And if you
19:02want a peek in the book, go ahead. your
19:05book is going to be with you when you
19:07take your exam. Yeah. So feel free and
19:11if you don't want to, you want to do it
19:13by memory, feel free to do that as well.
19:15All right. So the answer is
19:19few more seconds.
19:23And that answer is false. Yeah. So, it's
19:28not um it's not um I believe the other
19:32modifier that you would use would be 78,
19:35not 58.
19:37All right, let's keep going. Modifier 59
19:42may be used to identify a different
19:44procedure when when procedures would
19:47typically be bundled. True or false?
19:51What say you?
20:08Okay.
20:13Welcome new member. I like your name
20:15hepatologist. Hey, they may be. Let us
20:18know if you are. All right. So, the
20:21answer is true. Absolutely. key word is
20:25different, but we're going to learn to
20:27distinguish them, I believe, next week.
20:30Modifier 62 indicates that two surgeons
20:35worked together and each performed a
20:38distinct portion of the same procedure.
20:43True or false? What say you?
20:53All right, I see those answers coming
20:55through and you all are moving so fast
20:58and I know you're putting those answers
21:00in and the answer is true. This modifier
21:04requires that two surgeons perform this
21:08are are working on one
21:13procedure.
21:14So two surgeons aren't carrying out two
21:17different task. They're carrying out the
21:20same. So if they're operating on the
21:21heart, both of those surgeons are doing
21:24the work on the heart, not one doing a
21:27harvest of of a graft for the heart. No,
21:32those are two different procedures. So
21:34they have to be working on the same
21:37procedure. All right. Modifier 66. This
21:40indicates a surgical team was required
21:43to complete a highly complex procedure.
21:47True or false? What say you?
22:03Okay, good answers coming through. All
22:07right, the answer is true. Way to go.
22:11Way to go. All right, we're getting down
22:13to the wire. Modifier 77 is reported
22:16when the same physician repeats a
22:19procedure. True or false? That's right.
22:23They're spot on.
22:31All right, I'm going to put the answer
22:33up. I know you all are answering and the
22:36answer is false. It is not the same
22:41physician repeating a procedure. U
22:46modifier 77 if you open up your book is
22:49repeat procedure by another
22:52physician or other qualified health care
22:55professional. Now we're moving on to
22:58modifier 80. This identifies an
23:02assistant surgeon. True or false?
23:09Okay, I'm going to say the answer is
23:12true.
23:14Modifier 90 is used when laboratory
23:18services are performed by an outside
23:20reference lab. True or false?
23:28Look at that. You all are get you are so
23:30fast. So fast. They're reading faster
23:32than me. Good. The answer is true.
23:38Now,
23:39here's another question. Modifiers 59
23:43and modifier 51 can be appended to an
23:47add-on code. True or false? What say
23:51you?
24:02All right, the answer is false. You may
24:05never do that. We know you can't add
24:07modifier 51
24:10um to an add-on code, but more recently,
24:14modifier 59 has been, you know, added to
24:17that guideline as well. So modifier 59
24:21and 51 cannot be added or appended to an
24:25add-on code. And if you know if I move
24:29too fast, I don't know if this will help
24:32or not, but um there were only five
24:37incorrect or five falses. And I'm just
24:41going to put this up on the screen for a
24:43moment for you. Hopefully you can see
24:45it. If you can't, I apologize. And if
24:48you can't, you can watch the playback
24:50and enlarge it. But if you watch the
24:52playback, you can see the others as
24:53well. But I want to take a moment to
24:55look in the chat and just really
24:57encourage you all. Somebody said, "Aha,
25:00that's right, Lucky." That's right. All
25:02right, let's go. Now, one thing I want
25:06to tell you, um, let's talk. Let's just
25:10have a a, you know, just a regular
25:13conversation. So, we know that these are
25:16modifiers and we know that modifiers
25:20modify a procedure. And you know what a
25:24modifier really does?
25:27Number one, it's going to either
25:29increase the payment, number two, it's
25:33going to decrease the payment, or three,
25:36it's only. It's going to explain the
25:40story.
25:42It's either one, two, or three.
25:47And these modifiers
25:51can you can use as many modifiers
25:55that apply. And these modifiers also
25:59have sequencing order.
26:02So in other words,
26:05if the modifier impacts the money,
26:09that's called a functional modifier
26:12and it should be sequenced or used or
26:15appended before theformational modifier.
26:22So, your functional
26:25takes precedence over theformational.
26:32Good. Somebody said they can't believe
26:33they remember so much. That's good.
26:36Someone said modifiers are their
26:37friends. I love it, JBV. Okay, Lily, I
26:41see you. All right, so now let's go
26:43ahead and let's get into our discussion
26:46and we're going to hone in on modifiers
26:4822, 52, and 53.
26:51And we're going to call this the CPT
26:54modifiers of volume. More, less, or
26:59stop. Right? So modifier 22
27:03if more work was needed or it was more
27:07extensive. Modifier 52 if less or
27:12reduced
27:14work took place. and modifier 53 that
27:18procedure was stopped.
27:22You all with me?
27:30I need somebody to answer in the chat.
27:33And if you're not, you can say, "Hey,
27:34Mrs. Jay, you're going too fast.
27:48Okay, I see a few people answering.
27:51Good, good, good.
27:54All right, so let's take a procedure.
27:58The procedure that we're going to look
28:00at is an exploratory laparottomy,
28:04right? Code 490000.
28:08This is our base procedure code. Now, if
28:12a an exploratory laparottomy took place
28:17and that was it, you would just code
28:224900 0. However, if you had a modifying
28:27circumstance that increased
28:33this procedure or made it more
28:35difficult,
28:37you're going to need to append a
28:39modifier 22. So let's say the patient
28:41had was morbidly obese and had lots of
28:47maybe had a previous abdominal procedure
28:51and had lots of adhesions.
28:54If the documentation says that then you
28:58will append modifier 22 for increased
29:03procedural services.
29:09Now, let's say
29:13that the doctor
29:16was supposed to carry out this
29:18exploratory
29:20laparottomy. And when you're doing these
29:22laparottoies, these exploratory
29:25laparottoies,
29:26you're looking at a bunch of anatomy,
29:30right? So you might look at the um
29:34the
29:36um stomach, the dadum, the small
29:40intestine, the colon, the liver, etc.
29:43But let's say the doctor said he went
29:46in, he looked at the stomach, and that
29:49was it. And he said, "You know what? I
29:51don't need to go further. I see
29:52everything that I need to see right
29:54here."
29:56So that doctor should not be entitled to
30:00that full laparottomy
30:03procedure
30:05and in the documentation he will specify
30:09that hey I did less I viewed less of
30:11that anatomy and he's going to append
30:14modifier 52
30:27Are you all with me?
30:33And modifier 52,
30:37type in the chat what the definition of
30:39modifier 52 is. I mean, just the brief.
30:48Somebody said that I'm going a little
30:49too fast. So, I'm just going to slow it
30:50up just a bit.
30:56You know what? I'm not seeing the chat.
31:02Okay, good. Now it's coming through. All
31:04right. So, yes, it's reduced services.
31:07So, modifier 22 and modifier 52, they're
31:11the exact opposite of one one another.
31:14And you should be able to identify them
31:15by the number two.
31:19in the ones column. All right. So 22 and
31:2252 are the opposite of one another. Now
31:25this modifier
31:27um 53 this is if they had to discontinue
31:31this laparottomy altogether they had to
31:33stop it before the surgery took place
31:38right and sometimes during but often
31:41it's before like at the induction of
31:45anesthesia etc and I'm going to explain
31:48why
31:50all right
31:53but the thing that you should Always
31:54remember that the money is almost always
31:59impacted when you use these three
32:01modifiers. When you use modifier 22,
32:05that provider is going to get more
32:06money. You use modifier 52, that
32:09provider is going to get less money.
32:12Modifier 53, probably nothing.
32:16Probably.
32:17And sometimes they will. Let me let me
32:20correct myself. If they put 53 on there,
32:23they're going to get some but not as
32:25much, right? We have to pay for the
32:28doctor's time. Now, I want to go back to
32:31my analogy of that European trip, right?
32:35So, when that trip was more difficult,
32:38that person um had to to had a delay and
32:43they you know their their flight was
32:46cancelled.
32:48um that was more difficult for them when
32:51they had to go to the hospital, you
32:54know, to the doctors and perhaps cancel
32:57their trip and go back home. That's more
33:00money. Yes, difficulty is often attached
33:03to more money
33:06and that would have been modifier 22 if
33:08we put modifiers on trips. But yes, this
33:10is a modifying modifying circumstance.
33:14Now if something happened where they did
33:18less for instance the person who got
33:22sick cancelled you know their the part
33:26of a portion of their um trip they
33:30didn't go to Greece they were sick if
33:32they stayed in wherever they were in
33:35Europe they didn't pay for maybe
33:39expenses sightseeing etc they may have
33:42still had to have paid for it but they
33:44paid less because they didn't go. Now,
33:47if they went home, they might have paid
33:49more. And if they just didn't go
33:51altogether, let's say they missed their
33:53flight,
33:55then that would have been a modifier 53
33:58and they still may have had to pay for
34:00the trip, but not as much.
34:03So, hopefully you understand how
34:06modifiers work. And just like in
34:09medicine and medical coding, the money
34:13is almost always impacted.
34:19Now, let's turn our attention back to
34:2122. Remember, I said this is a mastery.
34:23We want you to master. I want you to
34:26leave here and I want you confident in
34:28knowing what modifier 22 is. This is
34:31increased procedural services. Modifier
34:3422 is used when that provider performs a
34:36substantially greater work than is
34:39normally required. It is the exact same
34:42procedure but significantly more
34:46difficult, complex or timeconsuming.
34:49Right? So 22 means that provider had to
34:52work extra hard.
34:55And how do you know the provider worked
34:58extra hard? Well, those key words are
35:00going to tell you. You're going to see
35:02keywords in your documentation
35:05saying extensive,
35:08severe,
35:10significantly
35:11increased. This procedure was
35:14complicated.
35:15It was difficult. It was a difficult
35:19dissection. We had prolonged
35:23operative time, greater than usual
35:27effort.
35:28So, it's not going to be something
35:31light. These adjectives
35:35are going to be very it's you're going
35:38to feel it. You're going to say, "Hey,
35:40this this was tough when you read that
35:42documentation."
35:43All right. So, what you need to do ask
35:47yourself why, what, how much, and why
35:51again? Why was this procedure more
35:54difficult? What was the additional work?
35:56how much time or effort actually
35:59occurred or why did this specific
36:03service exceed the expected norm. So you
36:06could ask yourself that but you don't
36:08really have to. Just look for those key
36:10words. The key words will tell the story
36:15and you can never assume
36:17never assume. Just look at the
36:19documentation. All right. So these are
36:21some of the things that might catch you.
36:24So you might see language like this took
36:27slightly longer. Slightly longer. No,
36:33we said extensive, right? We had some
36:37minor complications. Nope. That's not
36:39going to cut it. An unexpected
36:42complexity.
36:44No, be more specific, doctor.
36:47Normal obesity. No, that's not going to
36:51cut it. Now, when someone's morbidly
36:54obese, that might make you say, "Hey,
36:57this probably is." And then you might
36:59want to look more for more documentation
37:02to substantiate using this modifier 22.
37:07All right. So, we So, how do you all
37:10feel about modifier 22? We're going to
37:12practice in a moment, and I want to move
37:14on to modifier 52.
37:24So let me know how you feel about
37:25modifier 22. You understand that it is
37:29extensive. It increases
37:32that procedure.
37:35It modifies it in a way that it
37:39increases
37:41that procedure. Okay,
37:44good. So people said they're pretty
37:46good. Now we're going to turn our
37:47attention to modifier 52.
37:50And modifier 52 is the opposite of 22.
37:55This is reduced services. So it's a
37:59procedure or service particular
38:03partially reduced or intentionally
38:06less than normally performed. The
38:10defining characteristic is choice. the
38:13provider intended to do less from the
38:16outset or made an elective decision to
38:19reduce the procedure.
38:25All right.
38:27And modifier 52 has some key words.
38:31Limited,
38:34partial,
38:36reduced,
38:38incomplete examination,
38:41less than usual,
38:45electively discontinued.
38:48These are some keywords that will, you
38:50know, in the documentation that will
38:51point you to, hey, this modifier 52 is,
38:55you know, this is the the modifier you
38:57should use.
39:04All right. So now when you're looking at
39:07your documentation in order to apply
39:10this modifier 52, the documentation must
39:14document the reason why the service was
39:17reduced, the scope, what specific
39:21portion of the procedure was actually
39:23completed and the choice why the doctor
39:26made that decision to reduce the
39:29procedure.
39:36All right. So, I think reduce they're a
39:38little more relaxed on reduce
39:41and now we're going to turn our
39:43attention to discontinued.
39:46The procedure was started with every
39:50intention of completion but was
39:53discontinued because continuing would
39:56place the patient at severe risk or the
39:59intention to finish or safety forced a
40:03hard stop. No matter what this was
40:06stopped now I got to tell you all stops
40:09are not discontinued.
40:12It rests on the documentation
40:15and I'm going to explain how you can
40:18determine the difference between
40:21discontinued
40:22and reduced procedure.
40:29Somebody said the harder you work the
40:31more it costs, right? The less you work
40:34the less. All right, so now we're on
40:38stopped, discontinued.
40:40These are your key words. Discontinued,
40:44aborted, terminated, procedure stopped,
40:48safety concern, patient instability,
40:51arhythmia,
40:52respiratory distress.
40:55These are all common keywords. These are
40:58not all. This is not an exhausted list,
41:02but this should point you in the right
41:04direction. Now your documentation
41:10can when it's pertinent to the safety of
41:12the patient, why they halted the
41:15procedure, why exactly was that
41:17procedure stopped, the threat to the
41:20patient, what specific documented safety
41:23concern occurred, the progress, how much
41:26progress was successfully completed
41:28before the halt. This is key right here.
41:33That progress will tell you whether you
41:36can code a um modifier 52 reduced or
41:43stopped.
41:45Okay. And the justification, why was it
41:49unsafe to continue?
41:54Now, here's a warning when not to use
41:56modifier 53. If it was never started, if
42:00the procedure never started, then you
42:03can't stop it. Right. Right. So, you
42:06don't need modifier 53 if it never
42:08started.
42:10And also pre-anesthesia,
42:13if it's canceled during the
42:14pre-anesthesia, like at the induction of
42:16anesthesia, you don't use modifier 53,
42:20you just don't bill it.
42:23and elective do not use for intentional
42:27non-emergency
42:28reductions. They tell you to use um
42:32modifier 52.
42:34In other words, you know what? Okay, let
42:37me just stop and pause right here.
42:40If the doctor says, "Okay, I'm going to
42:45stop right here." Let's say the doctor
42:47enters the patient's body and says looks
42:51in does some some um you know
42:55observation or might just kind of just
42:58look around that doctor is entitled to
43:02be compensated for that. And this is not
43:05necessarily a discontinued. This is more
43:08like a modifier 52. Now, modifier 52 is
43:13different than modifier 53 because you
43:16will need to determine what took place.
43:19If the doctor did anything, then it's
43:23typically a modifier 52. If the doctor
43:26really didn't do anything,
43:28just observed, eyeball, gross, then it's
43:33a modifier 53. And that's typically
43:39yes. Someone said, "Will this be on
43:41playback?" Absolutely. And I'm going to
43:42show you where you can get it. Okay. So,
43:46this is the slide that explains the
43:50difference is down to the intent versus
43:52the circumstance. It's reduced if the
43:56doctor did something. It's stopped 53 if
44:01the doctor really didn't.
44:06So, it's based on the documentation.
44:08What did the physician do?
44:11You focus on that and you can't go
44:13wrong.
44:15Are you all with me?
44:31All right, somebody said something in
44:33the chat. Awesome.
44:38All right. So, the base
44:42operative procedure tells us what
44:45happened. That laparottomy tells you
44:47what happened. The modifiers tell us how
44:51it happened. Either it was more
44:54extensive, it was less than expected, or
44:59we stopped it.
45:0222
45:0352
45:0553
45:09Now it's your turn coders. Are you all
45:11ready?
45:17Okay.
45:19All right. So, I have a scenario here
45:22and we're just going to kind of go with
45:24the flow. If you can read it ahead of
45:25time before me, that would be fantastic.
45:28If you um want to wait for me, that's
45:31good, too. All right. Which modifier
45:34should be appended to the procedure?
45:37Modifier 22, 52, 53, or 59? A
45:4158-year-old patient presents for
45:44excision of a benign lesion on the
45:46scalp.
45:48During the procedure, the physician
45:50discovers extensive scar tissue from a
45:54prior traumatic injury that
45:57significantly
45:59complicates the excision and closure.
46:03The [snorts] procedure required
46:04extensive dissection and nearly doubled
46:08the expected operative time.
46:12So, you all might be saying, "Okay, Mrs.
46:14Jay, since you read it that way, right?
46:16So, I'm just going to go ahead and pull
46:19out those modifier focused keywords,
46:22extensive scar tissue, complicates,
46:26extensive dissection, double operative
46:29time, and you all got it. Outstanding.
46:32It is 22.
46:34Increased procedural services. [snorts]
46:38Outstanding job. Outstanding. Great job.
46:43A physician. Oh, no. No. I'm got I gotta
46:45and for those of you this is your first
46:47time with us. Welcome. But we do read
46:51the answer first. All right. Which last
46:55sentence first and the answers. Which
46:57modifier should be reported? 22. No
47:00modifier 52 or 53.
47:03A physician performs a colonoscopy that
47:06takes longer than usual because the
47:08patient had poor bowel preparation
47:11requiring additional irrigation and
47:14repositioning. The physician
47:16successfully completes the procedure.
47:19Which modifier should be reported?
47:22A, B, C, or D?
47:47All right, I'm going to let a few more
47:48answers come through.
47:55And if you said be good because there
48:00was only language like longer than
48:04usual,
48:05right?
48:07nothing extensive or you know what I
48:10mean. You got to have that language and
48:13no modifier is the correct answer.
48:19That's right. We do have great
48:20participation.
48:22All right.
48:24Which modifier should be reported? A 22
48:3052 53 or technical component? A patient
48:34is scheduled for a bilateral diagnostic
48:37mammogram. Due to severe patient
48:40discomfort, the provider completes
48:43imaging of only one breast and elects
48:47not to continue the study.
48:52What's the answer? Is it A, B, C, or D?
49:20Okay. What are my modifier focused
49:24keywords? This patient had a bilateral
49:27mammogram and only one breast was
49:30completed and the doctor said, "Hey,
49:32we're not going to continue because the
49:34patient is in dis um you know is in um
49:39pain."
49:41All right.
49:43So, which modifier reduced the
49:46procedure? Because remember, we have to
49:48compensate the physician for what they
49:50did. We don't focus on that it was
49:53stopped. We focus on what they did and
49:56he did or she did. They completed one
49:59breast. Right? So 52 modifier reduced
50:05procedural services. And I'm going to
50:08let that marinate.
50:12Remember,
50:14focus on what that physician did.
50:20Good job. Good job. Good job. All right.
50:24Which modifier should be reported? A 53,
50:2752, 59, or 22? A physician schedules a
50:31colonoscopy. However, because of an of
50:33an obstructing stricture, only a limited
50:37examination of the colon is completed.
50:39The physician elects not to proceed
50:41beyond the reachable area and document a
50:44partial examination.
50:47What say you?
51:02Okay.
51:05So, here are my modifier focused
51:08keywords. Only a limited exam, partial
51:12exam. You know what? The doctor did
51:14something, right? So if the doctor did
51:17something, it's modifier 52.
51:22You all are getting this.
51:26Getting this.
51:31I'm going to let that marinade.
51:38That's right. Way to go. And if you
51:40learn something, priceless.
51:43There's Mr. Sandeep shouting you out
51:46from the screen. Thanks Mr. Sandeep. All
51:49right. During a card Oh. Oh, sorry.
51:52Which modifier should be appended? A 53
51:5652 22 or 59. During a cardiac
51:59catheterization, the patient develops
52:02ventricular tachicardia. Shortly after
52:05catheter insertion, the physician
52:07immediately terminates the procedure and
52:10stabilizes the patient.
52:13What say you?
52:37[snorts]
52:39Okay.
52:41Yeah, this one's a little tough, huh?
52:43So, the doctor immediately terminates
52:46the procedure, but I also too want to
52:48focus on the fact that a cath was um
52:56introduced into the patient. So, no
52:58procedure, nothing was done like there
53:02was no assessment. The doctor didn't go
53:04in and assess. He just advanced the
53:06catheter. So, I'm not saying you didn't
53:08do anything, but it's not going to
53:10count. And that answer is going to be
53:1253. It's discontinued services.
53:19All right? So, if it start if the
53:21documentation says that the doctor did
53:24something, saw something, etc., then
53:27that counts. Whereas just entering the
53:31the surgical site may not. Okay? Okay,
53:35the doctor's got to tell us. We got to
53:37follow the documentation.
53:39Hopefully that makes sense. Now we're
53:42almost finished. Which modifier should
53:45be reported? A 22, B 53, C 52, or D59?
53:52During an upper GI endoscopy, the
53:54patient becomes increasingly anxious and
53:57requests that the provider stop the
54:00examination. The physician only viewed
54:02the esophagus and stomach and did not
54:05review view the deadnum. The physician
54:08discontinues the procedure before
54:09completing the intended study. What is
54:13the answer?
54:31Now pay attention to what the doctor
54:34did. Did the doctor do anything. That's
54:37going to distinguish 53 from 52. What
54:41did the doctor document that they've
54:44done?
54:48Okay. Here are my modifier focused
54:51keywords. Well, during the upper GI
54:55patient becomes anxious. The provider
54:57stops the examination. But the doctor
55:00viewed the esophagus and the stomach.
55:05So the doctor did something. So this is
55:08not a stop. This is a reduced procedure.
55:14Somebody said they're getting it. I love
55:17it.
55:19Good job. Good job. Good job. Remember
55:21coders, always pay attention to what the
55:24doctor did. What did the doctor document
55:27that they did? And that will pretty much
55:31that's going to drive you to the correct
55:33answer. All right. Which modifier should
55:36be reported by the physician? A 53, B
55:3852, C 73, D no modifier. A patient's
55:43brought to the O for arthoroscopic knee
55:46surgery. Prior to anesthesia
55:48administration,
55:50elevated blood pressure causes the
55:52surgeon to cancel the procedure. Okay.
55:55coders, what is the answer? Type your
55:58answers in the chat.
56:14Okay. So, well, prior to the induction
56:18of anesthesia, the surgery was
56:20cancelled. What did the doctor do? Well,
56:24the doctor did absolutely nothing. So,
56:28it's no modifier. They didn't even have
56:31surgery. They didn't, you know, enter
56:34the surgical site or anything. It was
56:36cancelled before surgery.
56:40Yeah. Boom. Home run. And it's more of a
56:43home run if you learned something.
56:49And for those of you got it correct,
56:51outstanding.
56:52Outstanding. Outstanding.
56:55And it just takes a moment. Just slow
56:57down a little bit and process. Marinate.
57:02Definitely watch the playback. Watch it.
57:06Right. All right. So, basically,
57:09modifier 22
57:12more. It's turned up. Substantial work.
57:16Modifier 52 turned down. Intentional
57:20choice to to kind of turn it down. the
57:22doctor says, "Hey, I'm going to skip
57:23this or I'm going to, you know, do
57:26less." And modify 53, that means it
57:29stopped in the process or somewhere um
57:32in the process, but the doctor really
57:34didn't do much or anything.
57:38All right,
57:40remember, you can't stop
57:44whatever started. So, if it didn't
57:46start,
57:48no modifiers at all.
57:52And I just want to just tell you, remind
57:54you that modifiers 22 and 52 are the
57:58opposite of one another.
58:03Now you're all ready to rock and roll. I
58:06think some of you have moved towards
58:09mastery. You're on your way. And we've
58:12got three more weeks to go. And we are
58:17finished with
58:19the um modifiers 22, 52, and 53. And
58:25next week, we'll keep testing it just to
58:27make sure that you kind of get it. Also,
58:30don't forget about your um the inside
58:33cover of your CPT.
58:36That's where your modifiers are. If you
58:38want our reference cheat sheet, I will
58:41give it to you. Um, and I'll probably
58:44have it for you next week. If you're an
58:45MCDC student, it will be in your course
58:49so you don't have to worry about it. And
58:50speaking of you MCDC students, um,
58:53Lucine is your, you know, it's in your
58:57course. Now, what is Lucine? really
58:59quickly. It is your AI coach, but it's
59:05powered by AMCI instructors. We're there
59:08every day answering your questions and
59:11making sure that you have the support
59:13that you need with your scenarios. So,
59:15if you want to test out the modifiers,
59:18you've got some modifier questions. So,
59:21check it out. It's in your course. And
59:23also check your email. we sent you a an
59:26email and also a demonstration on how it
59:29works. All right. So again our agenda is
59:34you know for the first weeks sorry about
59:37that uh for the first week one um we
59:41tested or we moved towards mastery of 22
59:4452 and 53. Next week, our focus is going
59:47to be 505159.
59:49And yes, we'll be testing all of the
59:52modifiers from week to week. All right.
59:56And for those of you that want to know
59:59where the playback, how do I get to the
1:00:01playback? Go to our YouTube channel,
1:00:04AMCI YouTube channel, and then click on
1:00:07the live.
1:00:09And then you just go to the live session
1:00:12that you want the playback of. It will
1:00:14be sitting here. So right now it is live
1:00:17now but immediately this will become
1:00:21your playback.
1:00:23All right.
1:00:26And that's it.
1:00:29Oh, while you're at it, don't forget to
1:00:31like it up right now. Can you like up
1:00:33this video? We only have zero likes
1:00:35right now. Well, at the time of me
1:00:38making this, we had none. So, if you can
1:00:40do me that, I would appreciate it. And
1:00:43we've got a survey team. The survey is
1:00:46in the um the section the notes section.
1:00:51Please if you will put it in the chat.
1:00:55And I just want to thank my team. Mr.
1:00:57Sandep, Miss Mills, Miss Haley, Miss
1:00:59Beth, Miss um Star Wars Girl, Miss Vina
1:01:03D, Miss I feel like I'm missing
1:01:06somebody.
1:01:07I'm I feel like I'm missing somebody.
1:01:10And I do apologize. I do. All right. And
1:01:13some of you are here so often I I'm
1:01:15almost mistakenly call you interns. So I
1:01:19just want to thank all of you for
1:01:21coming. And Rue, I see you. Welcome. DC
1:01:26Kicks. Hey, how are you? And you know,
1:01:30thank you all so much. Miss Vtaves,
1:01:35good to see you. Lucky always.
1:01:41Waka
1:01:43Pash
1:01:45and
1:01:47that's it. Look, can you believe we are
1:01:52on time? And fill out that survey. Let
1:01:54me know how we did today. Did you learn
1:01:57something? Did you learn? Is there
1:02:00something more? I only wanted to focus
1:02:02on those three next week. I promise you
1:02:05it's going to be amazing. All right. So,
1:02:08I just want to say so long everyone and
1:02:11we'll see you next time.
1:02:25[music] AMCI.
1:02:28Learn to go straight from home or on the
1:02:31road at
1:02:33[music]
1:02:33CI.
1:02:35We're on the east coast, the west
1:02:38[music] coast. We're all around the
1:02:41world.
1:02:44A m c i. A m c i. A m c i. A m c i.

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