Description

Accurate coding is critical not only for proper reimbursement but also for maintaining compliance and avoiding payer audits. The National Correct Coding Initiative (NCCI), developed by the Centers for Medicare & Medicaid Services (CMS), is designed to promote correct coding and prevent inappropriate billing practices. However, navigating the complexities of NCCI edits and the correct use of Modifier 59 can be challenging even for experienced coding professionals.

This webinar provides a deep dive into NCCI edits, including Procedure-to-Procedure (PTP) edits and Medically Unlikely Edits (MUEs), and explains how to determine when modifiers are appropriate to bypass these edits. Special focus will be given to the appropriate use of Modifier 59, including its purpose, misuse risks, and how it differs from the more specific subset modifiers XE, XS, XP, and XU.

Participants will learn how to identify scenarios that warrant Modifier 59, understand what constitutes sufficient documentation, and apply best practices for compliant claim submission. We will also explore strategies for internal auditing, error prevention, and appeal preparation.

Whether you’re a coder, biller, auditor, or compliance officer, this session equips you with the knowledge and tools to strengthen your modifier usage, reduce denials, and protect your organization from compliance risk.

Learning Objectives:

• Identify the correct use of Modifier 59 and distinguish it from related modifiers (e.g., XE, XS, XP, XU)
• Develop internal review protocols and training strategies to improve modifier usage compliance and reduce denial rates
• Understand the compliance risks of inappropriate Modifier 59 usage, including payer audits, claim denials, and potential fraud investigations
• Apply best practices for documentation and coding accuracy to support Modifier 59 and ensure defensible claim submission

Areas Covered in the Session:

• Overview of the National Correct Coding Initiative (NCCI): Purpose, structure, and the CMS role in preventing improper coding.
• Breakdown of NCCI Procedure-to-Procedure (PTP) Edits and Medically Unlikely Edits (MUEs): How they function, how to access them, and what they mean for claim processing.
• Detailed Explanation of Modifier 59: Its intended use, documentation requirements, and regulatory risks.
• Distinguishing Modifier 59 from XE, XS, XP, and XU: Understanding the CMS-defined subset modifiers and when to apply them instead.
• Identifying Common Coding Scenarios Where NCCI Edits Apply: Real-world examples involving bundling edits, column 1/column 2 relationships.
• Risks of Improper Modifier 59 Use: Common mistakes, compliance concerns, and how overuse can trigger audits.
• Documentation Best Practices: What auditors and payers look for when Modifier 59 is used to bypass an edit.

Suggested Attendees:

• Hospital Administrators
• Clinic Owners
• Providers – Physicians and NPPs
• Medical Billing Professionals
• Medical Coding Professionals
• Practice Managers
• Officer Managers
• Information Officers
• Compliance Officers
• Regulatory/ Risk Officers
• Healthcare Attorneys