Joshua Everts, DDS, MD, FACS’ Post

Quick Guide to CPT Modifier 58, 59, 78, 79, 24 Modifiers 58, 78, 59, 79, and 24 are CPT modifiers applied to surgery claims. They each have very specific, though related definitions. They often cause confusion, especially between modifiers 58 and 78, but also among 59, 79, and even 24. Here are the definitions, according to Current Procedural Terminology (CPT): ✓ Modifier 58 Definition: “Staged or related procedure or service by the same physician during the post-operative period.” ✓ Modifier 78 Definition: “Unplanned return to the operating or procedure room by the same physician following initial procedure for a related procedure during the post-operative period.” ✓ Modifier 79 Definition: “Unrelated procedure or service by the same physician during a post-operative period.” ✓ Modifier 59 Definition: “Distinct Procedural Service: Under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-E/M services performed on the same day…” ✓ Modifier 24 Definition: “Unrelated E/M service by the same physician during a post-operative period” Knowing when to choose modifier 58 over 78 or 79 over 78 is vital. Why? Using the wrong modifier can mean denied claims. The different modifiers also carry varying reimbursement schemes. For instance, Modifiers 59 and 78 can reduce Medicare reimbursement below 100%. • Modifier 58 and modifier 78 are often mixed up, because both refer to related procedures by the same physician in the post-operative period. However, modifier 58 generally describes staged/planned procedures, while modifier 78 is used for unexpected procedures. • Modifiers 59 and 79 can be confused as well. Both can refer to unrelated procedures by the same physician. However, 79 focuses on the post-operative period, while 59 centers more specifically around same-day or same-session procedures. • Finally, modifier 24 covers only E/M services by the same physician during the post-op period. • Billing with the right modifiers means less denied claims and higher reimbursement. That means health care workers can ultimately save money for employers. The decision tree below aims to simplify the choice between modifiers 58, 78, 79, and 59. #CPTModifiers #SurgeryClaims #SurgeryCoding #ModifierUsage #CleanClaims #AvoidDenials #Reimbursement

A Spine Center of Excellence (COE) program not only helps steer clear of unnecessary surgeries, it also has lower re-admission rates, shorter hospital stays, and faster return-to-work timelines. Consider a Spine COE program for your benefit plan. #Healthcare #SpineCare #centersofexcellence

UPDATE: Anthem Blue Cross says it's reversing a policy to limit anesthesia coverage Can we please stop maximizing profit over actual healthcare coverage, looking for reasons to deny coverage or "refer for more testing"? Non medical friends tl:dr if your surgery goes longer than the insurance company thinks it should in these states, they won't cover your anesthesia care time which means you pay the bill not your insurance. "The proposed new policy will no longer reimburse anesthesia services for the complete duration of certain surgical procedures, opting instead for a partial coverage model, and the head of the ASA has called it "appalling" and "egregious," creating a precarious situation for patients undergoing surgery." https://lnkd.in/e2bXwdUg #healthcareonlinkedin

I’m always amazed at all the different ways health systems use SeamlessMD… What about reducing time to Bariatric Surgery by 1.5 to 3 months? Pretty incredible, huh? That’s what’s been happening at Ohio State University’s Wexner Medical Center. In a webinar that featured Dr. Sabrena Noria, Surgical Director for OSU’s Bariatric Center of Excellence, she shared 4 key lessons on how they used SeamlessMD to improve patient adherence to completing pre-surgery insurance milestones - thereby shortening the time to surgery. Here were the 4 lessons: 1️⃣ Digital care journeys can reduce time to bariatric surgery by at least 1.5 months - and perhaps up to 3 months. 2️⃣ The business case to hospital leadership for a digital care journey platform should focus on getting patients to surgery faster. 3️⃣ A key reason why Digital Patient Engagement works to improve patient adherence to pre-surgery milestones is by helping patients understand the “Why” 4️⃣ A digital platform to guide patients from referral to surgery has very high patient-rated usability (97 on the System Usability Survey!) Link in the comment to the 4 lessons in more detail 👇 What patient journey should we tackle next? #digitalhealth #healthcareinnovation

Not sure how Elxo Inc. can help your healthcare IT process? Check out this case study of a major bariatric surgery center for an example of how we can help you get the focus back to patient care. 

At a leading medical group, manual workflows were causing patients to wait far too long for the care they needed. In one high-volume center, bariatric surgery patients were facing year-long waits, burdening both patients and nurses. With elxo's help, an automated solution was crafted to streamline the process, ensuring faster access to vital care. Curious about the process? Check out the case study:👉 https://hubs.la/Q02lyhrT0 #healthcareIT #customsoftware

There is an insurance company that actually cares about patient outcomes, supports private practice spine surgeons, and is not adversarial to hospitals. However, it’s not a health insurer. They are a partner to Marvel Group. Together we provide: - A surgery guarantee to spine surgery patients called the Patient Promise. - A shared cost savings program for private practice spine surgeons. - A powerful differentiator for hospital spine surgery programs. A few key characteristics include: - Underwriting benchmarks using national averages year after year, so it’s not a race to the bottom for surgeons. - Reducing healthcare costs by returning money to patients when outcomes are poor. - Including a private PROMs registry for each surgeon with the ability to anonymously benchmark against peers. - Allowing hospitals to purchase this program and partner with private practice spine surgeons to improve clinical and financial outcomes for patients, surgeons, and themselves.

New article alert! Check out my latest article in Cataract & Refractive Surgery Today Global about patient satisfaction versus patient experience. Even if your patients are satisfied with their surgical outcomes, a negative experience can still cost you valuable referrals. Read the full article here: https://lnkd.in/d7pvF2VR

By modernizing the preference card process with a digital solution, a surgical facility in enabled real-time card edits instead of semi-annually. Because PREFcards can integrate real-time inventory information like costs, charge codes, and the quantity of every item used during a case, the ability to capture costs more accurately for each surgery is greatly improved. Over six months, the preference cards tied to the most popular surgical procedures saw a $16,046 improvement in cost accuracy. To learn more: https://lnkd.in/eceYR3sp #prefcards #surgery #sterileprocessing #CSSD #surgicalequipment #surgicaltable #surgicalcart #casecart #medical #medicalequipment #surgeryroom #sterile #sterileequipment #hospital #operatingroom #perioperative #nurseleaders

An insurance company called a patient and told them to schedule their surgery with A DIFFERENT surgeon. Why? Because the original surgeon's quality metrics were terrible. Were they doing this out of concern for the patient? Maybe... but likely they knew expensive complications, readmissions and repeat surgeries were more likely with the original surgeon. So surgeons, yes, do good surgeries and avoid complications... But your op notes and progress notes affect your metrics more than you think. As Dr. Erica Remer describes in her modules: Surgeon #1 has a mortality rate of 22% Surgeon #2 has a mortality rate of 14% But... Surgeon #1 see's the sickest of the sick and the EXPECTED mortality is 35%. Surgeon #2 see's simple patients and the EXPECTED mortality is 5%. Which one would you pick? Which one do you think the insurance picked? 👇 --------- If you liked this post, consider reposting to share with your audience. I'm Dr. Robert Oubre, a CDI medical director and hospitalist, and I teach residents and new inpatient physicians/APP's how to bill and document.