CPC Certification Hyderabad - PowerPoint PPT Presentation

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CPC Certification Hyderabad

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Medical coding plays an essential role in the business of healthcare. medical coding coaching courses cause you to learn the basics of medical coding coaching, trains you for certification and help to make a more robust platform for his or her career within the medical coding industry. Now Clinizen is providing high-quality coding services like medical coding, medical billing and CPC training With experienced real-time Faculty with placement assistance. – PowerPoint PPT presentation

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Title: CPC Certification Hyderabad


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MODIFIER 53
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MODIFIER 53
  • Modifier 53 Discontinued Procedure Under certain
    circumstances, the physician may elect to
    terminate a surgical or diagnostic procedure. Due
    to extenuating circumstances, or those that
    threaten the well-being of the patient, it may be
    necessary to indicate that a surgical or
    diagnostic procedure was started but
    discontinued. Medical Coding Training in Hyderabad

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MODIFIER 53
  • For hospitalists, I believe most of the time we
    should be using modifier 53 on our procedures
    (central line, thoracentesis, paracentesis,
    lumbar puncture) that are discontinued before
    completion. Most of the time a procedure is
    aborted, it will be because of anatomical
    reasons, medical stability reasons or agitation
    that prevents a safe completion.

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WHEN TO USE
  • Use of procedures that are terminated prior to
    completion. I provide a special review of
    colonoscopy due to additional guidance by CMS.
  • Use if the surgery or procedure is
    discontinued after anesthesia is administered.
  • Use for the discontinued procedure after
    induction of anesthesia.

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WHEN TO USE
  • Use if equipment malfunction prevents
    completion of the intended procedure.
  • Use if the procedure is terminated for reasons
    beyond the physician's control. This would
    appear to qualify as an extenuating circumstance.
  • Use when the patient is having a complication
    of the procedure.
  • Use when the patient cannot tolerate the
    procedure.

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WHEN NOT TO USE
  • Don't use modifier 53 with E/M services.
  • Don't use modifier 53 with time-based codes.
  • Don't use when converting a laparoscopic or
    endoscopic intervention to an open intervention.

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WHEN NOT TO USE
  • Do not use for elective cancellation of a
    surgery or procedure.
  • Don't use for discontinued surgeries prior to
    anesthesia induction or surgical prep.
  • Not for use by ASCs. They are instructed to
    use modifiers -73 and -74. See below.

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DOCUMENTATION
  • Provide operative report documenting why and at
    what point in the procedure it was medically
    necessary to discontinue. If the procedure was
    not surgical, provide a statement or report
    detailing how the procedure that was done
    differed from usual.
  • Provide the length and amount of procedure
    completed and the reason for discontinuing the
    procedure.

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REIMBURSEMENT
  • Reduce the normal fee by the percentage of the
    service you did not provide.
  • Ultimately, you're gonna get paid whatever the
    insurance company says they're going to pay you
    and you'll have to go through whatever appeals
    process they have in place for denials or
    reductions in claims if you want payment for your
    services.

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REIMBURSEMENT
  • From Medicare Claims Processing Manual Chapter
    13 page 52/73 on Section 80.1 regarding physician
    presence for Supervision and Interpretation (SI
    codes) and Interventional Radiology
  • Radiologic supervision and interpretation
    (SI) codes are used to describe the personal
    supervision of the performance of the radiologic
    portion of a procedure by one or more physicians
    and the interpretation of the findings. In order
    to bill for the supervision aspect of the
    procedure, the physician must be present during
    its performance.

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