Use These Resources for Educational Conversations
Question: I’m an auditor who works with both coders and providers who want to do things correctly regarding documentation and coding, but also want to know why, in some situations, I’m right and they’re wrong. It’s been frustrating to receive denials based on their mistakes and not be able to break the cycle, for example, misusing modifiers 59 and 22. What resources are appropriate to bring in when discussing these pain points? New Mexico Subscriber Answer: Think about what you use when you want to check or cross reference a code, procedure, or condition. While coders may rely on some specialized coding resources, there are ample reference points you can share that can bring fuller context to a provider’s documentation and a coder’s claim preparation. Consider bringing the coder or provider a reliable reference, like the National Correct Coding Initiative (NCCI) manual; a specific NCCI edit, which you may find via your respective Medicare Administrative Contractor (MAC); any relevant AMA definitions or appendices, such as information and guidelines for modifier 59 (Distinct procedural service) and modifier 22 (Increased procedural services); and documentation requirements to support code or modifier choices. Rachel Dorrell, MA, MS, CPC-A, CPPM, Production Editor, AAPC
