Packaging is a payment concept that indicates an item or service is not separately paid, but rather paid as part of another service. Unlike bundled items and services, packaged items and services may, and sometimes are required to, be reported separately on the claim with a HCPCS code.

The top challenges of healthcare bundled payments include achieving scale, leveraging post-acute care resources, and managing uncontrollable costs.

As you’re probably aware, claims are “bundled” when a payer refuses to pay for two separate services a practice has billed. Instead, it groups, or bundles, the two charges and pays only one, smaller fee.

A global fee for surgical procedures is a concept established by third-party payers. Under such a system, a single fee is billed and paid for all necessary services normally furnished by the surgeon before, during and after a procedure.

Global fee system is a fixed fee arrangement between an employer and a health care provider. In a global fee system, a health care provider consent to allow a fixed fee for all treatment relating to a specific area of care such as orthopedics or cardiac.

Modifier 25 (significant, separately identifiable evaluation and management [E/M] service by the same physician on the same day of the procedure or other service) is the most important modifier for pediatricians in Current Procedural Terminology (CPT®).

Modifier 59 is used to identify procedures/services, other than E/M services, that are not normally reported together, but are appropriate under the circumstances. Only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used.

A new modifier (-GX) has been created with the definition “Notice of Liability Issued, Voluntary Under Payer Policy” and is to be used to report when a ABN was issued for a service.

Never use both modifier 51 and 59 on a single procedure code. If there is a second location procedure (such as a HCPCS code for right or left), use the CPT® modifier first.

Modifier 52 This modifier is used to indicate partial reduction, cancellation or discontinuation of services for which anesthesia is not planned.

Modifier 55 When a physician or other qualified health care professional performs the postoperative management and another physician performed the surgical procedure, the postoperative component may be identified by appending this modifier to the surgical procedure.

Modifier -74 is used by the facility to indicate that a surgical or diagnostic procedure requiring anesthesia was terminated after the induction of anesthesia or after the procedure was started (e.g., incision made, intubation started, scope inserted) due to extenuating circumstances or circumstances that threatened …

Modifier -73 is used by the facility to indicate that a procedure requiring anesthesia was terminated due. to extenuating circumstances or to circumstances that threatened the well being of the patient after the. patient had been prepared for the procedure (including procedural pre-medication when provided), and.

Modifier 76 Used to indicate a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service.

Modifier -73 indicates procedures discontinued prior to anesthesia, whereas modifier -74 is appropriate for procedures discontinued after anesthesia administration or after the procedure has begun (e.g., the physician made the incision or inserted a scope).

CPT modifier 77 is used to report a repeat procedure by another physician. Guidelines and Instructions. Submit this modifier to indicate that a basic procedure or service performed by another physician had to be repeated.

Modifier 57 Decision for Surgery: add Modifier 57 to the appropriate level of E/M service provided on the day before or day of surgery, in which the initial decision is made to perform major surgery. Major surgery includes all surgical procedures assigned a 90-day global surgery period.

Appendix A — Modifiers tells us: Under certain circumstances 2 or more modifiers may be necessary to completely delineate a service. In such situations modifier 99 should be added to the basic procedure, and other applicable modifiers may be listed as part of the description of the service.