decisionhealth Newsletters, Part B News - 2022 Issue 7 (July)
In 2020, modifier 78 use less frequent, and much less successful
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Article Overview
This article reviews Medicare claims data to show how use of modifier 78 changed from 2019 to 2020, with attention to overall claim volume, denial trends, and shifts in performance for several frequently billed procedures. It also places modifier 78 in context by noting a related pattern for modifier 22. The piece is useful for billing staff, coders, compliance teams, and practices that track postoperative return-to-procedure reporting and claims outcomes.
Why This Topic Matters
The article highlights year-over-year changes in claim volume and denial rates that can affect reimbursement and operational planning for practices that bill with postoperative-related modifiers. It is relevant for understanding broader Medicare claims behavior during the first year of the COVID-19 pandemic.
What You Will Learn
- How modifier 78 claim volume changed from 2019 to 2020
- How denial rates shifted for claims using modifier 78
- How Medicare claims data can reflect broader utilization changes during 2020
- How modifier 22 compared with modifier 78 in the reported period
- Which broadly referenced procedure codes saw notable changes in denial experience
Who Should Read This
- Medical coders
- Billing staff
- Revenue cycle professionals
- Compliance teams
- Physician practices
- Practice managers
Codes Discussed
Modifiers Discussed
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