Modifier Mondays: a KZA Podcast

We wrap up our Modifier 58 series with KZA Coding Expert Rebecca Mizelle exploring what payers are looking for when reviewing these claims, with content prepared by KZA Coding Expert Christine Banks. Learn why payers often evaluate Modifiers 58, 78, and 79 together, what makes staged procedures and serial debridements particularly important from an audit perspective, and how Medicare, Medicare Adv...

In Part 3 of our Modifier 58 series, KZA Coding Expert Rebecca Mizelle breaks down common mistakes that can turn a seemingly straightforward modifier into a reimbursement or compliance problem, using content prepared by KZA Coding Expert Christine Banks.  From incorrectly using Modifier 58 for postoperative complications to missing prospective staging documentation and failing to reset the global...

In Part 2 of our Modifier 58 series, KZA Coding Expert Rebecca Mizelle takes a deeper dive into the documentation needed to support proper use of this modifier, with content prepared by KZA Coding Expert Christine Banks. Learn how documentation requirements differ depending on whether a procedure is staged or anticipated, more extensive than the original procedure, or therapy following surgery. Th...

In Part 1 of our Modifier 58 series, KZA Coding Expert Rebecca Mizelle walks us through the fundamentals of this staged or related procedure modifier, using content prepared by KZA Coding Expert Christine Banks. Learn the three distinct circumstances in which Modifier 58 may apply, how it differs from Modifiers 78 and 79, and what it communicates to the payer during an active global period. We als...

In this Modifier Mondays Spotlight episode, KZA Coding Expert Rebecca Mizelle breaks down Advance Beneficiary Notices (ABNs) and the modifiers that communicate a patient’s financial responsibility to Medicare. Rebecca reviews when an ABN should be issued, the choices available to beneficiaries, and the differences between modifiers GA, GZ, GX, and GY. She also shares important documentation and re...

We conclude our Modifier 79 series by exploring what payers are currently scrutinizing when reviewing these claims. KZA Coding Expert Christine Banks discusses Medicare, Medicare Advantage, commercial payer, and workers' compensation expectations, explains the audit triggers she's seeing most often, and shares practical strategies for appealing denials, auditing your own claims, and strengthening...

In Part 3 of our Modifier 79 series, Christine Banks explores the most common coding mistakes she encounters during audits, from billing postoperative pain management incorrectly to confusing Modifiers 79, 78, and 24. She also shares practical workflow tips to help practices identify unrelated procedures, properly track overlapping global periods, educate providers, and avoid costly denials and co...

Part 2 of our Modifier 79 series takes a deeper dive into the documentation required to support unrelated procedures performed during an active global period. KZA Coding Expert Christine Banks shares practical documentation tips, explains how to distinguish truly unrelated conditions, and walks through real-world orthopedic and general surgery case studies that demonstrate proper application of Mo...

In Part 1 of our Modifier 79 series, KZA Coding Expert Christine Banks breaks down the definition and proper use of this often-confused modifier. Learn when Modifier 79 should be used for unrelated procedures performed during a postoperative global period, how it differs from Modifiers 58 and 78, and why understanding these distinctions is critical for accurate reimbursement. Christine also explai...

We wrap up our Modifier 78 series with KZA Coding Expert Christine Banks, who shares what she's seeing in today's payer landscape surrounding unplanned returns to the operating room. From increased audit activity and denial trends to differences between Medicare, Medicare Advantage, commercial payers, and workers' compensation, Christine explains how payer expectations are evolving and what practi...

In Part 3 of our Modifier 78 series, KZA Coding Expert Christine Banks breaks down the most common pitfalls and mistakes she sees with unplanned returns to the operating room—and how to avoid them. From confusing Modifiers 58, 78, and 79 to misunderstanding global periods, operative settings, and complication diagnosis coding, Christine shares practical tips to help practices reduce denials, captu...

In Part 2 of our Modifier 78 series, KZA Coding Expert Christine Banks takes a deeper dive into the documentation requirements that support an unplanned return to the operating room during the global period. Christine explains the four key elements every operative note should include, discusses the importance of complication-specific diagnosis coding, and walks through real-world examples from gen...

We’re kicking off our four-part series on Modifier 78 with KZA Coding Expert Christine Banks. In this first episode, Christine lays the foundation by explaining what Modifier 78 is, when it should be used, and why it’s often confused with Modifiers 58 and 79. Learn how unplanned returns to the operating room are handled during the global period, why the global period doesn’t restart, and how prope...

In this Modifier Mondays Spotlight Episode, KZA Coding Expert Christine Banks shines a light on one of the most common causes of denials, downcoding, and audit risk: documentation pitfalls. From vague clinical notes and missing medical necessity to Modifier 25 errors, undocumented imaging guidance, time-based coding mistakes, and copy-forward concerns, Christine shares real-world examples from her...

We wrap up our Modifiers 52 and 53 series with KZA Coding Expert Deb Grider, who dives into the documentation and compliance issues surrounding these modifiers. Learn about common mistakes, audit risks, payer scrutiny, and the key elements that should be included in your procedure notes. Deb also shares practical guidance for internal audits and ensuring your documentation tells the complete story...

In Part 3, KZA Coding Expert Deb Grider tackles one of the most important questions practices have about Modifiers 52 and 53: how do they affect reimbursement? Deb explains how payers typically evaluate reduced and discontinued procedures, why documentation plays a critical role in payment decisions, and what providers should expect when these modifiers are appended to a claim. This episode offers...

In Part 2 of our Modifiers 52 and 53 series, KZA Coding Expert Deb Grider takes us beyond the definitions and into real-world clinical examples. From cardiology and general surgery to ENT and orthopedic procedures, Deb walks through scenarios that demonstrate when each modifier is appropriate and how patient circumstances drive coding decisions. This episode helps bring these often-confused modifi...

We're kicking off our four-part series on Modifiers 52 and 53 with KZA Coding Expert Deb Grider. In this first episode, Deb breaks down the definitions of Reduced Services (Modifier 52) and Discontinued Procedures (Modifier 53), explaining when each modifier should be used and why understanding the distinction is critical for accurate coding and compliance. If you've ever wondered where the line i...

We wrap up our Modifier 93 and 95 series with KZA Coding Expert Deb Grider, who brings it all together with key questions every practice should be asking before billing telehealth services. From verifying modality and CPT eligibility to ensure documentation and place of service align, this episode provides a practical checklist to support accurate, compliant telehealth billing. A must-listen for a...

In part 3 of our Modifier 93 and 95 series, KZA Coding Expert Deb Grider takes us into the complexities of payer policies and real-world scenarios. From Medicare vs. commercial payer differences to behavioral health examples and connectivity challenges mid-visit, deb highlights how quickly telehealth billing can become nuanced. This episode helps you think beyond the basics and navigate payer-spec...

In Part 2, KZA Coding Expert Deb Grider explores what happens when telehealth modifiers are used incorrectly, and how to avoid those mistakes. From mismatched documentation and missing patient consent to incorrect place of service and modifier selection, Deb walks through common audit findings and practical strategies to clean up your telehealth workflows. This episode is packed with real-world in...

We’re kicking off this four-part, two-modifier series with KZA Coding Expert Deb Grider, diving into the fundamentals of Modifiers 93 and 95. In this episode, Deb breaks down the key differences between audio-only and audio-video telehealth services, when each modifier applies, and why getting it right matters more than ever. If telehealth billing still feels a little unclear, this episode lays th...

We wrap up our Modifier 57 series with KZA Coding Expert Michelle DelMonico, who shares what she’s seeing in the payer space right now. From timing requirements and common denial trends to policy nuances across Medicare and commercial payers, this episode provides actionable strategies to stay ahead of payer scrutiny. Learn how to align documentation, timing, and policy expectations to reduce deni...

In Part 3, KZA Coding Expert Michelle DelMonico highlights the most common pitfalls and mistakes with Modifier 57—and how to avoid them. From applying the modifier to the wrong code to confusing it with Modifier 25, this episode offers practical tips, real-world scenarios, and quick checkpoints to help ensure accurate and compliant use. Perfect for both coders and providers, this episode bridges t...

In Part 2 of our Modifier 57 series, KZA Coding Expert Michelle DelMonico dives into the documentation requirements that make—or break—this modifier. From clearly supporting medical necessity to explicitly documenting the decision for surgery, Michelle walks through what payers are looking for and why vague documentation leads to denials. With real-world examples, this episode helps you build clea...