Importance of Using permissible Modifiers:
1. The physician performed complicated procedures
2. The procedure performed was bilateral
3. The E/M aid was done on the same day of the procedure
4. The procedure was increased or decreased
5. The procedure has both expert and technical component
6. The procedure was performed by other victualer (Anesthesiologist, Surgeon corporal Therapist, Speech Pathologists etc.)
7. procedure on whether one side of the body was performed
8. The E/M aid was provided within the postoperative period
9. The E/M aid resulted to Decision of Surgery
10. Unusual Circumstance
Maximize your repayment for bilateral procedures by using the definite modifier.
Bilateral Modifier (-50)
Depending upon the insurance payer, processing claims with bilateral procedure should be paid 150%
Medicare Part B requires one single line of bilateral procedure code with Modifier 50. They ordinarily process the claim with 150% reimbursement. But again, you have to check on this in your state and in your region.
Some market insurance would prefer Two Lines of the same code, once with 50, second without 50. Then second modifier on the 1st line is Rt or Lt, modifier Rt or Lt on second line, with 1 unit of aid each code. Must be reimbursed at 150%
Some market insurance would prefer two lines of the same code with modifier Lt or Rt on each line with 1 unit of aid each code. Must be reimbursed at 150%
Always check on your Physician's Fee agenda if the procedure code is billable as bilateral J.
Using Lt & Rt modifier is used to specify which side of the body the procedure was done by the physician. Medicare Part B based on my touch requires specific modifier, whether Lt or Rt. Example you may description procedure 64626 done on the Right C4-C7 Facet Joint Nerve Ablation as 64626-Rt.
Modifier -26. expert Component.
Example: description procedure code 77003 - Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures (epidural, transforaminal epidural, subarachnoid,, paravertebral facet joint, paravertebral facet joint nerve or sacroiliac joint) together with neurolytic agent destruction) with modifier -26 to indicate the physicians expert Component only repayment and not technical component. If the provider's office owns the fluoroscopic equipment, do not append -26 modifier.
Modifier -25. Significant, Separately Identifiable evaluation and management aid by the Same physician on the Same Day of the procedure or Other Service.
Example: description E/M code 99213 (Office or other outpatient visit for the evaluation and management of an established patient) with Modifier -25 for procedure code 20610 Knee Joint Injection done on the same day of the procedure. Modifier -25 indicates significance and isolate identifiable E/M aid surface the procedure done on the patient. Do Not use modifier -25 to description E/M aid that resulted for preliminary decision for surgery.
Instead use modifier -57 for Decision for Surgery
Modifier -24. Unrelated evaluation and management aid by the Same physician while Postoperative Period
Example: description E/M code 99213 with Modifier -24 if the outpatient came back while the postoperative period. The physician must recognize this aid as thoroughly unrelated with the up-to-date procedure done on the patient. A detailed curative documentation is a good sustain for curative necessity.
Modifier -51 for complicated Procedures.
Modifier -59 for distinct Procedural Service
Modifier-Gp Services Rendered under outpatient corporal Therapy plan of care
Modifier-Go Services Rendered under outpatient Occupational Therapy plan of care
Modifier -Gn Services Rendered under outpatient Speech analysis plan of care
Always check your up to date Cpt Book. Check the Cms Cci Edits. Check the insurance payor's policies and guidelines.
What You Don'T Know Might Hurt You. If You Don'T Know It, Don'T Make It Up. Find It.
No comments:
Post a Comment