All About medical Billing, Coding & Claims Modifiers

All About medical Billing, Coding & Claims Modifiers-Billing And Coding

Importance of Using proper Modifiers:

Billing And Coding

1. The physician performed many procedures

2. The course performed was bilateral

3. The E/M assistance was done on the same day of the procedure

4. The course was increased or decreased

5. The course has both professional and technical component

6. The course was performed by other victualer (Anesthesiologist, Surgeon physical Therapist, Speech Pathologists etc.)

7. course on whether one side of the body was performed

8. The E/M assistance was in case,granted within the postoperative period

9. The E/M assistance resulted to Decision of Surgery

10. Unusual Circumstance

Maximize your reimbursement for bilateral procedures by using the spoton modifier.

Bilateral Modifier (-50)

Depending upon the assurance payer, processing claims with bilateral course should be paid 150%

Medicare Part B requires one single line of bilateral course 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 commercial assurance 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 assistance each code. Must be reimbursed at 150%

Some commercial assurance would prefer two lines of the same code with modifier Lt or Rt on each line with 1 unit of assistance each code. Must be reimbursed at 150%

Always check on your Physician's Fee schedule if the course code is billable as bilateral J.

Using Lt & Rt modifier is used to specify which side of the body the course was done by the physician. Medicare Part B based on my contact requires definite modifier, whether Lt or Rt. Example you may record course 64626 done on the Right C4-C7 Facet Joint Nerve Ablation as 64626-Rt.

Modifier -26. professional Component.

Example: record course code 77003 - Fluoroscopic advice 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) along with neurolytic agent destruction) with modifier -26 to indicate the physicians professional Component only reimbursement 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 assistance by the Same physician on the Same Day of the course or Other Service.

Example: record E/M code 99213 (Office or other patient visit for the evaluation and management of an established patient) with Modifier -25 for course code 20610 Knee Joint Injection done on the same day of the procedure. Modifier -25 indicates point and cut off identifiable E/M assistance surface the course done on the patient. Do Not use modifier -25 to record E/M assistance that resulted for preliminary decision for surgery.

Instead use modifier -57 for Decision for Surgery

Modifier -24. Unrelated evaluation and management assistance by the Same physician while Postoperative Period

Example: record E/M code 99213 with Modifier -24 if the patient came back while the postoperative period. The physician must recognize this assistance as wholly unrelated with the modern course done on the patient. A detailed healing documentation is a good sustain for healing necessity.

Modifier -51 for many Procedures.

Modifier -59 for definite Procedural Service

Modifier-Gp Services Rendered under patient physical Therapy plan of care

Modifier-Go Services Rendered under patient Occupational Therapy plan of care

Modifier -Gn Services Rendered under patient Speech determination plan of care

Always check your up to date Cpt Book. Check the Cms Cci Edits. Check the assurance 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.

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