Modifier Coding

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    “Am I at risk?” This question comes up so often when I am approached at conferences by practice managers and physicians. Many in the healthcare industry have a sense of dread when thinking about what could happen if they are targeted for a government audit   Read more..
    Posted on 20 Sep, 2017
    TCI is Heading to MGMA
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    P modifiers help to ID patient health at time of anesthesia.
    Whenever you are filing a claim that involves anesthesia administration, be sure to include a physical status (“P”) modifier on any anesthesia codes. Reason: The modifiers put a spotlight on the patient’s health at the time of the anesthesia administration. There is always the risk of adverse   Read more..
    Posted on 8 Mar, 2016
    Use P Mods to Put Patent Health Info at Forefront of Claims
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    Catastrophes that occur nearby can affect your coding.
    When a disaster strikes and you have to treat patients affected by the event, be sure you’re coding properly. Explanation: Depending on the extent and circumstances surrounding the disaster, it could affect your coding, and modifier usage, when reporting services for affected patients. To make claims   Read more..
    Posted on 2 Feb, 2016
    If Disaster Hits, You Might Need Modifier CR
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    Reduced services claims often require more than just encounter notes.
    It’s a denial that’s all too common; you submit a claim for reduced services with modifier 52 (Reduced services) appended, and all is well. Correct? Well …: The claim might pass muster with the payer; to solidify your claims against denials, however, you should always include   Read more..
    Posted on 8 Jan, 2016
    Coding for Reduced Services? Make Sure Your Documentation Is In Order
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    If provider furnishes separate E/M before repair, remember 25.
    When your physician stops a nosebleed, should you report an E/M service or CPT® code? The answer: It depends. If the patient reports to the physician with complaints of a nosebleed, and the provider stops the bleed with conventional methods such as ice or pressure, you   Read more..
    Posted on 3 Jan, 2016
    Make E/M Decision First to Plug Nosebleed Coding Holes
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    When you’re only claiming the code’s professional portion, include this modifier.
    If your physician performs a service in a location where he doesn’t pay the rent, you should be on the lookout for a potential modifier 26 (Professional component) coding situation. Why? Often, a CPT® code’s relative value units (RVUs) are broken down into a technical component   Read more..
    Posted on 26 Dec, 2015
    Put 26 to Work for Many Off-Site Services
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    Leave E/M-25 off the claim unless you can prove E/M components separate from the procedure.
    Coders will need to use modifier 25 on the E/M code when the provider performs a procedure or service, and also treats an entirely different problem with an E/M during the same encounter. Dilemma: When a patient has a pair of unrelated problems that the provider   Read more..
    Posted on 23 Dec, 2015
    Check Out How Separate Diagnoses Can Result in an E/M-25
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    You might need multiple modifiers to make fluoroscopy/injection claim fly.
    Coding for arthroscopic injections can become a maze of confusion quickly if you don’t sort out the details before you start; you have to check for codeable procedures that the physician might perform for each injection. If you want to squeeze every ounce of reimbursement out   Read more..
    Posted on 21 Dec, 2015
    Let This Example Guide Your Arthroscopic Injection Coding
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    Payer preference drives decision to use modifiers.
    If you’ve ever gotten a puzzling denial for a psychotherapy session provided by a clinical psychologist (CP) or clinical social worker (CSW), you’re not alone. There is many a coder who has been flummoxed by payer peculiarities for these services. The problem could have been as   Read more..
    Posted on 17 Nov, 2015
    You’ll Need AJ/AH Modifiers for Some CSW and CP Services
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    Using 87804 x 2 might result in denial.
    If you’re performing a test that detects the flu via immunoassay in the office, your provider might test for two strains of the virus. Impact: When you file these claims properly, you’ll be paid for two flu tests rather than one. Read on for a bit   Read more..
    Posted on 12 Nov, 2015
    Get Modifiers Right for Flu Multiple Flu Tests

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