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 processing for patients in disaster areas go more smoothly, the Centers for Medicare & Medicaid Services (CMS) created modifier CR (Catastrophe/disaster related).
Remember, however, that the event has to meet some very specific parameters in order to be considered a “disaster.” Check out this info on what has to happen before you can start using modifier CR.
According to Mary I. Falbo, MBA, CPC, CEO of Millennium Healthcare Consulting, Inc. in Lansdale, Pa., the feds must clearly define the catastrophe/disaster before you can use modifier CR.
In disaster/catastrophe situations, Section 1135 of the Social Security Act authorizes the Secretary of the Department of Health and Human Services (HHS) to waive or modify certain Part B Medicare, Medicaid, Children’s Medicaid (CHIP), and Health Insurance Portability and Accountability Act (HIPAA) requirements.
Why? HHS allows these waivers in order to better monitor how payers process claims amid the chaos of a disaster, explains Dawn Rogers, coding specialist at Caduceus Inc. in Jersey City, N.J.
Before HHS can invoke the 1135 waiver, and you can use modifier CR, two events must occur:
According to Rogers, some of the most recent declarations to meet the above parameters are:
All of the above scenarios involve weather, although you might use modifier CR modifier “for mass shootings, bombings, explosions; anything that would meet the criteria for a Section 1135 waiver,” explains Rogers. Once the President and Secretary make the Section 1135 waiver official, you should report modifier CR along with any services for patients affected by these catastrophes, she adds.
To see the most recent Section 1135 waiver, for Hurricane Sandy, go to: