Modifier Coding

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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
  • [addtoany]
    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
  • [addtoany]
    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
  • [addtoany]
    Modifier separates E/M from normal surgical aftercare.
    When you’re coding for your provider’s surgical services, you’ll need to be familiar with modifier 24 in case the same provider performs an unrelated E/M service on the same patient during the postoperative (global) period. Avoid E/M denials during the postop period with this expert advice   Read more..
    Posted on 9 Nov, 2015
    Avoid Denials for Unrelated Postop E/Ms with Modifier 24
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    If physician provides operative care only, you’ll need modifier to clarify claim.
    When your physician provides fracture care for a patient, but does not follow up with any postoperative care, coders need to be ready to append modifier 54 (Surgical care only) to the fracture care code in order to code the encounter correctly. Consequences: If your physician   Read more..
    Posted on 27 Sep, 2015
    Rely On Modifier 54 When You’re Breaking Up Fracture Care

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