Modifier Coding

Do you know? Many federal, state, and private payers report incorrect modifier use as one of the top billing errors — one that results in denials, reductions in payment, or delays in reimbursement. These claims are missing a modifier or they have an incomplete or   Read more..

Separate Evaluation and Management (E/M) Services from the Rest When a provider performs an E/M service and other services including a procedure for the same patient, on the same day, you can code and bill for the procedure and the E/M service separately. You   Read more..

Streamlining accounts receivable processes, fine-tuning patient engagement, improving staff efficiency, finessing payer relations, negotiating equitable contracts, maintaining compliance with ever-changing regulations—there’s always something. Managing a medical practice is not easy. But you can make the job easier on yourself and your staff with tips to get   Read more..

What’s the most valuable asset a practice or office manager could possess—number of years in the industry, an impressive resume, a wall of certificates? None of these hold a candle to the one tool you can’t afford to lack—a positive, constructive attitude. It’s not what you   Read more..

“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..

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..

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..

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..

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..

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..