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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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