All About curative Billing, Coding & Claims Modifiers

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Importance of Using permissible Modifiers:

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1. The physician performed many procedures

2. The course performed was bilateral

3. The E/M service was done on the same day of the procedure

4. The course was increased or decreased

5. The course has both expert and technical component

6. The course was performed by other victualer (Anesthesiologist, Surgeon corporeal Therapist, Speech Pathologists etc.)

7. course on either one side of the body was performed

8. The E/M service was provided within the postoperative period

9. The E/M service resulted to Decision of Surgery

10. Unusual Circumstance

Maximize your reimbursement for bilateral procedures by using the literal, modifier.

Bilateral Modifier (-50)

Depending upon the guarnatee payer, processing claims with bilateral course should be paid 150%

Medicare Part B requires one singular line of bilateral course code with Modifier 50. They usually process the claim with 150% reimbursement. But again, you have to check on this in your state and in your region.

Some market guarnatee would prefer Two Lines of the same code, once with 50, second without 50. Then second modifier on the 1st line is Rt or Lt, modifier Rt or Lt on second line, with 1 unit of service each code. Must be reimbursed at 150%

Some market guarnatee would prefer two lines of the same code with modifier Lt or Rt on each line with 1 unit of service each code. Must be reimbursed at 150%

Always check on your Physician's Fee program if the course code is billable as bilateral J.

Using Lt & Rt modifier is used to specify which side of the body the course was done by the physician. Medicare Part B based on my sense requires exact modifier, either Lt or Rt. Example you may description course 64626 done on the Right C4-C7 Facet Joint Nerve Ablation as 64626-Rt.

Modifier -26. expert Component.

Example: description course code 77003 - Fluoroscopic advice and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures (epidural, transforaminal epidural, subarachnoid,, paravertebral facet joint, paravertebral facet joint nerve or sacroiliac joint) including neurolytic agent destruction) with modifier -26 to indicate the physicians expert Component only reimbursement and not technical component. If the provider's office owns the fluoroscopic equipment, do not append -26 modifier.

Modifier -25. Significant, Separately Identifiable estimation and administration service by the Same physician on the Same Day of the course or Other Service.

Example: description E/M code 99213 (Office or other inpatient visit for the estimation and administration of an established patient) with Modifier -25 for course code 20610 Knee Joint Injection done on the same day of the procedure. Modifier -25 indicates importance and detach identifiable E/M service surface the course done on the patient. Do Not use modifier -25 to description E/M service that resulted for preliminary decision for surgery.

Instead use modifier -57 for Decision for Surgery

Modifier -24. Unrelated estimation and administration service by the Same physician while Postoperative Period

Example: description E/M code 99213 with Modifier -24 if the inpatient came back while the postoperative period. The physician must identify this service as wholly unrelated with the recent course done on the patient. A detailed medical documentation is a good preserve for medical necessity.

Modifier -51 for many Procedures.

Modifier -59 for unavoidable Procedural Service

Modifier-Gp Services Rendered under inpatient corporeal Therapy plan of care

Modifier-Go Services Rendered under inpatient Occupational Therapy plan of care

Modifier -Gn Services Rendered under inpatient Speech diagnosis plan of care

Always check your up to date Cpt Book. Check the Cms Cci Edits. Check the guarnatee payor's policies and guidelines.

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