“If it isn’t coded then it hasn’t been done,” is a proverb that isn’t heard in the healthcare setting frequently enough. Correctly applying modifiers, though, isn’t always as cut and dry as it seems. Many times
providers inappropriately use modifiers, an abuse that inevitably leads to claim denials. “Modifiers are essential tools in the coding process,” says Laura Reeds, director of coding compliance at IASIS Healthcare in Franklin, Tenn. “They clarify how things should be paid … and further explain or qualify a CPT code.” CPT modifiers (also referred to as Level I modifiers) are used to supplement the information or adjust care descriptions to provide extra details concerning a procedure
or service provided by a physician. Code modifiers help further describe a procedure code without changing its definition. Let’s take a look at 3 commonly misused modifiers, and how they’ve been applied to different care situations. Modifier 59 The 59 modifier is considered the most misused modifier by coders. It is normally used to indicate that two or more procedures were performed during the same visit to different sites on the body. Unfortunately, it is too often applied to prevent a service from being bundled or conjoined with another service on the same claim. It should never be used strictly to prevent a service from being bundled or to bypass the insurance carrier’s edit system. 59 should also only be used if there is no other, more appropriate modifier to describe the relationship between two procedure codes. If there is another modifier that more accurately describes the services being billed, it should be used in place of the 59 modifier. A dermatologist does a Photo Dynamic Therapy session with a BLU-U machine on the face/scalp of a patient. Following the face/scalp session, the BLU-U was repositioned to treat other extremities. Coding examples:9656796567 – 59The first code is the face/scalp performed on the patient. Then, modifier 59 is added to the second procedure indicating a distinctly different procedure performed on separate extremities. ” Modifier 25 “Modifier 25 is a Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service.” This modifier for physicians to indicate that on the day a procedure or service (identified by a CPT code) was performed, the patient’s condition required a significant, separately identifiable E/M service above and beyond the other service provided. When Not to Use the Modifier 25:
A patient visits the cardiologist for an appointment complaining of occasional chest discomfort during exercise. The patient has a history of hypertension and high cholesterol. After the physician completes an office visit, it is determined the patient needs a cardiovascular stress test that same day.Coding example:99214 – 2593015The physician codes an E/M visit (99214) and he also codes for the cardiovascular stress test (93015). The modifier 25 is added to the E/M visit to indicate that there was a separately identifiable E/M on the same day of a procedure. ” Modifier 91 When not to use modifier 91:
A patient with high blood pressure who has been on a low-salt diet may receive a plasma renin activity (PRA) test (84244 Renin) in the morning in the supine position. Because physicians may use variations in PRA levels due to time of day and patient position to evaluate certain conditions such as hyperaldosteronism they may order repeat renin in the afternoon with the patient standing upright for a period of time.Coding example:8424484244 – 91Report the second 84244 with modifier -91 to indicate that the lab performed two separate renin assays for the same patient on the same day. ” If you’d like more information, all modifiers can be found in the CPT (Current Procedural Terminology) and HCPCS (HCFA Common Procedural Coding System) codebooks. Free e-book: Pros and Cons of In-house vs. Outsourced Medical BillingDownload Now! What does CPT code modifier mean?What are CPT Modifiers? Code modifiers are codes that supply further information about a CPT or HCPCS code, such as if the procedure was more complicated than normal or performed under unusual circumstances.
What is a modifier in CPT coding quizlet?Modifiers. additional numeric digits appended to CPT® codes to further explain the service provided.
What are modifiers used for quizlet?modifier for multiple procedures; When multiple procedures, other than E&M, physical medicine and rehab services, or provision of supplies, are performed at the same session by the same individual. The additional procedure(s) or service(s) are identified with this modifier.
What is CPT quizlet?CPT stands for current procedural terminology. It provides ervices and procedure codes reported on insurance claims. Overview of CPT. CPT provides a list of identifying and descriptive codes for procedures and service. CPT coding is the uniform language that describes surgical procedures and services.
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