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Modifier Coding Alert

Modifier Madness:
Capture Deserved Separate E/M Payment with Modifier 25
Identify second service as above and beyond to use 25 to generate deserved revenue. Pa... Read more
ICD-10:
Circle the ICD-10 Release Date on Your Calendar
Take advantage of the resources CMS has made available online to assist you. Move full... Read more
Specialty Focus -- Podiatry:
Think Q7-Q9 with Foot Care Class Findings
Without systemic condition, your claim may go cold. If you don’t include modifie... Read more
Cardiology Spotlight:
Brush Up on Your 5 Coronary Modifiers
Appeal denied PCI claims to recoup hundreds of dollars. Some of your percutaneous coro... Read more
Reader Question:
Use AI for the Principal Physician
Question: My physician admitted a patient to the hospital and a specialist performe... Read more
Reader Question:
Get to the Details When Using Modifier 80
Question: What modifier would I use if two of my physicians, a primary surgeon and ... Read more
Reader Question:
Think 51 with Multiple Procedures
Question: My surgeon did a fracture reduction and a triangular fibrocartilage (TFCC... Read more
Reader Question:
Have JW Ready with Multi-Use Vials
Question: A healthcare professional administered 100 mg of herceptin to a patient f... Read more
Reader Question:
Return to OR Calls for Modifier 78
Question: Our surgeon removed ear tubes in the operating room under general anesthe... Read more
You Be the Coder:
Count How Many Patients and Pick a U Modifier
Question: A physician in our office used a portable x-ray machine to take a two-vie... Read more
Mind Your Modifiers:
Unusual Anesthesia Calls for 23 in Your Repertoire
Prepare for the unplanned need for general anesthesia and enhance your coding. You may... Read more
Specialty Focus:
Urogynecology: Use Severity Modifiers With Physiotherapy Treatment to Complete Your Coding
Report the non-payable G codes to demonstrate the status of the treatment. Therapy ser... Read more
CMS Proposal:
You May Find That 10- and 90-Day Global Periods are Things of the Past
Surgeons may benefit from being paid individually for all their visits. CMS is proposi... Read more
Reader Question:
Surgery on Same Day as E/M Requires Modifier 57
Question: On the day our general surgeon admitted a patient with abdominal pain, he... Read more
Reader Question:
Attach 62 with Two Surgeons
Question: We have a patient with chronic pelvic pain diagnosed as polycystic ovary ... Read more
Reader Question:
Surgical Team of Multiple Specialists Calls for 66
Question: Two doctors from our practice worked with other doctors as a team for a l... Read more
Reader Question:
Consider More Than Time For Modifier 22
Question: One of my doctors performed a procedure to excise a lesion on an obese pa... Read more
Reader Question:
E/M and Service on Same Day Equals Modifier 25
Question: A physician in our practice went to the emergency department to perform a... Read more
You Be the Coder:
Capture IV Needle Guidance with 26
Question: A provider from our practice performed ultrasonic guidance for a sciatic ... Read more
News You Can Use:
Home In On 4 New Modifiers You'll Need Next Year
Dodge 59 abuse by substituting X{EPSU}. Of all of the modifiers available for you to u... Read more
General Surgery:
Differentiate Skin Substitute Graft From Dressing with JC, JD
Talk to your payers to see if Q codes need a modifier to prevent denials. Because Medi... Read more
Payer Policies:
Reduce Denials with Correct Use of Modifier 50
Get started by reviewing modifier 50/RT/LT policies from three payers. Don’t get... Read more
Reader Question:
Attach Modifier KX with Pacemaker Insertions
Question: We have a patient experiencing symptomatic bradycardia, atrial fibrillati... Read more
Reader Question:
Look for Reduced Procedures When Using Modifier 52
Question: A physician in our office expected to perform a bilateral tonsillectomy, ... Read more
Reader Question:
Modify a Discontinued Procedure with 53
Question: One of our patients was scheduled for paracentesis but it was cancelled a... Read more
Reader Question:
Grab Modifier 58 for Staged Services
Question: A patient of one of our dermatologists presented with a diagnosis of prim... Read more
Reader Question:
Assessing Inhaler Use Plus E/M Warrants Modifier 25
Question: A family physician in our practice assessed an established patient with a... Read more
You Be the Coder:
Choose QY for Medical Direction from an Anesthesiologist
Question: When would you use modifiers QY, QK, and AD? I am not understanding the u... Read more
Hospital Outpatient:
Draw Attention to Multiple Same Day Outpatient Visits with Modifier 27
Try G0 with 27 to get closer to your best reimbursement. If a patient has more than on... Read more
Ob-Gyn Spotlight:
Grab Modifier GG for Mammogram Screening and Diagnostic in Same Day
Pay attention to patient age and sex for mammography screenings. Your physician may so... Read more
Patient Age and Frequency Requirements for Mammogram Screenings
Medicare will pay for only one screening for a woman between the ages of 35 and 39 years... Read more
Mythbuster:
Dispel 5 Modifier 24 Myths
A new diagnosis may make increasing your revenue easier. When your physician sees a pa... Read more
Reader Question:
Attach Modifier 58 with Staged, Not Included Procedure
Question: A physician performed a laparoscopic left partial salpingectomy due to ec... Read more
Reader Question:
Think Modifier 57 for Surgery Decision During E/M
Question: During an E/M of an established patient, my physician made the decision t... Read more
Reader Question:
Forget Modifier 26 for Interpretation Only
Question: Our allergy and immunology department is “provider based” and... Read more
You Be the Coder:
Dust Off Modifier 78 for Return Trip to Surgery
Question: One of our physicians has a patient that had an incisional biopsy of the ... Read more
Surgical Procedure:
Unjumble Assistant Surgeon Modifiers 80, 81, and 82
Multiply the MPFS calculation results by up to 85 percent. Coding a procedure can be c... Read more
Calculate Your Pay
Using the previously mentioned example of a PA assisting in the open repair of a patient... Read more
Outpatient Modifiers:
Surprise! Modifier 59 for Repeat Procedures May Not Fly
Payers are jumping on board with CMS’s directive to use modifiers 76 or 91. When... Read more
Specialty Focus:
Pediatrics: Match Modifier 63 to a Neonate Procedure
Look forward to a possible 20 percent increase in reimbursement. When your physician p... Read more
Reader Question:
Include Modifier 25 with Smoking Cessation Counseling
Question: How should I bill for “smoking cessation” counseling (99406-9... Read more
Reader Question:
Turn Denials into Receipts with Modifier U8 or U9
Question: I am getting denials from a Medicaid Care Management Organization (CMO)Am... Read more
Reader Question:
Accept That Modifier 51 Isn't Appropriate With CMT Codes
Question: What modifier would I report for a patient who had a CMT (98940-98943) fo... Read more
You Be the Coder:
Attach Q0 to a Procedure in a Clinical Trial
Question: We’ve been billing Medicare implantable cardioverter defibrillator ... Read more
Surgery Modifiers:
Focus on Who Did What When Choosing Modifier 54, 55, or 56
Ensure a transfer of care before attaching the modifier. When one of your physicians i... Read more
Clip and Save:
Call Yourself a Modifier 54 and 55 Pro with Help From This Chart
Answer questions with a yes or no to learn how to bill surgical and postsurgical service... Read more
ASC/Hospital Outpatient:
Focus on Whether Anesthesia Was Used to Reveal the Correct Modifier
Bring in 50-100 percent of reimbursements with anesthesia services. As an ambulatory s... Read more
Reader Question:
Choose PT or 33 Depending on the Screening Findings
Question: A 67-year-old Medicare patient at average risk for colorectal cancer repo... Read more
Reader Question:
Add a Modifier to Resident Charges in a Clinic
Question: Does modifier GC need to be added to all of the charges (such as E/M, bio... Read more
Reader Question:
Don't Forget Modifier QW with Waived Tests
Question: How do I get paid for a CLIA-waived test? Medicare is denying the test fo... Read more
Reader Question:
Partner GV and GW for Some Hospice Services
Question: I’ve always just used one or the other of modifiers GV and GW even ... Read more
You Be the Coder:
Wrestle With the ABCs of ESA Services
Question: Whenever I use modifier EA with J0881 or J0885, my claim is denied. The s... Read more
Surgical Procedure:
Support Your Modifier 66 Use With Proof of Team Surgery Necessity
Recognize that surgeons of the same specialty do not constitute a team. Every time you... Read more
Laboratory Tests:
Recognize 2 Lab Modifiers To Capture Same-day Test Payment
Re-running lab tests to confirm results and using modifier 91, won’t result in pay... Read more
News You Can Use:
Relish the Delay to Pay Cuts the Recent Law Provides
Resolution of the SGR formula has been pushed out, yet there’s hope for a future f... Read more
Reader Question:
Attach KX Modifier to Therapy Claims Exceeding the Cap
Question: I work in a PT office and we have several patients who have exceeded the ... Read more
Reader Question:
Performing Audiology on an Inpatient Warrants Modifier 26, Alone
Question: How do I bill for a 99203 and 92567 when the patient has been brought to ... Read more
You Be the Coder:
Discover How Modifier 22 Relates to Anesthesia Modifiers ZA and ZC
Question: Why are my claims being denied when I use modifier ZC with anesthesia ser... Read more
Modifier Partners:
Knowing When You Should -- And Shouldn't -- Attach Modifiers 26/TC Is Key to Proper Payment
Nail down when one modifier can be used alone. If your physician provides diagnostic o... Read more
ICD-10 Delayed Another Year
It was not an April Fool’s Day joke when, on Tuesday, April 1, President Obama sig... Read more
Correct Coding Initiative:
Override CCI Edits, When Appropriate, With Modifiers 51/59
Recognize that Medicare prefers you don’t use one of these modifiers. Depending ... Read more
Calculate Your Fees
CPT® code 23412 relative value units = 24.33 Multiply 24.33 x 35.8228 (nation... Read more
Clip and Save:
Answer the Questions in This Chart to Make Correct Modifier 59 Decisions
Guard against overriding every ‘1’ bundle. You’re not alone if you t... Read more
Reader Question:
Try Modifier 22 for Two AEP Tests
Question: In order to determine frequency-specific testing results for a patient, m... Read more
Reader Question:
Mind Your P Modifiers
Question: I need to determine which physical status modifier to use for a surgery i... Read more
Reader Question:
Don't Lose Focus of Medical Necessity
Question: One of our providers did a left heart catheter with a left/right coronary... Read more
Reader Question:
Base Use of Exclusion Modifiers on the Encounter
Question: My physician is treating a patient for services where we are able to use ... Read more
You Be the Coder:
Alert Billing With Modifier GA
Question: How can I avoid writing off charges for services if I know Medicare will ... Read more
Documentation:
Pump Up the Notes When Using Modifier 22
You could increase your reimbursement by as much as 50 percent.  When your doctor... Read more
Modifier Mix-ups:
Guard Against Modifier 52/53 Confusion With 4 Tips
Reducing fees may be your practice’s policy. When your surgeon discontinues a pr... Read more
Multiple Surgeons:
2 Surgeons, 1 Procedure Calls For 1 Modifier 62
Calculate your fees to know what is at risk. Multiple surgeons may be necessary becaus... Read more
Reader Question:
Remember Modifier 32 is Mandated
Question: We have a patient whose family has requested a second opinion concerning ... Read more
Reader Question:
Carefully Read Code Descriptors
Question: One of the physicians in our practice performed a bilateral hysterosalpin... Read more
Reader Question:
Digest OIG Findings of Modifiers GY and GZ
Question: Since modifier GX was replaced by GY and GZ, I’m not sure which mod... Read more
Reader Question:
Grasp When You Use Modifier 33
Question: I’ve been told by other coders that I can use modifier 33 on preven... Read more
You Be the Coder:
Make the Call Between Modifier 23 and 47
Question: We had a young patient who came into the office for an ingrown toenail (1... Read more
Mind Your Modifiers:
Replace Confusion with Expertise When Using Modifier 57
Crack down on denials by knowing how global periods factor in. You’re always und... Read more
Things for you to remember about modifier 57
Use for E/M services only. Use when an E/M service results in a surgery. Make... Read more
You May Be Able to Blame Claim Denials on Your Payer's Software
Communicating your concerns with your payers may help. When you have a continually den... Read more
Compliance:
Eliminate 3 Modifier Mishaps That Could Be Costing Your Practice Money
Billing two codes on the same date isn’t the end of the story. Between the rules... Read more
Specialty Focus:
Optometry: Save Money on Appeals by Using the Correct Modifiers for Diagnostic Tests
Follow Medicare’s rule of thumb when billing for unilateral tests. If you don&rs... Read more
Reader Question:
Leverage Your Physician's Subspecialty
Question: We are in a large GI group all under the same tax ID. One of our physicia... Read more
Reader Question:
Supporting Your Modifier 25 Billing is Vital
Question: A patient came into the office to see our orthopedist to receive a knee i... Read more
Reader Question:
Watch for Combined CPT® Codes
Question: Which modifier can I use when billing 93010, 93016, 93018, and 78452? M... Read more
You Be the Coder:
Consult Your Payer About the Need for Modifier AI
Question: My physician’s office is having trouble getting reimbursed for char... Read more