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Modifier Coding Alert

Put Postop Surgeries into Focus with 78, 79
Crucial question: Is second surgery related to most recent procedure? When a patient h... Read more
Third-Party Billing:
Use Modifier 32 When Third Party Mandates Service
Third-party payers could include social workers, lawyers. When you are billing for ser... Read more
Specialty Focus:
Anesthesia: Represent Patient's Health with P Modifiers
Here’s why you must use modifiers even when you don’t get paid extra. When... Read more
You Be the Expert:
Coding Return E/Ms for Similar Injuries
Question: An established patient with a history of left knee injuries reported to o... Read more
Reader Question:
I.D. Separate Sites Before Using 59 for Lesion Excision, Repair
Question: We billed CPT® codes 12042 and 11420 with modifier 51. I billed the 1... Read more
Reader Question:
Consider F/T, 51 Modifiers When Provider Fixes Cut, Splints Finger
Question: A patient reports to the physician with a laceration to her left index fi... Read more
Reader Question:
Include Modifier GC,Avert TP Coding Headaches
Question: What are the rules on teaching physicians (TP) being present during surgi... Read more
Reader Question:
Remember RT, 25 on FBR + E/M Claims
Question: An established patient who was shooting off fireworks the previous day re... Read more
Site Modifiers:
Work Full-Time With F/T Modifiers, and Quit Getting Denials
Here’s why you should use these modifiers whenever the insurer requires them. Th... Read more
CPT® 2016:
Learn New Prolonged Services Codes, Master 'Team' Coding
Modifier 25 might be the key to your claims with these new/revised codes. When CPT®... Read more
Modifier Madness:
Look to 66 In 'Team' Situations
Remember, every surgical team member has to use modifier 66. There are several modifie... Read more
You Be the Expert:
Coding E/M-Nosebleed Repair Combos
Question: A 19-year-old established patient reported to our family physician (FP) w... Read more
Reader Question:
Use Modifier 27 On Multiple Outpatient E/Ms
Question: I code outpatient hospital services for a multispecialty physician clinic... Read more
Reader Question:
Prove Separate Services; Append Modifier to E/M During Well-Woman Visit
Question: An established, high-risk 72-year-old Medicare patient presents to the of... Read more
Reader Question:
Know CPT® Rules to Nail Bilateral Claims
Question: Our physician recently performed a diagnostic thoracentesis for a patient... Read more
Reader Question:
Make QW Part of All Your CLIA-Waived Claims
Question: Our physician recently performed a cardiovascular blood screening for an ... Read more
Flu Testing:
Include 59 When Providers Test For 2 Flu Strains
Here’s why reporting 87804 x 2 is a bad idea. Despite the medical community&rsqu... Read more
CMS FAQ Clarifies 'Grace Period,' Implementation Date
Use ICD-10 codes beginning Oct. 1, or your claims will be sent right back to you. In t... Read more
Specialty Focus:
E/M Modifiers: Rely On Modifier 24 to Succeed In Coding Unrelated Postop E/Ms
If you forget the modifier, insurers will probably consider the E/M part of surgical aft... Read more
You Be the Expert:
Scrubbing Your Debridement Claims Clean
Question: An established patient reported to the physician with open sores on his l... Read more
Reader Question:
Utilize 26 to Add Fluoroscopy Code to Claim
Question: Our gastroenterologist met a patient at our local hospital to perform a f... Read more
Reader Question:
Physician Must Start Surgery On 53 Claims
Question: Our surgeon recently performed all of the preoperative preparation and po... Read more
Reader Question:
Remember TC to Make Your FAST Exam Claims Go
Question: A 40-year-old man was brought to the emergency department (ED) by ambulance af... Read more
Reader Question:
Remember 57 On E/Ms After Physician Makes Surgery Decision
Question: A patient had an office visit (99213) with a 185 diagnosis on Aug. 17. Th... Read more
Modifier Madness:
Sort Out Modifier Mess On Multi-Provider Fracture Care
When you divide fracture claims, providers engage in a 70/30 split. Let’s face i... Read more
E/M Modifiers:
Let Payer Policy Guide Your Pre-Fracture Care E/M Decision
Both 25, 57 are in play with E/M-fracture code combo. When your physician provides int... Read more
Specialty Focus:
Gastroenterology: Be Ready With Modifier Knowledge When Screenings Turn Therapeutic
Medicare, CPT® offer different guidance on modifier choices. When your gastroenter... Read more
Reader Questions:
Back Up CMT Claims With AT Modifier
Question: Our chiropractor provided chiropractic manipulative treatment (CMT) on th... Read more
Reader Questions:
Dig Deep Into Training With These ICD-10 Tips
Question: The closer we get to the ICD-10 implementation date, the more antsy emplo... Read more
Reader Questions:
Break Out 25 When Counseling Leads To Vaccination
Question: An established 19-year-old patient reported to our family physician for c... Read more
Reader Questions:
Mind Modifiers When Coding I&D Repeats
Question: A new patient recently reported to our practice complaining of a cyst tha... Read more
Reader Questions:
Make Modifier a Part of Multi-Shot Claims
Question: A 36-year-old new patient reports to the physician complaining of a heada... Read more
You Be the Coder:
Coding Injections With Fluoroscopy
Question: Our physician recently performed multiple arthroscopic injections, and the enc... Read more
ABNs: Make The Extra Effort To Remain In Modifier Mainstream
Modifier quartet won’t affect payment, but Medicare might notice if you don’... Read more
Modifier Madness:
Capture Deserved Pay for Excisions In Same Body Area
Use 59, 51 in these multi-excision encounters. When your physician removes multiple le... Read more
Clip 'n Save:
Use These Modifiers On Potentially Uncovered Medicare Services
Keep your ABN-related modifiers straight with this table. When the physician performs ... Read more
Emergency Department Coding:
Unlock $280 Extra on Multi-Code Critical Care Encounters With Modifier 25
Ensure the services aren’t bundled into 99291 first. When a patient is criticall... Read more
Reader Questions:
Append Q6 For Every Locum Service
Question: We will employ a substitute physician to fill in for one of our physician... Read more
Reader Questions:
Rely On Documentation to Drive Modifier 22 Claims
Question: I work for a four-physician gastroenterology practice. Three weeks ago, o... Read more
Reader Questions:
Relax ... A Little ... About ICD-10 Start
Question: Has there been any news on the ICD-10 implementation? We feel like we&rsq... Read more
You Be the Coder:
Coding X-ray/FBR Encounters
Question: A 10-year-old established patient fell from his bicycle and reported for ... Read more
Bilateral Modifiers:
Dig Into Descriptors When Considering Modifier 50
Remember, you won’t code all ‘two-sided’ procedures the same. When y... Read more
Cooperative Surgery:
Include Modifier 62 When Physicians 'Share' a CPT® Code
The documentation details will point you to the right modifier. When physicians work t... Read more
Case Study:
Let this Urogynecology Scenario Help Guide Your Modifier 62 Decision
Modifier will reap each surgeon 62.5 percent of procedure code. When deciding how to r... Read more
Reader Questions:
Use 59 When Physician Performs Procedure, Separate Therapy
Question: An established patient reports to the office three days after injuring he... Read more
Reader Questions:
Code 'Component' Procedures With 51
Question: An established patient reports for a scheduled discectomy with decompress... Read more
Reader Questions:
Medicare Offers 1-Stop Shop for ICD-10 Prep
Question: My practice is doing its best to prepare for the change to ICD-10 diagnos... Read more
Reader Questions:
Key On 'Family' When Choosing Multi-Catheter Placement Modifier
Question: An established patient reports to the surgeon for scheduled arterial cath... Read more
Reader Questions:
Include AJ/AH Modifiers For Some CSW and CP Services
Question: I am new to psychiatry coding, and I am now coding for a group practice. ... Read more
You Be the Coder:
'Buddy Taping': Fracture, E/M, or Both With 25?
Question: I work in an emergency department (ED), and I have a question about fract... Read more
News You Can Use:
Don't Skip Over 59 In Favor of the New X Modifiers
CMS says you can stick with 59 for now. Like most coders, you are probably still searc... Read more
Payer Pointers:
Follow 3 Tips from NGS to Increase Your Modifier Success
Don’t count 99 as useless.  While you may think you have a handle on every ... Read more
Follow 6 Tips to Transform Your Accounts Receivables
Pre-visit and post-visit efforts are as important as in-person patient contacts. Coord... Read more
Reader Questions:
ICD-10 Won't Eliminate Laterality Modifier Use
Question: I have heard the ICD-10 codes are expanded and more specific than ICD-9 c... Read more
Reader Questions:
Skip 51 With CMT Codes
Question: A patient with a complaint of back pain presented to the doctor. After id... Read more
Reader Questions:
XP Won't Override 0 Modifier Indicato
Question: One of our physicians performed an E/M service along with same day psycho... Read more
Reader Questions:
Modifier 22 May Be Your Unusually Complex 11982 Answer
Question: Our surgeon removed 56 antibiotic beads from a patient’s distal rad... Read more
Reader Questions:
Stick to Most Definitive ICD-10 Code
Question: Though there are many crosswalks between ICD-9 to ICD-10, there are many ... Read more
You Be the Coder:
Get to Know Modifier JW
Question: Can we bill for pump medications that were ordered and not used due to th... Read more
Modifier Mix-Ups:
Add Modifier 58 to Claim for Proper Postop Procedure Reimbursement
Rely on the medical record for to solidify staging. Choosing the right modifier to rep... Read more
Be Ready for More COPD Codes That Spell Out Complications
Four of the seven COPD base code descriptors for ICD-9 are direct matches to ICD-10. I... Read more
Informational Modifier:
Don't Miss Modifier QW for CLIA Waived Tests
Medicare will deny test claims that don’t include the CLIA waived test modifier. ... Read more
Ambulance Modifiers:
Tackle Challenging Ambulance Service Coding With Q Modifiers
You’ll need to know when a patient is pronounced dead to use modifier QL. Whethe... Read more
Reader Questions:
Match 2 Assisting Surgeons with AS and 80
Question: Our clinic’s doctor was the primary surgeon during a surgery. Our a... Read more
Reader Questions:
Make Sure the Surgery is Major with 57
Question: My physician admitted a patient with parotitis to the hospital for IV ant... Read more
Reader Questions:
Attach GA When You Have an ABN
Question: A Medicare patient is coming in to our office for a tetanus shot, but he has n... Read more
Reader Questions:
Follow the Restrictions on Modifier 90 with Referred Lab Claims
Question: My physician ordered a carcinoembryonic antigen (CEA) and hemoglobin test... Read more
Reader Questions:
Picture Modifier 32 with Mandated Services
Question: A 40-year-old male came into our office with a work-related back injury. ... Read more
Reader Questions:
Don't Forget GZ When There's a Suspicion of a Service Denial
Question: A Medicare patient came into our practice to see his doctor. The doctor p... Read more
You Be the Coder:
Be Careful Matching Your Modifiers to the Record
Question: I coded a claim with anesthesia code 00140 with 3.5 units and modifier QS... Read more
Modifier Guidance:
Look at Published X{ESPU} Examples Some Payers Are Offering, Part 2
Making your distinct separate procedural coding more specific will strengthen your claim... Read more
Wait to See If 6 Experts Will Influence HHS and Make the Oct. 1 Date Stick
The cost of preparing for the ICD-10 upgrade is far less than originally thought. Opin... Read more
Avoid Modifier 55 Errors By Identifying Transfer of Care
Hint: Don’t attach 55 when your physician is covering for another doctor. When t... Read more
Case Study:
Modifier 22 Success Relies on Your Skills to Uncover Note Details
Detailed notes will help support added work and bring in the accurate pay. In order to... Read more
News You Can Use:
Help Compile Data on PBDs by Using Modifier PO
CMS pays more when physicians perform services in a provider-based department. The inc... Read more
Reader Question:
Try Modifier AU for Tape Application
Question: A doctor applied non-waterproof tape (A4450) over the skin of one of her patie... Read more
Reader Question:
See What CMS Has to Say About Units of Service
Question: I recently coded knee injections for the right and left knee, both done w... Read more
Reader Question:
If You Count More Than 2 Plugs, Use E Modifiers
Question: What modifier should I use when a doctor performs a punctual plug inserti... Read more
Reader Question:
KX Directs the Payers to the Medical Record for Justification
Question: My doctor has a patient with non-reversible symptomatic bradycardia and t... Read more
You Be the Coder:
Determine a Modifier for a Return Visit
Question: Our pediatrician treated a patient for reduction of subluxed radius (2464... Read more
Modifier Guidance:
Look at Published X{ESPU} Examples Some Payers Are Offering, Part 1
Now you have guidance from Moda Health to better equip yourself to pick a new modifier o... Read more
Modifier Mix-ups:
You Have a Modifier 76/77 Choice to Make with Repeat Procedures
The same procedure performed twice on the same day requires a modifier to avoid claim de... Read more
Finally You Can Code All Types of Psoriasis
Go from two to 14 codes to produce claims with more accuracy. You will have more psori... Read more
Quick Quiz:
Test Yourself with 3 Family Practice Modifier Questions
Put your modifier knowledge to the test and see where your education needs refreshing. ... Read more
Quick Quiz Answers:
Read Our Answers and Evaluate Your Skills
Put your modifier knowledge to the test and see where your education needs refreshing. ... Read more
Facility Coding:
Unravel Modifier PD Criteria to See If Your Encounter Qualifies
If you miss the three-day payment window, your payment is out the window. Deciding whe... Read more
Reader Question:
Watch for Details Impacting Modifier Choice
Question: During a routine visit on Monday, the physician made the decision to perf... Read more
Reader Question:
Be Ready for a Minimal CF Adjustment
Question: Has the new conversion factor been updated since it was released in error... Read more
Reader Question:
Associate a Discontinued Procedure Before Anesthesia to 73
Question: My provider had a 65-year-old male patient in the operating room for the ... Read more
Reader Question:
Claim 78 for Unplanned Returns to OR Related to the First Procedure
Question: Two days after a surgery a Medicare patient experienced a profuse trachio... Read more
You Be the Coder:
Check Notes to Support a Rare Modifier
Question: Our surgeon performed an endometrial biopsy (58558). Prior to surgery, sh... Read more
Specialty Focus -- Pathology:
Get the X{EPSU} Scoop and Give 59 a Rest
The future may bring clinical situations that require an “X” modifier. Med... Read more
Outpatient Procedure:
Uncover ASC's Use of 52 with Radiology Procedures
Ignoring modifier 52 can cost your ASC thousands over time. You’ll find that Med... Read more
Modifier Mania:
Choose 1 of 8 Modifiers to Identify the Type of Provider
Informational modifiers can clarify who should be paid when there are multiple professio... Read more
Focus on ICD-10 Prep For a Smooth Transition
Upfront effort may save your practice from frustration down the road. ICD-10 implement... Read more
Reader Question:
Separate Procedures with Modifier 51
Question: One of my surgeons did a bone flap craniotomy adopting the extradural app... Read more
Reader Question:
Modifier 99 May Simplify Reporting Codes
Question: My health professional shortage area physician performs an E/M service fo... Read more
You Be the Coder:
Split Post-Op From Surgical Care
Question: My group only uses modifier 55 with post-operative care. For example, whe... Read more
Modifier Madness:
Curb Your Screening Denials Using Modifier 33
Some payers accept 33, while others won’t. If your practice sees patients for pr... Read more
Have No Fear with Future Appendicitis Codes
The ‘other’ appendicitis codes are expanded and more precise. If coding ap... Read more
Modifier Partners:
Use GC to Recoup Resident Charges
You might get paid even when your physician is not with her resident performing services... Read more
Multi-Use Modifier:
Untangle Modifier 52 and 53 to Bring in Deserved Dollars
Never use modifier 53 when patient elects to stop the procedure. When your provider st... Read more
Reader Question:
Rely on Code Descriptors, Then Attach Modifier 50
Question: I have a physician who removed both the tube and ovary on one side and on... Read more
Reader Question:
Shelf Modifier GW When Not Hospice-Related
Question: My physician has an established 85-year-old patient who lives at home and... Read more
Reader Question:
Be Sure There's One Practice with 77
Question: A patient came in this week to see our otolaryngologist. The doctor treat... Read more
Reader Question:
Pick Modifier 24 with Unrelated E/M
Question: One of my physicians’ patients came into our office for a follow-up... Read more
You Be the Coder:
Modify Anesthesia Services From AA to QY
Question: When would you use modifiers AA, AD, QY, and QK? I don’t understand... Read more