Proper use of CPT code modifiers.CPT CPT See: Carriage Paid To code modifiers provide additional details regarding various services. There are three ways to ensure that you are using modifiers appropriately: * Use modifiers to improve reimbursement and avoid denials. Software technology is available that will prompt physicians to select all appropriate modifiers at the time of service (figure). (1) * Know your payers' policies regarding the use of modifiers. Rules may differ among payers. (2) * If the modifier (programming) modifier - An operation that alters the state of an object. Modifiers often have names that begin with "set" and corresponding selector functions whose names begin with "get". is likely to reduce the amount of payment, leave the amount as is and let the payer reduce it when the payer receives the claim. If the modifier is likely to increase the payment, increase the amount on the claim before you file it; do not expect the payer to do it for you. For example, you should assign modifier "-24" to any CPT code to designate any "unrelated evaluation and management service" that you provide during a postoperative visit. This would apply to, say, an office visit by a patient with serous otitis media (ICD ICD International Classification of Diseases (of the World Health Organization); intrauterine contraceptive device. ICD abbr. 381.01) during the postoperative period following a procedure with a global period (e.g., laryngectomy Laryngectomy Definition Laryngectomy is the partial or complete surgical removal of the larynx, usually as a treatment for cancer of the larynx. Purpose Normally a laryngectomy is performed to remove tumors or cancerous tissue. , parotidectomy Parotidectomy Definition Parotidectomy is the removal of the parotid gland, a salivary gland near the ear. Purpose The main purpose of parotidectomy is to remove cancerous tumors in the parotid gland. , or tonsillectomy tonsillectomy /ton·sil·lec·to·my/ (ton?si-lek´tah-me) excision of a tonsil. ton·sil·lec·to·my n. Surgical removal of tonsils or a tonsil. ). (3) If you do not attach the modifier, you will not be paid for that encounter. Physicians are ultimately responsible for appropriate billing and coding. You may choose to continue to rely on another party to do your CPT coding and assignment of modifiers, but you are subject to their errors and omissions errors and omissions n. short-hand for malpractice insurance which gives physicians, attorneys, architects, accountants and other professionals coverage for claims by patients and clients for alleged professional errors and omissions which amount to negligence. as well as their availability or lack thereof. Learning how to assign modifiers is easier than learning how to perform neck dissections and stapedectomies. There are a limited number of modifiers, and most are fairly straightforward, although there will always be some differences of opinion. Technology is available that will remind you and allow you to assign appropriate modifiers at the time of each encounter and teach you which modifier to use as it displays the options in front of you. References (1.) Isenberg SF. Electronic "superbills." Ear Nose Throat J 2002;81:439. (2.) Isenberg SF. Reimbursement basics. Ear Nose Throat J 2003;82:260. (3.) Isenberg SF. Ensuring proper global payments. Ear Nose Throat J 2003;82:502. |
|
||||||||||||||||||||||
Printer friendly
Cite/link
Email
Feedback
Reader Opinion