Tag Archives: Modifiers

Use of Modifier 58

Staged or Related Procedure or Service by the Same Physician During the Postoperative Period: The physician may need to indicate that the performance of a procedure or service during the postoperative period was: a)planned prospectively at the time of the original procedure (staged); b) more extensive than the original procedure; or c) for therapy following [...]

Medical Billing Coding denials Errors/Modifiers

Denial – Incorrect diagnosis or Required Modifier not billied” As per Medicare newsletters “Incorrect Diagnosis” and “Required Modifier Not Billed” accounted for a large percentage of the provider/supplier billing errors. Lab services, radiology, physical therapy/occupational therapy, injections, cardiology, chiropractic services and surgery are the top specialties associated with diagnosis related appeals. The information below demonstrates [...]

Surgical billing modifier codes – preoperative and postoperative

Surgical Modifiers Global Surgery Surgeons have traditionally provided a “ Global Package ” of care. Under this concept , surgeons bill a single fee for all services usually associated with the surgery. The implementation of the Medicare fee schedule under physician payment reform requires all Medicare Carriers to adopt uniform payment policies, including a uniform [...]

What is Modifiers

What is A Modifier? Modifiers are two digit codes used to report additional information used during claims processing. Modifiers may be alpha-alpha, alpha-numeric or numeric -numeric, such as AA, E1 or 25. Some modifiers describe additional work or circumstances that affected the service provided and may impact reimbursement. Other modifiers are used for informational purposes [...]

What is CPT modifiers

Modifiers and their Role in Billing Modifiers are used to modify payment of a procedure code, assist in determining appropriate coverage, or otherwise identify the detail on the claim. The use of modifiers ensures the appropriate reimbursement by the insurer. Modifiers are entered in box 24 D on the HCFA-1500 (CMS-1500) claim form or UB [...]

CPT modifier 59

Modifier 59 The 59 modifier should only be used to identify codes that are on the Correct Coding Initiative bundling table, unless specific instructions have been published for additional functions for this modifier. A good example is for multiple anesthesia services on the same day. We published instructions in the Medicare Advisory for use of [...]

CPT modifier 26 and TC

Modifiers 26 and TC Recently Palmetto GBA has noticed a number of diagnostic services being filed on the same day by different providers. In some of these instances one provider has filed for either the professional or the technical component while the other provider has filed a global charge. It is important to make sure [...]

CPT Modifier 51 – Multiple Surgery payment

If a surgeon performs more than one procedure on the same patient on the same day, we will pay 100 percent of the global fee for the highest value procedure only and 50percent of the global fee for the second, third, fourth, and fifth procedure. Each procedure after the fifth procedure will require submission of [...]

CPT Modifiers for surgery global period package

Services Not Included in the Global Package of Major Surgeries These services may be paid for separately. In some instances, you must use the appropriate modifier when billing for these services. 1. The initial consultation or evaluation of the problem by the surgeon to determine the need for surgery (57 modifier). 2. Visits unrelated to [...]

CPT Modifier 22 and 24

Modifier 22 The 22 modifier is used to identify an unusual procedural service. By using this modifier you are indicating that the procedure in question required a level of care greater than that usually required. When using this modifier medical records must be submitted with the claim to support the increased level of care and [...]