Modifier 32 Usage in Medical Billing

Modifier 32 Usage in Medical Billing

Many things have changed for medical billing in 2006, but modifier 32 is not one of those things. Since 2005 several changes have occurred with the way hospitals and nursing facilities can bill claims. Some of these changes will affect medical billing reimbursement amounts. It is important to abide by all new medical billing rules to appease your payer.

One medical billing change for 2006 is the removal of inpatient follow-up and confirmatory consultations. These codes range from (99261-99263) and (99271-99285). Even though consultations may give more medical billing reimbursement, the only codes allowed are subsequent care codes 99231-99233 for hospital and 99307-99310 for nursing facilities.

The only time in which consultations are allowed for medical billing is the initial inpatient visit. You may still claim 99251-99255 for the first surgeon inpatient consultation.

Second opinions and consultations are both taking a hit this year. The second and third opinions are no longer allowed. Medical billing will be done for the evaluation and management of the second opinions. Also, consultations cannot be requested by patients.

The medical billing modifier 32 (Mandated services) may get used a lot this year. If a particular payer requires an evaluation and management visit for a second opinion, the medical billing modifier 32 should be used. This year modifier 32 will get a lot of use since the second opinion consultations are not allowed.

Sometimes it can be difficult to keep current with medical billing changes. However, that is your job. Failure to keep accurate medical billing policies could result in an audit or nonpayment. If you are not able to provide ongoing training to your medical billing staff consider outsourcing your responsibilities. Medical billing claims should be kept accurate whether it be done by your staff members or outsourced staff.

View all Articles by: Melissa Clark, CCS-P