Medical Billing Blog: Section - Modifiers

Archive of all Articles in the Modifiers Section

This is the archive containing links to all articles written in the Modifiers section of our blog.

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How to Choose Between Modifiers 25 and 57

When reporting an evaluation and management (E&M) service on the same claim with another service or procedure, you must append either modifier 25 “Significant, separately identifiable evaluation and management service by the same physician or other qualified healthcare professional on the same day of the procedure or other service,” or modifier 57, “Decision for surgery” to the E&M service code. Modifier Identifies Separate Nature of E&M Service A minimal patient evaluation is necessary to determine that a prescribed treatment is appropriate to manage the patient’s condition. For example, if a patient presents for a previously scheduled injection, the provider will briefly evaluate the patient to confirm that the injection remains

Published By: Melissa Clark, CCS-P, RT | No Comments

Proper reporting of modifier 99 gets claims paid

Modifier 99 Multiple modifiers doesn’t get a lot of attention — maybe because it’s rarely needed — but knowing when to apply it can make the difference in getting a claim paid. Refer to CPT® Guidance Appendix A — Modifiers tells us: Under certain circumstances 2 or more modifiers may be necessary to completely delineate a service. In such situations modifier 99 should be added to the basic procedure, and other applicable modifiers may be listed as part of the description of the service. In practice, call on modifier 99 only if a single line item requires five or more modifiers. The reason is the standard 1500 Health Insurance Claim

Published By: Melissa Clark, CCS-P, RT | No Comments

When to Use Modifier 91

When to use Modifier 91? Modifier 91 is used for the reporting of repeat laboratory tests or of studies that are performed on the same patient on the same day. You will only add Modifier 91 when additional tests results are to be subsequently obtained to the initial administration or the performance of the tests done on the same day. When Not to Use Modifier 91 Modifier 91 is not used when laboratory studies or tests are rerun as a result of equipment or specimen malfunction or error. It is also not used when a test is repeated to confirm the results that the initial test reported. In addition, based

Published By: Melissa Clark, CCS-P, RT | No Comments

Medical Billing Mesh

Medical Billing Mesh Mesh placement medical billing can be a mess. Hernia repairs are very common, therefore mesh placements are very common. To keep your mesh placement medical billing accurate there are four steps to follow. There are many different types of hernias. Mesh placement in medical billing is only allowed for two types: ventral and incisional hernia repairs. The first step to correctly do medical billing for mesh is to be sure the surgery was a ventral or incisional hernia repair. The second medical billing step for mesh placement is similar to the first step. You must always remember that any other hernia repair will not reimburse separately for

Published By: Melissa Clark, CCS-P, RT | No Comments

Circumcision Medical Billing

Circumcision Medical Billing There are two main circumcision medical billing codes. Although one code is used more often, there are two that are acceptable. The two medical billing codes used for newborns circumcision are 54150 and 54160. 54150 means, circumcision, using clamp or other device; newborn. The current procedural terminology code 54160 means circumcision surgical excision other than clamp, device or dorsal slit; newborn. As you read a circumcision with any type of device or clamp uses the code 54150. Most physicians use this medical billing code because it is the most common way to perform a circumcision. Another important point to remember is to charge for a ring block

Published By: Kathryn Etienne, CCS-P, RT | No Comments

Medical Billing CPT found for Transposition of Ovary

Medical Billing CPT found for Transposition of Ovary There are many procedures in which there is no particular medical billing code to represent it. For instance, an Oophoropexy is usually performed for radiation therapy, but what if it were performed for polycentric ovarian syndrome? Is there a CPT code to represent this? Knowing your options is an important trait in the medical billing world. In the oophoropexy example above, some medical billing staff members may use the current procedural terminology code 58825 (Transposition, ovary). Unfortunately, they would be incorrect. The definition of transposition is when an ovary is moved due to radiation therapy. Since radiation therapy is not being performed,

Published By: Melissa Clark, CCS-P, RT | No Comments

Medical Billing for Emergency Procedures

Medical Billing for Emergency Procedures Knowing when to use code 90782 in emergency department procedures can help with your medical billing reimbursements. For example, if a doctor examines a patient in the ED for an injury, and injects a preventative tetanus toxoid, your first instinct might be to use 90782 as a modifier for this procedure. But you would not receive a medical billing reimbursement because the incident to provision does not apply in the emergency department so you would not be able to justify having the doctor administer this injection. There would be no way to justify the medical necessity of such a shot. However, when you are in

Published By: Melissa Clark, CCS-P, RT | No Comments

Medical Billing Denials During A Natural Disaster

Avoiding Medical Billing Denials During A Natural Disaster Several natural disasters in America have demanded a new medical billing policy. The insufficient relief effort after Hurricane Katrina made everyone want to proactively prepare, should another disaster occur. The healthcare industry has been no exception. A new medical billing condition code and modifier have been created for disaster related care for the present and future. The two new medical billing codes are DR (Disaster related), and CR (Catastrophe/Disaster Related). DR is a condition code and CR is a new medical billing modifier. All Medicare contractors must use the new codes on claims for August 21, 2005 and after. These medical billing

Published By: Melissa Clark, CCS-P, RT | No Comments

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