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.
Click any of the article links below to read the entire article or browse another section to the right to read articles on another subject.
E/M and Repair on Laceration Claims
Let’s say an otherwise healthy man reports to the ED with lacerated index and middle fingers on the palmar surface, but there is no significant bleeding. The patient cut himself on a table saw. There is a 1.5cm jagged laceration with protruding fat located on the pad of the distal phalanx of both fingers. The physician uses Marcaine to apply digital blocks to both fingers, explores the wounds and finds no foreign bodies, and then closes the wounds. This encounter should be coded with a pair of E codes, in order to identify the cause of injury. Report this claim as follows: Report 12002 for the wound closure (this is …
2 Code Claims Complex Closures on Excision Claims
When closures become complicated, it is possible to have a two code claim. If the ED physician removes a lesion, he or she will also need to close the site prior to releasing the patient to go home. If the closure is a simple repair, then the work is combined into the lesion excision code. If the repair is more complicated then that though, then you can report the closure separately. If an intermediate closure is performed by the ED physician, then you will choose a code from the 12031 – 12057 set, but for complex closures, then you will choose a code from the 13100 – 13153 set. These …
Medial Dislocation – Billing it Right
A common occurrence in the emergency is the dislocation of various joints. They are sometimes incorrectly handled as breaks but shouldn’t be and you could be setting your practice up for a denial at best and audit at worst if you report these procedures incorrectly on your medical billing. Even if the reduction of the dislocation fails, the attempt should be reported on not only the medical billing as a procedure but also in the documentation as another procedure will have to be tried to relocate the elbow to its proper placement and you can show the timeline for the necessity of other and more involved treatments. On the claim …
Deciding to Use Modifier 59 on Certain Procedures
Sometimes in medical billing it is difficult to decide when to use current procedural terminology codes 58661 and 49322-59. These codes, like many others seem similar, but in actuality, are quite different. When performing medical billing it is necessary to know when to use current procedural terminology code 58661 versus 49322-59. The medical billing code 58661 (laparoscopy, surgical; with removal of adnexal structures) is used when any part of the ovaries or Fallopian tubes are removed. For example, If a surgeon was doing a cystectomy of an ovarian cyst and ended up removing some of the ovary as well, they physician could do medical billing with 58661. The current procedural …
Better Medical Billing For MRI Claims
Medical billing hip MRI rules are not as straightforward as you might assume. There are many variations on how to correcting bill for this service. There are some facts you should keep in mind when doing medical billing for lower extremity MRIs. Unfortunately, there is no specific medical billing CPT code for an MRI of the hip. You need to use the codes 73721-73723 (Magnetic resonance imaging, any joint of lower extremity). The hip joint falls into this medical billing category because it is a lower extremity joint. Doing medical billing for bilateral hip MRIs is also a bit more complicated. Different payers require different modifiers for payment. For example, …
