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.
Ending Confusion Over 99000 Series Codes in Your Medical Billing
There were two new codes issued in 2006 that continue to confuse many medical billers still over halfway into 2007. These two codes were created to specifically address the after-hours and red-eye services for procedures done by physicians outside the normal hours. Previously when compiling the medical coding for medical billing, a coder would have used 99050 as a “catch-all” coding. Now CPT has revised the original code and added new codes. 99053 is ” “for services between 10 p.m. and 8 a.m. in 24-hour facilities,” and will be used by both physicians on call and hospitals. Please note that code 99053’s wording to include “24-hour facility” will put a …
Global Billing for Ob-Gyn Services
One of the common dilemmas in medical billing for Ob-Gyn services is how to report the birth of a baby when there was no doctor on hand to deliver the newborn. When the delivery is progressing trouble-free, it isn’t uncommon is for a nurse to deliver a baby when the ob-gyn is in the next room doing a procedure on another patient such as an episiotomy; then the question arises, can the service still be billed globally? Fortunately in many cases you can. It is up to the individual payer and you can find out quickly by either checking their guidelines or website to see if the service will be …
CCI Updates You Need to Know
In the most recent updated of the Correct Coding Initiative (CCI) there are a number of edits you won’t want to miss if the services to the patient include debridement and treatment on the same burn site. CCI version 13.1 outlaws reporting a pair of debridement codes with certain burn treatment codes in most situations. However, CCI now bundles 11000 (Debridement of extensive eczematous or infected skin; up to 10 percent of body surface) and 11040 (Debridement; skin, partial thickness) into 16020 (Dressings and/or debridement of partial thickness burns, initial or subsequent; small [less than 5 percent total body surface area]), 16025 (… medium [e.g., whole face or whole extremity, …
Mastectomy and Lymph Excision Medical Billing Tips
When the surgeon removes lymph nodes during a partial mastectomy, it may be confusing as to how to the mastectomy and the lymph excision. A common point of confusion is whether they should be bundled or reported separately. The answer is pretty cut and dried. In most cases, with partial mastectomy, the surgeon will perform an axillary lymphadenectomy to remove the lymph nodes between the pectoralis major and the pectoralis minor muscles. The surgeon may also remove the nodes in the axilla through a separate incision at the same time. When this occurs, you should not report the mastectomy and lymphadenectomy (38745, Axillary lymphadenectomy; complete) separately. Instead, you should use …
Medical Billing Tips for Modifier 59
Using a modifier incorrectly can cost you in terms of reimbursements and time. Carriers are closely scrutinizing medical billing claims for incorrect usage of modified 59. There are two main areas that you can concentrate on to avoid getting his with denials or pay backs and insure that you use the modifier correctly. A study of the OIG found a 40% error rate for modifier 59 and you can double check your billing. First of all, in order to use modifier 59 there must be services performed at separate regions. Fifteen percent of the OIG’s audited claims using modifier 59 had procedures that weren’t distinct because “they were performed at …
