UNDERSTANDING & CODING WITH MODIFIERS
|
|
- Leslie Elliott
- 8 years ago
- Views:
Transcription
1 UNDERSTANDING & CODING WITH MODIFIERS -21 Prolonged Evaluation and Management When the service provided is prolonged or otherwise greater than that usually required for the highest level of service in a given category. An office visit that usually requires 45 minutes to 70 minutes to complete. (This modifier may only be used with the highest levels of service for E&M codes.) Correct coding: (Established patient office visit) -22 Unusual Procedural Services When the service provided is greater than the time or service usually required for the procedure. A surgical procedure that usually takes 1 hour took 3 hours. A report or summary should accompany the claim to explain the reason for the increase in charges. Correct coding: (Supracervical abdominal hysterectomy) -23 Usual Anesthesia Occasionally, a procedure that usually requires either no anesthesia or local anesthesia must be done under general anesthesia because of unusual circumstances. This situation is reported by adding modifier -23 to the procedure codes of the basic service. During a sigmoidoscopy, the patient required general anesthesia. Correct coding: Sigmoidoscopy, flexible General anesthesia applied -24 Unrelated Evaluation and Management Service by the Same Physician during a Postoperative Period Use this modifier when the physician needs to indicate that an E&M service was performed during a post-operative period for a reason unrelated to the original procedure. A patient had gall bladder surgery but came to the office because of a cold 3 weeks following that procedure (same physician). By using this modifier, the coder alerts the carrier that the office visit was not related to the surgical procedure. The physician will then be paid for the visit pertaining to the cold. -25 Significant, Separately Identifiable E&M Service by the Same Physician on the Day of a Procedure This modifier indicates that on the day a procedure or other service was performed, the patient's condition required a significant, separately identifiable E&M service in addition to the usual preoperative and postoperative care associated with the procedure. 1
2 Patient was seen for a sore throat and removal of a wart. Both services (the office visit and the procedure) could be coded because the office visit (sore throat) was unrelated to the reason for the surgery. -26 Professional Component Certain procedures are a combination of a physician component and a technical component. To report only the physician component, add this modifier to the CPT code number. The patient has had a chest x-ray. and the physician is only interpreting the film. -32 Mandated Services This modifier applies to mandated consultation and services related to mandated consultations. -47 Anesthesia by Surgeon Use this modifier to code regional or general anesthesia provided by the surgeon. Do not use it to code for local anesthesia. The surgeon who drains this patient's cyst also administered the regional anesthesia. -50 Bilateral Procedure When the same procedure is performed on both sides of the body use this modifier to indicate that service. The modifier is appended to the second procedure. This patient has two hernias. one in the right groin and one in the left -51 Multiple Procedures When multiple procedures other than E&M services are performed on the same day or at the same session by the same provider, the primary procedure or service may be reported as listed and the additional procedure reported 2
3 with the multiple procedures modifier. The surgeon removed the patient's uterus and also cut an opening into the bladder and drained it. -52 Reduced Services Under certain circumstances, a service or procedure is partially completed. This modifier alerts the carrier that a reason exists for a lower-than-usual charge. The reduced services modifier will protect the charge data for the practice. Noninvasive physiologic studies of upper or lower extremity arteries, multiple levels or with provocative functional maneuvers, complete bilateral study (e.g., segmental blood). The study was performed on a patient who has a history of amputation of the extremity. -53 Discontinued Procedure The physician may need to terminate a procedure due to extenuating circumstances or terminate those that threaten the well-being of the patient. Note: This modifier is not used to report the elective cancellation of a procedure before patient's anesthesia induction and/or surgical preparation in the operating suite. Physician began a colonoscopy but had to discontinue the procedure because the patient had not been properly prepped -54 Surgical Care Only This modifier indicates that one physician performed a surgical procedure and another physician provided preoperative and/or postoperative management. The physician performed only the laminectomy. -55 Postoperative Management Only This modifier indicates that a physician other than the surgeon provided the postoperative care. The physician provided the postoperative management for a laminectomy performed by another physician 3
4 -56 Preoperative Management Only This modifier indicates that a physician other than the surgeon provided the preoperative evaluation of the patient. The physician provided the preoperative evaluation for a laminectomy performed by another physician. -57 Decision for Surgery Use this modifier for an evaluation and management service that resulted in the initial decision to perform surgery. It applies only to major procedures (those with a 90 day global period) when surgery is performed within 24 hours of the decision for the surgery. The patient saw the surgeon, and the decision was made for surgery the next day. -58 Staged or Related Procedure or Service by the Same Physician during the Postoperative Period This modifier is used when the physician needs to indicate that a procedure or service performed during the postoperative period was planned prospectively at the time of the original procedure (staged), was more extensive than the original procedure, or was performed for therapy following a diagnostic surgical procedure. Patient had breast biopsy. Results indicated a need for a partial mastectomy. The service was scheduled within the 10-day global period of the biopsy. -59 Distinct Procedural Service This modifier indicates that a procedure or service was distinct or independent from other services performed on the same day. It is used to identify procedures or services that are not normally reported together but are appropriate under the circumstances. It may represent a different patient encounter, different site or organ system, separate lesion, or separate injury not ordinarily encountered or performed on the same day by the same physician. Removal of a lesion from the arm and another lesion from the back. -62 Two Surgeons Under certain circumstances two surgeons (usually with different skills) may be required to manage a surgical procedure. Laminectomy performed by a neurosurgeon and an orthopedic surgeon. Each bills the same CPT code with 4
5 modifier Procedure Performed on an Infant Weighing Less than 4 kg In some cases, the small size of an infant significantly increases the complexity and physician work components required for a procedure. This modifier is only used for procedures on patients in this circumstance. The patient is a 3-kg infant who requires an enterectomy, resection of small intestine. -66 Surgical Team Used when highly complex procedures (requiring the concomitant services of several physicians, often of different specialties, plus other highly skilled, specially trained personnel, various types of complex equipment) are carried out under the. surgical team concept A heart transplant involves the skills of a highly trained cardiovascular team -76 Repeat Procedure by Same Physician Use this modifier when a physician needs to indicate that a procedure or service was repeated subsequent to the original service on the same day. Patient had an EKG in the morning with a repeat EKG in the afternoon. -77 Repeat Procedure by Another Physician This modifier indicates that a procedure had been performed by another physician on the same day and was repeated by a different physician. Patient had an EKG at the primary care physician's office and was sent to a cardiologist that same day who repeated the EKG on the same day. -78 Return to the Operating Room for a Related Procedure This modifier indicates that another procedure, related to the first procedure, was performed during the initial procedure's postoperative period and required a return to the operating room. 5
6 The patient had abdominal surgery. Three days after surgery an infection occurs in the wound site, requiring the patient to be returned to the operating room for debridement of the wound site. -79 Unrelated Procedure or Service in a Postoperative Period When a patient is seen by the same physician for an unrelated problem or condition in a postoperative period, use this modifier. A patient has a Maze procedure for treatment of atrial fibrillation. The patient goes home; the wound site is healing well. Two weeks later, the patient is seen by the same physician for pericardiotomy for removal of foreign body. Since the second procedure is within the global period for the original surgery, attach modifier -79 to the second procedure. -80 Surgical Assistant This modifier identifies the services of another physician, who acts as a second pair of hands during a surgical procedure. A patient is treated for an intestinal fistula closure, which required the assistance of another physician to complete the procedure. The primary surgeon reports the service. To report the services of the assistant you would add modifier -80 to the code. -81 Minimum Assistant Surgeon Use this modifier for a procedure that does not normally require a surgical assistant but because of extenuating circumstances, requires the services of another physician for a short time. Note: Many commercial insurance companies allow this modifier to be used when assistance is provided by personnel other than an MD or DO. For Medicare carriers, you must use modifier -AS to report services provided by an assistant who is not an MD or DO. A patient is treated for gingivitis requiring Gingivectomy, excision gingiva, each quadrant. The assistance of another physician was required for a short period of time to complete the procedure. Using the same example, if the physician had used a nurse practitioner or physician assistant for help with this service you could apply modifier -81 with some commercial carriers. 6
7 -82 Assistant Surgeon Use this modifier when a qualified resident surgeon is not available. This modifier is typically reserved for teaching hospitals and teaching physician services A teaching physician required assistance for the closure of an intestinal fistula. At the time of the procedure, a resident was not available to provide assistance. Another teaching physician was called to provide surgical assisting. -90 Reference (Outside) Laboratory This modifier is used when laboratory procedures are performed by a party other than the treating or reporting physician. Only use this modifier with the code series. A patient with Conn's disease is scheduled for aldosterone studies in the morning and in the afternoon to compare results of electrolyte excretion by the kidneys. -91 Repeat Clinical Diagnostic Laboratory Test Used to indicate a repeat of the same laboratory test on the same day to obtain subsequent (multiple) test results. Note: This modifier may not be used when tests are rerun to confirm initial results; when testing problems with specimens or equipment occur; or for any other reason when a normal, one-time, reportable is all that is required. This modifier may not be used when other code{s) describe a series of test results (e.g., glucose tolerance tests, evocative/suppression testing) Patient's test results for aldosterone are inconclusive, so the lab runs the test again. 7
CUSTOM SOFTWARE SYSTEMS, INC
MODIFIERS 4 21 PROLONGED EVALUATION AND MANAGEMENT SERVICES 5 22 UNUSUAL PROCEDURAL SERVICES 6 23 UNUSUAL ANESTHESIA 7 24 UNRELATED EVALUATION AND MANAGEMENT SERVICE BY THE SAME PHYSICIAN DURING A POSTOPERATIVE
More informationModifiers. This modifier can be located in the following rule(s): Anesthesia Global Maternity
The Medical Clean Claims Task force has developed this modifier grid to identify modifiers that are considered to be important in the overall adjudication of a claim from a commercial payer perspective.
More informationModifiers and all you will need to know!
Modifiers and all you will need to know! 24Unrelated Evaluation and Management Service by the Same Physician during a Postoperative Period: The physician may need to indicate that an evaluation and management
More informationThere are two levels of modifiers: Level 1 (CPT) and Level II (CMS, also known as HCPCS).
PROVIDER BILLING GUIDELINES Modifiers Modifiers are two digit or alphanumeric characters that are appended to CPT and HCPCS codes. The modifier allows the provider to indicate that a procedure was affected
More informationModifiers. Page 1 of 6
Modifiers A Current Procedural Terminology/Healthcare Common Procedure Coding System (CPT/HCPCS) modifier is a twocharacter (alpha and/or numeric) code appended to a CPT/HCPCS procedure code to clarify
More informationModifier Usage Guide What Your Practice Needs to Know
BlueCross BlueShield of Mississippi Modifier Usage Guide What Your Practice Needs to Know Modifier 22 Usage Modifier 22 - Procedural Service The purpose of this modifier is to report services (surgical
More informationMy Coding Connection, LLC 618-530-1196. 24 Unrelated E/M by the same physician during a postoperative period
MODIFIERS Rachel Coon, CCS-P, CPC, CPC-P, CPMA, CPC-I, CEMC, ICD-10 My Coding Connection, LLC 618-530-1196 GLOBAL PACKAGE MODIFIERS 24 Unrelated E/M by the same physician during a postoperative period
More informationModifiers. Policy Number: 10.01.503 Last Review: 5/2015 Origination: 12/2004 Next Review: 5/2016
Modifiers Policy Number: 10.01.503 Last Review: 5/2015 Origination: 12/2004 Next Review: 5/2016 Policy Modifiers indicate that a service was altered in some way from the stated descriptor without changing
More informationCPT/HCPCS Modifiers. [Refer to WAC 182-531-1850(10) and (11)] Italics indicate additional Agency language not found in CPT.
CPT/HCPCS Modifiers [Refer to WAC 182-531-1850(10) and (11)] Italics indicate additional Agency language not found in CPT. 22: Unusual Procedural Services: When the service(s) provided is greater than
More informationOregon CO-OP Modifier Table - December 2013
Oregon CO-OP Modifier Table - December 2013 Modifier Modifier Description Pricing Functionality 22 Increased Procedural Services Modifier 22 should only be reported with procedure codes that have a global
More informationAppendix E: Modifiers that affect payment
Payment Policies Appendices Appendix E: Modifiers that affect payment Note: Only modifiers that affect payment are listed in this Appendix. Refer to current CPT and HCPCS books for a complete list of modifiers,
More informationIngenix Coding Lab: Understanding Modifiers
Ingenix Coding Lab: Understanding Modifiers Contents Contents Introduction...1 What Are HCPCS Modifiers?... 1 Outpatient Modifier Guidelines/Usage... 3 Modifiers and CPT Section to Which They Apply...
More informationModifiers. Disclaimer
Modifiers The Rest of the Story 1 Disclaimer This is not an all inclusive list of every modifier; this is an overview of many modifiers and their intended usage. This material is designed to offer basic
More informationModifiers. Hoda Henein, CHBME, CP President & CEO, Active Management A Practice Management Consulting and Billing Company
Modifiers Hoda Henein, CHBME, CP President & CEO, Active Management A Practice Management Consulting and Billing Company Fellow, Speaker, Billing & Coding Advisor American Academy of Podiatric Practice
More informationModifier Reference PAYMENT POLICY ID NUMBER: 10-011. Original Effective Date: 05/14/10. Revised: 05/31/12 DESCRIPTION:
Private Property of Florida Blue. This payment policy is Copyright 2012, Florida Blue. All Rights Reserved. You may not copy or use this document or disclose its contents without the express written permission
More informationPolicy #: 111 Latest Review Date: January 2010
Name of Policy: Co-surgeons and Team Surgeons Policy #: 111 Latest Review Date: January 2010 Category: Administrative Policy Grade: N/A Background: As a general rule, benefits are payable under Blue Cross
More informationMEDICAL POLICY Modifier Guidelines
POLICY.........PG0011 EFFECTIVE......10/30/05 LAST REVIEW... 10/13/15 MEDICAL POLICY Modifier Guidelines GUIDELINES This policy does not certify benefits or authorization of benefits, which is designated
More informationAUTHORIZED MODIFIERS. Updated: 01/16/2015
AUTHORIZED MODIFIERS Updated: 01/16/2015 A modifier provides the means for a provider to indicate that a service or procedure was altered by a specific circumstance but not changed in its definition or
More informationGlobal Surgery Fact Sheet
DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services R Global Surgery Fact Sheet Fact Sheet Definition of a Global Surgical Package Medicare established a national definition
More informationThe Impact of Modifiers. By: Rhonda Granja, B.S.,CMA, CMC, CPC, CMOM
The Impact of Modifiers By: Rhonda Granja, B.S.,CMA, CMC, CPC, CMOM A modifier provides the means to report or indicate that a service or procedure that has been performed has been altered by some specific
More informationAppropriate Modifier Usage
Anatomical modifiers Anesthesia modifiers EA, EB and EC FB, FC and FD Anatomical modifiers are used to indicate that a procedure or service was performed at a specific anatomic site or to indicate that
More informationGone are the days when healthy
Five Common Coding Mistakes That Are Costing You Fix these problems to increase your bottom line. GREG CLARKE Emily Hill, PA-C Gone are the days when healthy third-party reimbursements meant practices
More informationAnesthesia Processing Manual
Anesthesia Processing Manual Important Information The following disclaimer is applicable to all telephone inquiries and automated communications systems (i.e., telephone and fax) to Blue Cross and Blue
More informationIntegumentary System Individual Exercises
Integumentary System Individual Exercises 1. A physician performs an incision and drainage of a subcutaneous abscess in his office for a particularly uncooperative established patient. How should this
More informationPart B Education Exclusive: Modifier 59 Edit Update Questions
Cahaba GBA would like to provide some clarification of the use of Modifier 59. The modifier is not limited to National Correct Coding Initiative (NCCI) pairs. We apologize for any confusion our July article
More informationModifier Reference Guide
General Instructions Ranking Modifiers Modifier Categories Modifier Reference Guide A. Pricing Modifiers B. Statistical Modifiers that Affect Pricing C. Statistical / Informational Modifiers Level I -
More informationModifier Magic 4/13/2015. Modifiers. Anatomical Modifiers. April 15, 2015 MMBA
Modifier Magic April 15, 2015 MMBA Modifiers Modifiers should be reported to bypass a clinical edit ONLY if the criteria for the use for the modifiers is met and supporting documentation is included in
More informationApplying Modifiers. Applying Modifiers
$traight Talk XXII November 11, 2013 Sandy Steele, CPC, CPMA, CEDC, CAC What is a Modifier? A modifier added to a CPT code will help provide additional information on the claim. A modifier can help answer
More informationQuestion and Answer Submissions
AACE Endocrine Coding Webinar Welcome to the Brave New World: Billing for Endocrine E & M Services in 2010 Question and Answer Submissions Q: If a patient returns after a year or so and takes excessive
More informationMedicare 101: Basics of Modifier Billing. Part B Provider Outreach and Education February 26, 2014
Medicare 101: Basics of Modifier Billing Part B Provider Outreach and Education February 26, 2014 Housekeeping Tips When you called in, did you enter your attendee code? Dial-in number: 1-800-791-2345
More informationDEPARTMENT OF SOCIAL SERVICES AUDIT PROTOCOL PHYSICIAN SERVICES UPDATED FEBRUARY 1, 2015
DEPARTMENT OF SOCIAL SERVICES AUDIT PROTOCOL PHYSICIAN SERVICES UPDATED FEBRUARY 1, 2015 Listed are the most common audit findings noted for physician services provided under the State Medicaid program,
More informationRotator Cuff Repair Surgical Procedures
Rotator Cuff Repair Surgical Procedures 2011 Reimbursement and Coding Reference Guide for Physicians and Hospitals This coding reference guide is intended to illustrate the common CPT * codes, ICD-9 CM
More informationCPT Coding in Oral Medicine
CPT Coding in Oral Medicine CPT - Current Procedural Terminology Medical Code Set (00000-99999) Established as an indexing/coding system to standardize terminology among physicians and other providers
More informationCORRECT CODING INITIATIVE OB/GYN CPT CODES INTRODUCTION
CORRECT CODING INITIATIVE OB/GYN CPT CODES INTRODUCTION 2015 NOTE: CMS UPDATES THE CCI QUARTERLY. FOR THE MOST RECENT VERSION, SEE DEPT. OF HEALTH ECONOMICS AND CODING WWW.ACOG.ORG CMS Correct Coding Initiative
More informationProfessional/Technical Component Policy
Policy Number 2015R0012C Professional/Technical Component Policy Annual Approval Date 1/27/2014 Approved By Payment Policy Oversight Committee IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY You are responsible
More informationThe ASA defines anesthesiology as the practice of medicine dealing with but not limited to:
1570 Midway Pl. Menasha, WI 54952 920-720-1300 Procedure 1205- Anesthesia Lines of Business: All Purpose: This guideline describes Network Health s reimbursement of anesthesia services. Procedure: Anesthesia
More informationCommon Billing Mistakes Costing Your ASC Money and Correct Modifier & Revenue Code Usage for ASC Claims
Common Billing Mistakes Costing Your ASC Money and Correct Modifier & Revenue Code Usage for ASC Claims October 2013 Beckers 20 th Annual ASC Conference Presenter: Stephanie Ellis, R.N., CPC, Speaker Ellis
More informationLaparoscopic Colectomy. What do I need to know about my laparoscopic colorectal surgery?
Laparoscopic Colectomy What do I need to know about my laparoscopic colorectal surgery? Traditionally, colon & rectal surgery requires a large, abdominal and/or pelvic incision, which often requires a
More informationClass Action Settlement Recap
Class Action Settlement Recap Enhancements to Claim Payment Policy, Processing and Payment Disclosure, and an Appeals Process for Class Action Settlement Providers The following enhancements are effective
More informationWelcome To The Digital Learning Center
Welcome To The Digital Learning Center Presented by Your Partner In Building High Performance Practices Today s Presentation Advanced CPT Coding A Detailed Review of CPT Elements Including Modifiers, CCI
More informationILLINOIS WORKERS' COMPENSATION COMMISSION MEDICAL FEE SCHEDULE INSTRUCTIONS AND GUIDELINES
Table of Contents ILLINOIS WORKERS' COMPENSATION COMMISSION MEDICAL FEE SCHEDULE INSTRUCTIONS AND GUIDELINES For treatment before 2/1/09 Introduction and Purpose Reference Materials Section 1. Ambulatory
More informationCODE AUDITING RULES. SAMPLE Medical Policy Rationale
CODE AUDITING RULES As part of Coventry Health Care of Missouri, Inc s commitment to improve business processes, we are implemented a new payment policy program that applies to claims processed on August
More informationUsing Modifiers Wisely Steven M. Verno, CEMCS, CMSCS, NREMT-P, CMBSI Medical Coding and Billing Professor 2009
Using Modifiers Wisely Steven M. Verno, CEMCS, CMSCS, NREMT-P, CMBSI Medical Coding and Billing Professor 2009 Disclaimer: Modifiers are copyrighted and the property of the American Medical Association.
More informationSTS/AATS CODING. NEWSLETTER Recent Information on CPT and ICD-9 CM Codes for Cardiothoracic Surgeons
N E W S STS/AATS CODING L E T T E R Vol. 13 No. 1, Spring 2004 2004, The Society of Thoracic Surgeons, Chicago, IL 60611 TEE s; Maze; 0,10, XXX Global Periods; Medicare Usage for Assistants-at- Surgery
More information100.1 - Payment for Physician Services in Teaching Settings Under the MPFS. 100.1.1 - Evaluation and Management (E/M) Services
MEDICARE CLAIMS PROCESSING MANUAL Accessed September 25, 2005 100.1 - Payment for Physician Services in Teaching Settings Under the MPFS Payment is made for physician services furnished in teaching settings
More informationCoding Modifiers Table
Updated 07/12 Coding Modifiers Table The following chart has been developed to assist providers in understanding how the Kansas Medical Assistance Program (KMAP) handles specific modifiers. It is imperative
More informationPhysician Fee Schedule BCBSRI follows CMS Physician Fee Schedule (PFS) Relative Value Units (RVU) for details relating to
Policy Coding and Guidelines EFFECTIVE DATE: 09 01 2015 POLICY LAST UPDATED: 09 02 2015 OVERVIEW This Policy provides an overview of coding and guidelines as they pertain to claims submitted to Blue Cross
More informationSECTION 4. A. Balance Billing Policies. B. Claim Form
SECTION 4 Participating Physicians, hospitals and ancillary providers shall be entitled to payment for covered services that are provided to a DMC Care member. Payment is made at the established and prevailing
More informationCONNECTIONS TESTING FOR ICD-10
TESTING FOR ICD-10 In conjunction with the Centers for Medicare and Medicaid Services (CMS), Providence Health Plan (PHP) and all major payers will convert from International Classification of Diseases,
More information1) There are 0 indicator edits, which are never correctly reported together;
Medical Coverage Policy Coding and Guidelines sad EFFECTIVE DATE: 11/15/2011 POLICY LAST UPDATED: 11/1/2013 OVERVIEW This Policy provides an overview of coding and guidelines as they pertain to claims
More informationDocumentation Guidelines for Physicians Interventional Pain Services
Documentation Guidelines for Physicians Interventional Pain Services Pamela Gibson, CPC Assistant Director, VMG Coding Anesthesia and Surgical Divisions 343.8791 1 General Principles of Medical Record
More informationUrinary Diversion: Ileovesicostomy/Ileal Loop/Colon Loop
Urinary Diversion: Ileovesicostomy/Ileal Loop/Colon Loop Why do I need this surgery? A urinary diversion is a surgical procedure that is performed to allow urine to safely pass from the kidneys into a
More informationPayment Policy. Evaluation and Management
Purpose Payment Policy Evaluation and Management The purpose of this payment policy is to define how Health New England (HNE) reimburses for Evaluation and Management Services. Applicable Plans Definitions
More informationModifiers XE, XS, XP, XU, and 59 - Distinct Procedural Service
Manual: Policy Title: Reimbursement Policy Modifiers XE, XS, XP, XU, and 59 - Distinct Procedural Service Section: Modifiers Subsection: None Date of Origin: 1/1/2000 Policy Number: RPM027 Last Updated:
More informationOffice Managers Association at Presbyterian Hospital of Plano
Office Managers Association at Presbyterian Hospital of Plano Update your charge slips annually Team approach Pain management example Grace period discontinued! New CPT, HCPCS and ICD-9 codes Changed definitions
More informationWORKERS' COMPENSATION MEDICAL FEE SCHEDULE RULE 40.000
WORKERS' COMPENSATION MEDICAL FEE SCHEDULE RULE 40.000 40.000 Workers' Compensation Medical Fee Schedule The five-digit numeric codes and descriptions included in Rule 40.000, Medical Fee Schedule, are
More informationClinical Privileges Profile Physician Assistant. Indu & Raj Soin Medical Center
Printed Name Clinical Privileges Profile Physician Assistant Indu & Raj Soin Medical Center Applicant: Check off the Requested box for each privilege requested. Applicants have the burden of producing
More informationMODIFIER 59 ARTICLE. The CPT Manual defines modifier 59 as follows:
MODIFIER 59 ARTICLE The Medicare National Correct Coding Initiative (NCCI) includes Procedure-to-Procedure (PTP) edits that define when two Healthcare Common Procedure Coding System (HCPCS)/ Current Procedural
More informationMEDICAL ASSISTANCE BULLETIN
MEDICAL ASSISTANCE BULLETIN ISSUE DATE October 20, 2008 EFFECTIVE DATE November 3, 2008 NUMBER 99-08-17 SUBJECT BY Implementation of ClaimCheck Michael Nardone, Deputy Secretary Office of Medical Assistance
More informationOffice Visits. Breast
Early Detection Works Reimbursement Fee Schedule Effective for services on or after July 1, 2015 Program guidelines require that be the payor of last resort. Program funds cannot be used to supplement
More informationReporting Hospital Outpatient Modifiers
Reporting Hospital Outpatient Modifiers Audio Seminar/Webinar April 17, 2008 Copyright 2008 American Health Information Management Association. All rights reserved. Disclaimer The American Health Information
More informationWellness Exam Coverage Highlights
The following Medicare Advantage plans have updated coding procedures for 2013: AARP MedicareComplete UnitedHealthcare MedicareComplete UnitedHealthcare Dual Complete UnitedHealthcare MedicareDirect Wellness
More informationSurgical Chart Auditing. Agenda
Surgical Chart Auditing Presented by: Rhonda Buckholtz, CPC, CPMA, CPC-I, CGSC, GENTC, COBGC, CPEDC 1 Agenda Importance of documentation Global surgical packages CCI Modifiers Dissecting an operative report
More informationLIVING DONATION. What You Need to Know. www.kidney.org
LIVING DONATION What You Need to Know www.kidney.org 2 NATIONAL KIDNEY FOUNDATION TABLE OF CONTENTS About Living Donation.... 4 The Evaluation Process.... 6 Surgery and Recovery.... 12 After Donation....
More informationModifiers 25 and 59. Modifier 25
Modifiers 25 and 59 This article discusses the appropriate use of modifier 25, Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure
More informationKanCare Managed Care Organization Network Access as of July 31, 2015
Provider Type Amerigroup Kansas, Inc. Providers/ Locations % Covered (Urban & Semi-Urban) Average Distance to Provider (Urban/ Semiurban) % Covered (Rural/ Frontier) Average Distance to Provider (Rural/Frontier)
More informationModifier Reference Policy
Policy Number 2015R0111C Annual Approval Date Modifier Reference Policy 11/12/2014 Approved By Payment Policy Oversight Committee IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY You are responsible for
More informationAnesthesia Guidelines
Anesthesia Guidelines Updated April 2012 Anesthesia BlueCross requires anesthesiologists and certified registered nurse anesthetists (CRNAs) to file claims using CPT anesthesia codes. We cover general
More informationEmpire BlueCross BlueShield Professional Reimbursement Policy
Subject: Modifier Rules NY Policy: 0017 Effective: 02/01/2014 06/30/2014 Coverage is subject to the terms, conditions, and limitations of an individual member s programs or products and policy criteria
More informationAPP PRIVILEGES IN ORTHOPEDICS
APP PRIVILEGES IN ORTHOPEDICS Education/Training Licensure (Initial and Reappointment) Required Successful completion of a PA or NP program Current Licensure as a PA or RN in the state of CA Current certification
More informationThe Global Surgery Package Part I. Riva Lee Asbell
The Global Surgery Package Part I Riva Lee Asbell Introduction One of the least understood concepts in surgical coding concerns the details involved in the Global Surgery Package. Some of the rules were
More informationGuide to Abdominal or Gastroenterological Surgery Claims
What are the steps towards abdominal surgery? Investigation and Diagnosis It is very important that all necessary tests are undertaken to investigate the patient s symptoms appropriately and an accurate
More informationThe 2015 edition of the South Carolina Workers Compensation Medical Services Provider Manual has been updated as follows:
Dear Customer: The 2015 edition of the South Carolina Workers Compensation Medical Services Provider Manual has been updated as follows: NOTE: Underlined text has been added; text with strikethrough has
More informationWhat You Need to Know About Anesthesia Filing Guidelines
What You Need to Know About Anesthesia Filing Guidelines 2015 Edition Published by Provider Relations and Education Your Partners in Outstanding Quality, Satisfaction and Service This document provides
More informationSURGICAL PREAMBLE SPECIFIC ELEMENTS SURGICAL SERVICES WHICH ARE NOT LISTED AS A "Z" CODE
Surgical PreambleApril 1, 2015 PREAMBLE SPECIFIC ELEMENTS In addition to the common elements, all surgical services include the following specific elements. A. Supervising the preparation of and/or preparing
More informationProcedure Based Coding
Procedure Based Coding Jon K. Hathaway Objectives Review Global definition Review common modifiers Procedure plus E&M codes 2013 MSACOG Snow Meeting 1 Vacuum assisted Vaginal Delivery was first reported
More informationModifier Reference Policy
Policy Number 2016R0111C Annual Approval Date Modifier Reference Policy 11/11/2015 Approved By Payment Policy Oversight Committee IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY You are responsible for
More informationThe Value of Improoperative Diagnostic Tests, Treatments and Procedures
The Value of Improving Appropriate Diagnostic Tests, Treatments and Procedures Presented by: Dr. Eric Bohm & Dr. Thomas Mutter On behalf of the Project Team Disclosure of Potential for Conflict of Interest
More informationSan Luis Dermatology & Laser Clinic, Inc.
San Luis Dermatology & Laser Clinic, Inc. Patient Name: Pharmacy Name: LOCATION Health History Intake Form The federal government has defined a complete electronic medical record (EMR) or electronic health
More informationCorrect Coding to Maximize Reimbursements: Common Urological Coding and Billing Errors. Michael A. Ferragamo, MD, FACS
Correct Coding to Maximize Reimbursements: Common Urological Coding and Billing Errors Michael A. Ferragamo, MD, FACS Coding and Reimbursement Consultant; Assistant Clinical Professor of Urology, University
More informationTotal Abdominal Hysterectomy
What is a total abdominal hysterectomy? Is the removal of the uterus and cervix through an abdominal incision (either an up and down or bikini cut). Removal of the ovaries and tubes depends on the patient.
More informationHysterectomy. What is a hysterectomy? Why is hysterectomy done? Are there alternatives to hysterectomy?
ROBERT LEVITT, MD JESSICA BERGER-WEISS, MD ADRIENNE POTTS, MD HARTAJ POWELL, MD, MPH COURTNEY LEVENSON, MD LAUREN BURNS, MSN, RN, WHNP OBGYNCWC.COM What is a hysterectomy? Hysterectomy Hysterectomy is
More informationX-Plain Inguinal Hernia Repair Reference Summary
X-Plain Inguinal Hernia Repair Reference Summary Introduction Hernias are common conditions that affect men and women of all ages. Your doctor may recommend a hernia operation. The decision whether or
More informationAG CancerCare Platinum Plus Initial Diagnosis Benefit First occurrence Internal cancer only (one-time payment)
AG CancerCare from American General Life Insurance Company (American General Life) is a specified disease policy that pays benefits for expenses related to the diagnosis and treatment of cancer, as well
More informationPage 1 of 11. MLN Matters Number: SE1010 REVISED Related Change Request (CR) #: 6740. Related CR Release Date: N/A Effective Date: January 1, 2010
News Flash Version 3.0 of the Measures Groups Specifications Manual released in November 2009 for 2010 PQRI has been revised. Version 3.1 of the 2010 PQRI Measures Groups Specifications Manual and Release
More information2. What HCPCS Level II code describes Ensure HN therapy with an enteral infusion pump with alarm?
Sample test questions for the CPC exam The following 20 questions were developed by Lisa Rae Roper, MHA, CPC, CCS-P, an instructor for HCPro s Certified Coder Boot Camp, for preparation of the Certified
More informationWhat s new in INCISIVE MD? Who should read these release notes?
April 2009 Contents What s new in INCISIVE MD? Who should read these release notes? National Correct Coding Initiative (CCI) Updates Corrected $0 Expected for Arthroscopic Chondroplasty CCI Edit Additional
More informationOklahoma Facts CPT. Definitions. Mohs Micrographic Surgery. What Does That Mean? Billing and Coding for Mohs Surgery
Billing and Coding for Mohs Surgery Cindy L. Wilson Dermatology Associates of Tulsa Oklahoma Facts Per square mile, Oklahoma has more tornadoes than any other place in the world. The highest wind speed
More information2 nd Floor CS&E Building A current UMHS identification badge is required to obtain medical records
Location Hours 2 nd Floor CS&E Building A current UMHS identification badge is required to obtain medical records The Health Information Services Department is open to the public Monday through Friday,
More informationCoding for multiple surgical procedures By Emily H. Hill, PA
Coding for multiple surgical procedures By Emily H. Hill, PA Many times, more than one surgical procedure is performed during the same encounter. When that occurs, a modifier(s) is required to explain
More informationPhysician and other health professional services
O n l i n e A p p e n d i x e s 4 Physician and other health professional services 4-A O n l i n e A p p e n d i x Access to physician and other health professional services 4 a1 Access to physician care
More informationModifiers 58, 78, and 79 Staged, Related, and Unrelated Procedures
Manual: Policy Title: Reimbursement Policy Modifiers 58, 78, and 79 Staged, Related, and Unrelated Procedures Section: Modifiers Subsection: None Date of Origin: 9/22/2004 Policy Number: RPM010 Last Updated:
More informationExcision of Vaginal Mesh
What is excision of vaginal mesh? This procedure is done to remove mesh from the vagina. When is this surgery used? If mesh has eroded into the vagina, bladder, urethra, or bowel If there is pain associated
More informationThe following is a description of the fields that appear on the results page for the Procedure Code Search.
Fee Schedule Legend Updated: 9/21/2015 The following is a description of the fields that appear on the results page for the Procedure Code Search. Procedure Code the five-character procedure code as listed
More informationProvider Education Webinars
Provider Education Webinars Course 6: Utilizing CPT & HCPCS Modifiers Housekeeping Items Technical Difficulties If you experience technical difficulties, please utilize the Chat feature of the GoToWebinar
More informationThe following instructions are taken directly from the Consultations section of CPT:
Heading: Clarification Title: Consultations Noridian Administrative Services (NAS) published this article on Consultations in Medicare B News, Issue 222, which was dated September 7, 2005. This article
More informationPATIENT REGISTRATION
PATIENT REGISTRATION Patient s Last Name: Patient s First Name: MI: Address: City, State Zip code: Patient s Date of Birth: Patient s Social Security: Best Number to contact: Secondary Number: Marital
More informationCOLONIAL LIFE & ACCIDENT INSURANCE COMPANY 1200 Colonial Life Boulevard, P. O. Box 1365 Columbia, South Carolina 29202 (800) 325-4368
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY 1200 Colonial Life Boulevard, P. O. Box 1365 Columbia, South Carolina 29202 (800) 325-4368 GROUP SPECIFIED DISEASE INSURANCE Outline of Coverage (Applicable to
More informationSample test questions for the CPC exam
Sample test questions for the CPC exam The following 20 questions were developed by Lisa Rae Roper, MHA, PCS, CPC, CPC-I, CCS-P, an adjunct instructor for HCPro s Certified Coder Boot Camp, for preparation
More information