By Deborah J. Grider

The final word modifiers resource-revised! crucial parts to the coding technique, modifiers support create transparent and concise communications among the supplier and payer. Coding with Modifiers presents counsel on how and while to take advantage of modifiers with a purpose to keep away from high priced money delays and denials. utilizing the 2012 code set, the fourth variation includes new, deleted and revised modifiers, in addition to updates to facilities for Medicare & Medicaid prone, third-party payer, and AMA-modifier instructions to help with coding accuracy. Coding tips-explain tips on how to use particular modifiers to assist remedy confusion surrounding modifier utilization Modifiers licensed for hospitals and ASCs-provide info for pro provider and health center reporting necessities educating tools-allow you to create and administer exams utilizing questions and solutions constructed by way of the AMA medical examples-guide readers in settling on the proper modifier to exploit with necessary situations Test-Your-Knowledge questions-test your comprehension of the fabric with greater than a hundred ninety questions

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Additional resources for Coding with Modifiers: A Guide to Correct CPT and HCPCS Level II Modifier Usage [With CDROM]

Sample text

The question always arises whether CPT modifiers can be used when Medicare, Medicaid, and private health plans are billed. Medicare administrative contractors and fiscal intermediaries vary on the use and acceptance of modifiers listed in the CPT codebook. Other commercial payers may accept only some CPT modifiers. The same is true for private health care plans and managed care plans. It is important to check with individual payers regarding their billing requirements. Good sources for this information are the insurance carrier’s provider manual or Web site.

Chapter 1 Review • Level 1 (CPT) modifiers are 2-digit extenders that are appended to a CPT code. • Modifiers explain to a carrier that the descriptor of the CPT code has not changed but has been modified to explain unusual circumstances. • Modifiers appended to the CPT code designate the need for additional consideration. • Some modifiers are informational, whereas others affect proper reimbursement. • To support coding with modifiers, the practitioner’s documentation must clearly support the circumstance.

Some modifiers impact reimbursement, whereas others are informational and help get the claim paid without costly delay. indb 15 11/7/11 11:18 AM 16 CODING WITH MODIFIERS Modifiers can be appended to a CPT code, further defining the service and, therefore, increasing the likelihood of accurate payment. Using a modifier—a CPT or an HCPCS modifier—does not guarantee reimbursement. In some cases, the provider might be asked to provide a report and/ or documentation to support the service(s) billed.

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