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.
Understanding the Basics of Urology Coding
Coding urology claims is a critical aspect of medical billing for urology practices. Accurate coding ensures that healthcare providers are reimbursed appropriately for the services they provide, minimizes claim denials, and helps maintain compliance with regulatory standards. However, the complexity of urology procedures, the frequent updates to coding guidelines, and the need to stay abreast of payer-specific requirements can make this task challenging. This article offers comprehensive tips to help a urology practice, or coder navigate the intricacies of coding urology claims effectively. ICD-10-CM Codes The International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes are used to describe diagnoses. In urology, these codes cover a wide range of …
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 …
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 …
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 …
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 …
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 …
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, …
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 …
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 …
Avoiding Claim Denials For AMCC Tests
Avoiding Claim Denials For AMCC Tests When billing with medical modifier codes for automated multi-channel chemistry it is important to bill correctly to prevent denial. When a patient has end-stage renal disease it is important to use the 50/50 medical billing rule. This rule requires automatic multi-channel chemistry tests to be correctly identified on claims. Recently, the Centers for Medicare & Medicaid services has decided to deny laboratory claims that do not comply with this rule. The correct medical billing modifier for an automatic multi-channel chemistry test is required in order to prevent this denial from occurring. This is required when ever a medical end-stage renal disease facility or a …
