General / Hot Coding Topics

Avoid These 5 Major Modifier Errors to Keep Your Cash Flowing

Reporting modifier 78 for a staged procedure? Expect denials.

When it comes to appending CPT® modifiers to your codes, the rules can be daunting, and Medicare’s regulations only compound the confusion. But if you’re up to speed on these key modifier billing practices, you’ll be raking in deserved pay.

Check out the following five tips to ensure that you aren’t missing any opportunities.

1. Don’t Avoid Modifier 26.

If your physician provides an interpretation and report for an x-ray or other radiological service in the treatment of a patient, that’s not always just part of his E/M—in some cases, you can separately bill for the interpretation and report by appending modifier 26 (Professional component) to the CPT® code.

Typically, the technologist that performed the patient’s x-ray will bill the code — such as 71010 (Radiologic examination, chest; single view, frontal) — with modifier TC (Technical component) to indicate that he is billing for the equipment, room charge, film and radiologic technician, but not for the physician’s interpretation. If the physician who renders the interpretation is with a separate professional group and is not a hospital employee, you should report the service with modifier 26 to obtain his proper share of the reimbursement.

2. Know the Difference Between Modifiers 58 and 78.

Because both modifier 58 and 78 describe procedures performed during another surgery’s global period, it can be easy to confuse them. But differentiating between the two can mean the difference between collecting your due and filing endless appeals.

Key: You’ll report modifier 78 (Unplanned return to the operating room for a related procedure during the postoperative period) when conditions arising from the initial surgery (complications) rather than the patient’s condition...

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July 20, 2011
Coding Challenge / General

Use -79 for Repeat Wart Freezing Within Global Period

Question: Eight days after an initial wart freezing, the patient returns, and the physician freezes another wart. Is the second procedure bundled into the first, or can we report it with a modifier? Answer: You may be able to report the second occurren...

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July 1, 2011
CPT Updates / Hot Coding Topics / modifier 76 / modifier 78 / Modifier GU / Provider News

CPT 2011: New Modifier GU and Revisions to 76, 77, and 78 Change Your Reporting

2011 adds a new modifier to your coding arsenal and updates the descriptors for several others you might often use. Get ready for modifier GU (Waiver of liability statement issued as required by payer policy, routine notice). You might have times when ...

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January 19, 2011
Coder's Cranium / modifier 58 / modifier 78 / modifier 79

Modifier 58, 78, 79 Tips to Get Postop Surgery Paid Correctly

Don’t miss out on extra pay when global period resets.

Just because you routinely append modifiers to your claims doesn’t mean you’re filing correctly and getting the most appropriate pay. Brush up on your modifier know-how with these tips for three of the trickiest choices: modifiers 58, 78, and 79.

Selecting between these modifiers can be carrier-specific in some situations, says Jacqui Jones, office manager for Benjamin F. Balme, MD, PC in Klamath Falls, Ore.

Remember All Possible Uses for 58

The descriptor for modifier 58 seems self-explanatory: Staged or related procedure by the same physician during the postoperative period. Coders sometimes trip, however, when they forget that modifier 58 actually applies to subsequent procedures that fall into one of three categories:

Planned or anticipated (staged):  A good example might be an infected hand that has to be debrided several times over the course of a couple of weeks. You won’t use a modifier on the first procedure, but will add modifier 58 on the subsequent procedures.

More extensive than the original procedure: The physician manipulates a patient’s ulnar fracture. An x-ray at the follow-up appointment shows that the reduction failed, so the physician completes pinning or an open reduction with internal fixation (ORIF). Code the procedure as needed (with 25545, Open treatment of ulnar shaft fracture, includes internal fixation, when performed, for example) and append modifier 58.

Therapy or treatment following a surgical or diagnostic procedure: This could apply to a soft tissue biopsy followed at a later date by malignant tumor excision.

You’ll only append modifier 58 to the second procedure if it occurs during the first procedure’s global period. The date of the second procedure resets the global period. You should expect 100 percent reimbursement for procedures you file with modifier 58.

Verify ‘Surprise’ Before Reporting 78...

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October 27, 2010
Coding Challenge / E/M / radiology

Radiology Medical Coders – Tighten Up Your LAP-BAND Coding

If your radiologist performs adjustments during the bariatric surgery’s global period, do this.

Question: Our radiologists perform percutaneous LAP-BAND adjustments. We report S2083 for the service and 77002 for the fluoroscopy. Is this the correct fluoroscopy code?

Connecticut Subscriber

Answer:...

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April 26, 2010
Hot Coding Topics / modifier 58 / modifier 78 / modifier 79 / surgery

Second Surgery Coding: Tips for Modifier 58, 78 Success

Don’t let ‘unplanned’ lead to ‘unpaid.’ The next time a patient takes an extra trip to the operating room, don’t let the added service throw your coding off track. Keep these tips in mind to know when to assign modifier 78 – or something else. Check for Surprise Versus Planned Two modifiers pertain to follow-up trips to the [...] Related articles:

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January 19, 2010
Coding Challenge / E/M / modifier 24

How Do I Bill For Follow-Up Visits After the Global?

Tip: Make sure the ICD-9 coding & documentation support follow-up visits after the global. Question: Code 19101 has a 10-day global period, which means you cannot bill an E/M for anything related to that procedure within that time frame. If the patient continues to have follow-up visits outside the global period, should we then report the [...] Related articles:

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January 11, 2010
Audit / Hot Coding Topics / MAC / modifier 58 / modifier 78 / modifier 79

Global Billing: Document ‘Unrelated’ for Modifier 79 Services

MACs are looking for ‘red flags’ to halt additional global period pay Billing for additional services during a global surgery period is always tricky, but now you can expect special scrutiny for modifier 79 claims. After the OIG got wind of fraudulent surgery billing with modifier 79 (Unrelated procedure or service by the same physician during the postoperative period), CMS contractors have been on the hunt [...] Related articles:

  1. These 8 Services Are Not Part Of The Global Surgical PackageIf you’re not reporting these services separately, you’re losing money....
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  3. Bone Up On ASC Orthopedic Coding With These Global Period, Modifier Tips 3 ways your physician claim better look different than...

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January 7, 2010
Coding Challenge / modifier 54 / modifier 55

Cataract Surgery Coding: When Optometrist Provides Postop Care

We’ve got the modifier you need when the ophthalmic surgeon passes the baton. Question: An ophthalmic surgeon performs cataract surgery, and then turns the patient over to the optometrist for postoperative management only. How should I code between the two providers? Do I need a modifier? Answer: If the ophthalmic surgeon turns the patient over to the [...] Related articles:

  1. Optometry Coding: Eye Exams, Cataract Surgery and Co-ManagementE/M or Eye Code? Choose Wisely With These Documentation Tips...
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  3. Cataract Removal Eye-Opener: 66984CPT 66984 is the number-one procedure performed in ASCs, according...

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December 7, 2009
Coding Challenge

Coding News Coding News – News about Coding 2009-11-30 23:00:02

Split Postoperative Cataract Care Question: An ophthalmic surgeon performs cataract surgery, and then turns the patient over to the optometrist for postoperative management only. How should I code between the two providers? Do I need a modifier? Washington Subscriber Answer: If the ophthalmic surgeon turns the patient over to the optometrist for all 90 days of postoperative care, the optometrist will report 66984 [...] Related articles:

  1. Optometry Coding: Eye Exams, Cataract Surgery and Co-ManagementE/M or Eye Code? Choose Wisely With These Documentation Tips...
  2. Bone Up On ASC Orthopedic Coding With These Global Period, Modifier Tips 3 ways your physician claim better look different than...
  3. Medical Coder’s Modifier 25 Checklist Append 25 with the greatest of ease … Appending...

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November 30, 2009