Make Modifiers Work for You

Missing or incorrect coding modifiers are a common reason why claims are denied or physicians are paid incorrectly for their services. Follow these steps to make sure your practice uses modifiers correctly:

  • Research and review the modifiers appropriate for the procedures and services that you typically perform.
  • Research specific payers' guidelines and the CMS National Correct Coding Initiative (NCCI) edits regarding use of the appropriate modifiers.
  • Always refer to a copy of the most recent CPT manual.
  • When filing claims, place functional modifiers (those that affect payment) before informational modifiers.
  • Identify the place of service where the work is performed; some modifiers are different for physician services and for hospital outpatient services.
  • Make sure the medical record documentation supports the need for a modifier.
  • Have billing staff attend coding workshops regularly.

Remember, just because a modifier exists doesn't mean you can add it to a code. Modifiers justify your charges to insurance companies or other payers by explaining that some specific circumstances have altered a CPT code.

Help From TMA

  • If you need coding assistance, TMA Practice Consulting can help by conducting a coding and documentation review of your practice. By analyzing a representative sample of your practice's patient charts and corresponding explanations of benefits, claims, and fees, TMA's experienced consultants can identify problem areas, make recommendations for improvement, and provide on-site training in correct coding and documentation procedures. For information, e-mail TMA Practice Consulting or call (800) 523-8776.


TMA Practice E-tips main page

Last Updated On

January 04, 2021

Originally Published On

March 23, 2010