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.
  • Contact your county medical society to schedule a 30-Minute Billing Cure day in your town, during which a TMA reimbursement specialist will conduct free (for TMA members only) 30-minute sessions with individual practices on topics such as coding, billing, payment, denial of services, or filing of claims. Each physician or office staff member who attends receives a packet of TMA resources on managed care, practice management, and more. Contact your county medical society to schedule a mini-consultation. For more information, e-mail  Genevieve Davis  at TMA.


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Last Updated On

June 03, 2016