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.
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Last Updated On
January 04, 2021
Originally Published On
March 23, 2010