Coding with Modifiers: A Guide to Correct CPT and HCPCS by Deborah J. Grider

By Deborah J. Grider

The final word modifiers resource-revised! crucial parts to the coding technique, modifiers aid create transparent and concise communications among the supplier and payer. Coding with Modifiers offers information on how and whilst to take advantage of modifiers that allows you to stay away from expensive check delays and denials. utilizing the 2012 code set, the fourth version includes new, deleted and revised modifiers, in addition to updates to facilities for Medicare & Medicaid companies, third-party payer, and AMA-modifier guidance to help with coding accuracy. Coding tips-explain tips to use particular modifiers to assist solve confusion surrounding modifier utilization Modifiers authorized for hospitals and ASCs-provide details for pro carrier and health facility reporting necessities educating tools-allow you to create and administer assessments utilizing questions and solutions constructed through the AMA medical examples-guide readers in settling on the proper modifier to take advantage of with important situations Test-Your-Knowledge questions-test your comprehension of the cloth with greater than a hundred ninety questions

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Extra resources for Coding with Modifiers: A Guide to Correct CPT and HCPCS Level II Modifier Usage [With CDROM]

Example text

5. These Level 1 modifiers were introduced in 2006 to indicate: a. genetic testing. b. physical status. c. performance measures inclusions and exclusions. d. none of the above. 6. Modifiers explain: a. that a code has changed in its definition. b. that a code has not changed in its definition but has been modified. c. that reimbursement should be higher. d. b and c. 7. What is an antidote to an incorrect reimbursement rate? a. Modifiers b. Unbundling c. Billing claims during the global period d.

Each year in the United States, health care insurers process more than 5 billion claims for payment. For Medicare and other health insurance programs to ensure that claims are processed in a consistent manner, HCPCS Level II codes were developed. indb 14 11/7/11 11:18 AM CHAPTER 1 ~ INTRODUCTION TO CPT MODIFIERS 15 products, supplies, and services that are not included in the CPT code set. Level II HCPCS codes were established for submitting claims for these services. The development and use of Level II HCPCS began in the 1980s.

In many cases, there are not additional or add-on codes to describe the increased complexity of the service. In these cases, modifier 22 should be appended to the CPT code(s). Documentation must support the substantial additional work and the reason for the additional work such as time, increased intensity, or technical difficulty of the procedure performed by the practitioner. Modifier 22 is appropriate in reporting unusual operative cases, such as the following: • Trauma extensive enough to complicate the particular procedure and that cannot be billed with additional procedures • Significant scarring requiring extra time and work • Extra work resulting from morbid obesity • Increased time resulting from extra work by the physician CMS Guidelines The CMS Medicare Carrier Manual (Publication 100-4, chapter 12, B3-4822 [10]) indicates that for modifier 22, the relative value units for services represent the average work effort and practice expenses required to provide a service.

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