Cardiology Coding Alert


Turn to Modifier 32 When Outside Party Has Power to Mandate a Service

Don’t assume this modifier is for E/M only.

In some cases, your cardiologist may perform a service mandated by an outside entity. If so, you want to be sure to keep modifier 32 (Mandated services) on your radar to boost your reimbursement chances.

Check out this Q&A on adding modifier 32 to your claims for mandated services.

Q: In Which Situations Would You Use Modifier 32?

A: Use modifier 32 any time the provider performs a service that was mandated by someone or by a specific contract, explains Marcella Bucknam, CPC, CPC-I, CCS-P, CPC-H, CCS, CPC-P, COBGC, CCC, internal audit manager with PeaceHealth in Vancouver, Wash.

For example, a second opinion might be mandated by:

  • An insurer (though that’s becoming rare these days)
  • A worker’s compensation board
  • An auto insurer.

Also: “Courts and law enforcement can also mandate services,” says Bucknam.

Adding modifier 32 helps the payer identify the reason for the service, and can also help the office identify services that might be grouped together to a specific payer — such as an attorney. Modifier 32 can help you tag these claims, and keep them separate from other services that you might report to a payer, Bucknam advises.

Warning: “This modifier is not appropriate when billing Medicare for federally mandated visits for patients in a skilled nursing facility [SNF] or nursing facility [NF],” says Mary I. Falbo, MBA, CPC, CEO of Millennium Healthcare in Lansdale, Pa.

Medicare can make payment for these federally mandated services based on Medicare Claims Processing Manual, Chapter 12, Section 30.6.13.B.

Q: Is Modifier 32 for E/Ms Only?

A: No. It can apply to any service, although E/Ms are absolutely on the spectrum of modifier 32 eligible services.

Q: Who Is Allowed to ‘Mandate’ Services?

A: The mandate might be stipulated in a contract, if it’s a third-party payer. Most mandated services, however, are done under the direction of “courts in some legal action. It has to be mandated by someone with authority to command the patient to comply,” according to Bucknam.

If someone has the legal authority to mandate a service, they are “usually going to be someone who can either put you in jail, or fine you, or who has financial control of payment for your care,” Bucknam says. 

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