Gastroenterology Coding Alert

Veterans recommend grouping modifiers by function for training If you're looking for a quick run-down of basic modifier concepts to keep handy for training purposes in your gastroenterology office, use these time-tested pointers provided by a veteran coding trainer. Don't Skimp on Modifier Training The right modifier is often the difference between an approved and a rejected claim, says Carol Buck, CPC, author of a series of coding instruction manuals, including Step-by-Step Medical Coding. To neglect modifier training for new coding employees is unwise; even though it may save time now, you could be paying for it in the future. Group Modifiers for Easier Understanding When you teach modifiers, group them by function, says Laureen Jandroep, OTR, CPC, CCS-P, CCS, director and senior instructor for CRN Institute, an online coding certification training center based in Absecon, N.J., and AAPC National Advisory Board Member.

"For example, teach all of the global-package modifiers as a group, then all of the modifiers related to the number of surgeons in the operating room (co-surgery, assistant at surgery, etc.)," Jandroep says.

Also, remind new coders that if the patient is not in a global period, then none of the global-package modifiers apply, "so know when your global periods end to avoid unnecessary modifier use," Jandroep says. Jandroep suggests that you stress the following modifier fundamentals. Exhaust Other Options Before Using -59 Modifier -59 (Distinct procedural service) is the modifier "of last resort." The CPT definition for -59 (in Appendix A of CPT 2004) directs coders not to use -59 "when another already established modifier is appropriate."

This is a common code modifier for gastroenterology offices because of all of the National Correct Coding Initiative (NCCI) edits that bundle different techniques unless you use modifier -59. Attach Modifier -62 Only When Codes Jibe You should use modifier -62 (Two surgeons) only when the co-surgeons share the same CPT code. If they can individually represent their work with their own CPT codes, then they don't need to use modifier -62. Example: In a gastroenterology office, coders would most likely use modifier -62 on the endoscopy with a PEG-tube placement procedure (CPT code 43246, Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with directed placement of percutaneous gastrostomy tube). Modifier -21 Is Only for Level-5 Services You can append modifier -21 (Prolonged evaluation and management services) only to the highest-level codes per category/subcategory.

For example, if the gastroenterologist provides prolonged E/M services for a new patient, you would append modifier -21 only to new patient code 99205 (Office or other outpatient visit for the evaluation and management of a new patient, hensive history; a comprehensive examination; and medical decision-making of high complexity). [...]