1. C

    DME and KV Modifier

    I have been running into trouble with Knee brace denials that need to be billed with the KV modifier to Noridian . The trouble I am having is that our Medicare patients come back in for a DME fitting for the brace with a MA, and we are unable to bill an E/M out. Due to this I can not use the...
  2. B

    Hospice Modifiers

    Hello! I am coding for a Hospice group and all of our claims for a patient have been denied from Amerigroup Medicaid for modifier TG. I have looked at the website they provided and I cannot find a modifier for High/complex level of care that is Medicaid approved. Anyone have any ideas for what...
  3. A

    Post-op chemo and subsequent visits

    Any thoughts on this would be much appreciated. We have received several denials for subsequent hospital visits as "“Pre/post-operative care payment is included in the allowance for the surgery/procedure.” Patient had a biopsy of a mediastinal mass performed using the chamberlain procedure...
  4. J

    What modifiers do I need in this case?

    Hello all, I'm wanting to make sure that I am correct in my thinking of what modifiers I would assign in this case, so I would love it if I could get your help! The patient had an E/M visit in the domiciliary setting, along with toenail debridement, cerumen impaction removal, and cryotherapy on...
  5. eharloff

    Medicare denying G0444

    I'm in Michigan and when we do a Medicare Annual Wellness Exam, we always bill G0444-59 for reporting purposes when eligible. For some reason Medicare has denied it with CO-236 This procedure or procedure/modifier combination is not compatible with another procedure or procedure/modifier...
  6. A

    Modifiers - 92273/92274

    Seeking additional information on these codes. Provider is billing for both and recently there have been several denials stating the the required modifier is missing when being billed together. What modifier is the insurance referring to? Are there any other codes that may be considered bundled...
  7. M

    Question PT, OT and ST modifier HELP

    Can someone please assist me? NCCI edits state CPT code 97110 is a component of CPT code 92507. Would the modifiers GP (on 97110) and GN (on 92507) be sufficient to identify the two modalities as distinct and separate? Or would you need a XP, XS, XE, XU, 59?
  8. J

    Question Report Modifier 57 When Clearance Not Yet Obtained?

    Hello All, As the CPT guidelines for Modifier 57 state, "Decision for Surgery: An evaluation and management service that resulted in the initial decision to perform the surgery may be identified by adding modifier 57 to the appropriate level of E/M service [emphasis mine]," my assumption has...
  9. emeskina

    Please read! Too complicated to title, thank you!

    CTS performed a debridement and removal of sternal wires on patient with non-healing thoracotomy. Patient receives serial wound vac changes until wound is ready to close. Reconstructive Plastics specialist performs myocutaneous muscle flaps to close and CTS is the assist. Operative note...
  10. L

    Hospice Location Modifier

    I work for an ambulance provider and lately, we've been seeing people who have elected hospice and are being transported to a relative's home to receive hospice care. Would the destination (relative's home) be considered an R (residence) modifier or an S (scene) modifier? I can't find anything...
  11. L

    Medicare Hospice Location Question

    I work for an ambulance provider and lately, we've been seeing people who have elected hospice and are being transported to a relative's home to receive hospice care. Would the destination (relative's home) be considered an R (residence) modifier or an S (scene) modifier? I can't find anything...
  12. J

    Tech Testing

    Hello - A patient comes in for testing with a technician ordered by Dr. B. Dr. B does not review the results until the patients appointment a few days later, can you bill globally for the test on the day the test was administered? Or do you have to bill with a TC modifier on the day of testing...
  13. R

    GC Modifier

    Does anyone know if Medicaid accepts the GC modifier? We get denials on these but I cannot find anything on line to support the denial. thanks
  14. Y

    Debridement question

    Hello, I have the following codes for this case: 11042 – Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 sq cm or less 11045 - Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); each additional 20 sq cm, or part thereof...
  15. K

    26 and TC modifier

    I work for a pain management physician who also owns an ASC where he performs some of his procedures. I an responsible for the coding for his practice and the ASC and need some help on this. If he perform a 64490 in the ASC do I append the TC modifier to the claim for the ASC and then for his...
  16. C

    25 Modifier ONLY to be appended by certified coder?

    Hello! I am a CPC for the department OBGYN for a large medical group. just spoke with a member of management from the central billing office at my place of work, and they requested that I advise our billers that they may not append the modifier 25 to any office visit if they are not coders. I...
  17. S

    Multiple Units of One Code??

    I'm trying to code for gouty tophi excisions done on multiple fingers and can't figure out how to do this... The code I found to use is 26160 (if you have a better one for gouty tophi then by all means correct me). The doctor performed the excisions on the left index, middle, and ring fingers...
  18. C

    KP and KQ modifiers

    Hello, I've used the KP and KQ modifier for billing J0585 (botox) and J0588 (xeomin) for separate NDC numbers. My RCx Rules system is kicking back my charges stating "The modifier code associated with this charge is not valid for this date of service". I cannot find anywhere that these modifiers...
  19. C

    Novitas Solutions JL bundling of benign lesion of .5cm or less with closure

    Medicare is bundling excision of benign lesion .5cm or less with intermediate closure. Based on the CPT manual instructions that intermediate and complex closures should be reported separately, my physician wants to add a 59 modifier to the closure. It is my understanding that Medicare...
  20. M

    Facility Charge and Modifiers

    For a facility charge what modifiers are/are not, if any, allowed to be used? There is some discussion in the office and we are just trying to be sure what is appropriate. Thank you.
  21. S

    Modifier for Medicare E/M help

    Hi, My colleague and I would be grateful to someone who could advise us on the proper modifier to use for Medicare when the E/M rendered is unrelated to the patient's primary disability plan? Thank you!
  22. R

    36620 and 36556 line modifiers

    There is a debate in our office about A-lines and CVP lines requiring a laterality modifier. I have not used any laterality modifiers and unable to locate any guidelines to that affect. If this is so, is there written guidelines that I am unaware of stating this to be true? Any input to this...
  23. C

    Home visit for Hospice Patient

    I have a provider that will be doing a home visit to a hospice patient for a non hospice problem. How do we bill for this? Modifiers? Thank you!
  24. B

    Gastrostomy Tube w/Silver Nitrate

    Is there a modifier we can use so that we can bill both the G-tube change and the silver nitrate of hyper granulation tissue if performed on the same day
  25. A

    Twins: Vaginal birth then C Section. How to bill.

    Hospital billing for a pt that had twins; delivered baby A vaginally and then baby B via C- Section. Which modifier would be most appropriate? :confused: Thank you!
  26. D

    billing multiple injections and services the same visit: different dx? Correctly

    Hello, I work for a family practice that sees clients for multiple reasons within the same visit. Can you tell me if the scenario listed below is the correct way to bill for the visits with the modifiers? I am afraid that I am using to many modifiers and that I only need to utilize modifier 59...
  27. M

    Modifier RT or LT on J codes?

    Are modifiers required on J codes? I have read yes and no. Who knows the answer or where I can find the answer in writing?
  28. R

    Modifiers TC and 26

    Do the TC and 26 modifiers need to be used when the test is split up between 2 different office locations on different days? The 2 locations are in different states but in the same company. Thanks!
  29. E

    Is there a modifier to use when billing Non-digital X-rays?

    Medicare is supposed to be decreasing reimbursement to providers not using digital x-rays starting 2017. To date I can't find any info on the modifiers we are supposed to be using to indicate we are billing non-digital x-rays
  30. R

    Coding against Yearly limits IE capped for testing

    I am interested in allergy testing, if a commercial plan has a 365 day cap of 40, medicare allows 90 when properly coded and documented is there a way to code to allow for additional tests? i.e. Aetna caps 40 for 365 days, is it possible to overcome this limit? Would a Xu, Xe or -59 on line 2...
  31. C

    Billing normal bundled procedures on separate anatomical site

    I have a question regarding normally bundled procedures. I work in an orthopedic surgeon's office and we are running into problems with one of our payors who states that normally bundled procedures cannot ever be billed separately, even if they are on opposite knees. We are aware of Medicare...
  32. M

    Ambulance Broke Down During Transport

    Hi Guys, We are working in Ambulatory Transportation coding. I have came across a report in which the ambulance which was taking patient to hospital from scene broke down during transport to hospital when patient was on board, from where another ambulance picked up the patient and took him to...
  33. M

    Modifiers with Level 5, prolonger service, fingerstick, and flu vax and admin

    Hi all, One of our providers is billing: 99215 - level 5 established patient e/m 99354 - prolonged service 82962 - glucose fingerstick 90661 - flu vaccination 90471 - vaccine administration What I am confused on is what modifiers to use in this situation, and where. I believe 59 would go on...
  34. L

    Denial of multiple units of lesion excision (same CPT)

    We've recently started to see denials for excisions (same CPT) on the same claim. For example, 11403 x 3 units. Sometimes 1 unit will pay and other times none will pay with a message that the modifier used is incorrect or missing. We were able to get these paid until now with -76-59 on the...
  35. M

    Multiple Procedure Help, please! - We had a patient in our office

    Hello! We had a patient in our office who had multiple procedures done in one day and we are stumped on how to code this. The patient received a TDAP vaccine and we administered it. The patient also had 3 skin tags removed, 2 of which are biopsies. This is what we are billing: 90715 TDAP...
  36. S

    Mod 25 on Preventive w a Procedure?

    Crikey I must be having a Friday brain fart...can't find a definitive answer...not trusting myself... Patient seen for 99396 P/E + 69209 done to remove impacted wax found (No other E/M codes). I can add Mod 25 to the P/E because of the procedure, right? I need to do that, right? Agree or...
  37. C

    BCBS denials for duplication on Diabetic shoes

    I am new to the Podiatry billing and have been having difficulties getting our claims paid for Diabetic shoes, CPT A5512 with Modifiers KX, LT, RT & CPT A5500 with Modifiers KX, LT, RT. We usually bill for 2 pairs of shoes and 3 pairs of inserts; therefore, 2 units and 6 units. We have the...
  38. C

    OB/GYN Modifiers

    I just started coding OB today and need some help with modifiers, particularly the 59. When we are billing out for multiple CPT's (ex: 76805,76819, 76825) do we put a 59 on all procedures after the first listed? Please help!!
  39. R

    Modifiers 25 and 57

    How do I do this? New inpt initial hospital care (99221) with the decision for both procedures (19303, 90 day global) & (36561, 10 day global). Medicare patient. I used the 57 modifier on the 99221. Medicare denied 99221 so we appealed. This is the response from Medicare: We received an...
  40. A

    Physical status modifiers

  41. Y

    HCPCS code modifiers

    Medicare requires modifier w/A4352, A4402-This is new. What modifier should we use?
  42. H

    History of Anatomical codes, why is hand modifier -FA for thumb rather then a number

    I am try to figure out the history behind why with both hand and foot anatomical hand modifiers that the left thumb is -FA rather then a -F(number) like the rest of the fingers. And same with the toes.
  43. K

    GC Modifiers

    I'm trying to find information on the use of GC modifiers and Critical Care. Do you use the modifier with CC time since it's documented by the physician and the physician's documentation must meet CC requirements? If so or if not, where can I find the information? Thanks
  44. D

    E codes and DMEPOS modifier help!

    I'm instructing my first class in coding and my students are having a tough time with E-codes (when to use them) and HCPCS Level II modifiers (so many from them to choose from). I'm trying to find an easier way of breaking this down to them. I've searched the internet and can't really find...
  45. G

    Modifiers 62 and 80 for asc's

    Is it appropriate for an ASC to use modifiers 62 (two surgeons as primary performing distinct part of procedure) and/or 80 (assistance surgeon)? Based on the CPT Appendix A these Modifiers are not listed for ASC approval.;)
  46. K

    Using modifier 59 with RT and LT

    I have a doctor who bills for tubes as: 69436, RT 69436, LT, 59 At a seminar he just attended, he was told that he doesn't need the 59 since they are marked RT and LT. Is this true? He was told that this would "red flag" the claim.:confused:
  47. L

    Modifier usage for National Exam

    I'm confused. I'm taking the National Exam in a month, and I am taking an on-line course in preparation. AAPC has provided the instructor with all the answers for the Step-by-Step text book. The instructor keeps crossing out things and writing in her own. The latest one: Well baby check-up...
  48. A

    Modifier 52

    I was asked the other day about the use of Modifier 52 specifically as it relates to billing code 95974 (Electronic Analysis of Implanted Neurostimulator, First Hour. This is a time based code for the first hour of testing. Does a Modifier 52 have to be appended if the dosing time falls short of...
  49. B

    Use of -25 Modifier with in-office procedure

    Can anyone cite a source that will clarify if a -25 modifier appended to a 99214 E&M visit when 46916 times 8 was done in the office at the time of the visit for "golfer's elbow" (different DX for E&M service) procedure code? Wouldn't the level billed for the E&M exclude time spent performing...
  50. C

    Modifiers AF/AG/AM and GF

    We have mulitple specialties in our office, sometimes we get denied by insurances when 2 specialties see pts in hospital on the same day. Becuase of this one of our Physicians was told by another Physician that their coder attaches modifiers to everthing and gets paid. The codes she wants us to...