Wiki Adding modifer

[oreyeszwirn]

Is it against the 'complaince rules' for the billing department to add a modifer that is required for reimbursement?

 

[FTessaBartels]

Depends

You should never add a modifier just to get paid. The purpose of the modifier is to alert the payor as to the specific circumstances of the service(s) provided.

So, it depends what modifier you are talking about. Our billing office routinely adds surgical modifiers which can be easily ascertained from the documentation. The coders read all operative/procedure notes and code from the note, not from what the surgeon might report.

However, they will NOT automatically add a -57 or -25 modifier to an E/M code if the provider did not so indicate on the encounter form. That's because they are billing off the superbill for clinic/office visits. They don't have the documentation in front of them, so they can't reasonably tell whether the E/M code is separately reportable.

Hope that helps.

F Tessa Bartels, CPC, CEMC