We are engaged in a discussion at my organization about the EP modifier. I code for a specialty department at a large hospital/clinician group. I started about a year ago and in training was told to append the EP modifier to our E/M charges if the patient was 21 and under and had a Medicaid plan. Something didn't sit right and in researching this and talking about it with my colleagues I'm not sure this is accurate billing. We don't have documentation from our clinicians that they're participating in a screening as part of the EPSDT/HCY program and their services are diagnostic/treatment rather than screening/preventive.
Are EP modifiers only to be used for PCP visits during which the screening examination is occurring or for other vision/dental/etc. screenings? We aren't getting denials for using the modifier but that doesn't mean it's correct.
Are EP modifiers only to be used for PCP visits during which the screening examination is occurring or for other vision/dental/etc. screenings? We aren't getting denials for using the modifier but that doesn't mean it's correct.