Wiki ER Facility CPT Modifiers and UB04

[jeannetala]

I'm in a pickle coding ER Facility for a new employer. The free standing hospital has only been open for 3 months. The coding manager insist that it' unnecessary to use modifiers on the Facility side, because the UB04 claim doesn't include the modifiers. We are only using modifiers on the ER Profee CMS 1500 HCPCS claim. In the past I have used mod -25, -59, -76,-QW, XU, TC, and CS where it applies. Will not having modifiers cause the Facility claims to be denied? The manager is also adamant that Facility pays a lumps sum amount and that we don't get paid for actual procedure. Can someone please explain this log and if modifiers are needed? Thank you.

 

[nickelclaw]

every facility has their own rules that being said. A UB-04 is still a UB-04 doesn't matter if hospital or free standing.
Maybe it is one your end that forms aren't allowing mods to stick.... That being said I would still add the mods if they fall off they fall off;
but at least you are sticking with coding guidelines by using them.

Is this considered a CAH- critical access hospital? If so then make sure the profee EM use AQ to state this
Usually these type of facilities are not in network with insurance companies maybe that is what the manager is trying to say it doesn't matter....
I would do as told per facility rules on this one. Good luck! If anyone else has thoughts please help her. Thanks