Wiki Modifier for Medicare E/M help

[Sec322@gmail.com]

Hi,

You may have already seen this question in the modifier forum, but I thought it wouldn't hurt to add it here as well. I hope someone has an answer.


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!

 

[thomas7331]

I'm not aware of any modifier for this purpose. I may be misunderstanding your question, are you speaking of a patient who is on Medicare due to disability, or a patient who has a plan covering the disability that pays primary to Medicare? If it's the former, it's my understanding that when a patient receives Medicare due to disability, it is a comprehensive medical coverage and is not just limited to services related to the disability, so there would be no need to indicate this on the claim form. However, if you're speaking of a patient who has another plan that is covering a disability due to an employment-related or other type of accident, you would indicate this in box 10 on the CMS-1500 form by checking 'yes' or 'no' to the questions to indicate whether or not the condition being treated is related to any of those things.