modifier help

dsmith06351

Networker
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I am having trouble understanding when to use the modifiers. Does anybody know where I can find iformation to help clarify modifier use?


Thanks for your help

Denise
 

carafry

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Did you review Appendix A of your CPT book? Sorry if I'm stating the obvious but a lot of people forget it's there.;)
 

MISSI

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This is the book that I used while working at Medicare and I use it now as a coder, it is by Ingenix and is it called Understanding Modifiers, it is a must to have in any office. I also use the PalmettoGBA website. Good Luck
 
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San Diego
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Hi,

I think that when coding and debating whether to use a modifier or not, you need to ask yourself if there is anything further you need to tell the payor that the procedure code doesn't quite do completely. Modifiers are used to enhance procedure codes, to provide even more info than the cpt code can do all by itself. For example:

  • Did this visit take place during a post op period? (-24)
  • Was there a procedure performed on the same date of service as this
    visit? (-25)
  • Did the MD perform this procedure on both sides (bilateral)? (-50)
  • Did the MD decide to do surgery because of what was found during this
    visit? (-57)

Hope this helps and Good Luck!
 

MISSI

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To elaborate more on the -24 mod, if the pt has a chronic condition then it should be paid regardless, or is by medicare usually, so make sure you are putting all DX's that are appropriate for the visit on the claim
 
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