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Wiki non workers comp modifer

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snjberry

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out of thousands of coders across the US no one knows what the modifer for Medicare is when a claim is NOT workmans comp or disability insurance related?
Someone must know. I'm sure I'm not the only one billing Medicare!
 
Modifiers?

First it is unclear what you are trying to modify. Is it a charges?

What type of charge is it and what are you trying to tell Medicare.
 
workers comp/ medicare modifier

To be more specific I billed a claim for OB/GYN cervical dyplasia...clm denied member has workers comp. This is not related to workers comp. I called medicare and gentleman I spoke with said I need a modifier that says this isn't workers comp related. I thought calling they would review but he didn't. However, he would not tell me what that was or if there even is a modifier. So I'm just wondering if anyone has used a modifier on a professional claim for claims that are not related. I have the boxes on the electronic claim that say no this is not workers comp. I found modifier 119 on Medicare site as he directed however, this doesn't work either.
If there isn't one then can someone tell me what they do in this circumstance.
Thank you
Sandi CPC, CPMA
 
snjberry said:
To be more specific I billed a claim for OB/GYN cervical dyplasia...clm denied member has workers comp. This is not related to workers comp. I called medicare and gentleman I spoke with said I need a modifier that says this isn't workers comp related. I thought calling they would review but he didn't. However, he would not tell me what that was or if there even is a modifier. So I'm just wondering if anyone has used a modifier on a professional claim for claims that are not related. I have the boxes on the electronic claim that say no this is not workers comp. I found modifier 119 on Medicare site as he directed however, this doesn't work either.
If there isn't one then can someone tell me what they do in this circumstance.
Thank you
Sandi CPC, CPMA
Click to expand...

I would just simply appeal this case. If box 10a on CMS-1500 says its not a work realated case, why would you have an additional modifier to state the same thing? What kind of job this woman has to have cervical dysplasia as work related disease?

FYI:
Causes, incidence, and risk factors

Most cases of cervical dysplasia occur in women ages 25 - 35, although it can develop at any age.

Almost all cases of cervical dysplasia or cervical cancer are caused by human papilloma virus (HPV). HPV is a common virus that is spread through sexual contact. There are many different types of HPV. Some types lead to cervical dysplasia or cancer.

The following may increase your risk of cervical dysplasia:

•Becoming sexually active before age 18

•Giving birth before age 16

•Having multiple sexual partners

•Having other illnesses or using medications that suppress your immune system

•Smoking
 
Last edited:
Just a thought ...

NOT my area of expertise (and I work in pediatrics so virtually never deal with Medicare) ... BUT ...

Perhaps this patient has had another claim for a work-related injury and is still in a global period for THAT procedure?

You'll need to find out from the patient about any other injuries/claims she has in process, even if they are unrelated to the reason YOU are seeing her.

Then ... if your claim is for an office visit try a -24 modifier.

Hope that helps.

F Tessa Bartels, CPC, CEMC
 
I've never heard of a modifier like that either...just checked with the Medicare collector in our office, she said that in this situation, she would contact MSP, advise that our claim is not work-related and point out to them that the diagnosis is different, and they should reprocess the claim.
 
I also have never heard of a modifier to indicate not workers comp related. You just dont check the box on the HCFA or electronic claim indicating comp. I would also appeal with the office note and a statement saying that the patients condition is not related, nor could it be related, to a comp injury.
 
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