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modifier help

  1. Default modifier help
    Medical Coding Books
    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


  2. Default
    There is a book that AMA puts out:
    Coding with Modifiers - 2nd Edition - A Guide to Correct CPT and HCPCS Modifier Usage


    there is also the "2008 Modifier Coding Survival Guide"

  3. Default
    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.

  4. Default
    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

  5. #5

    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!
    Sylvia Thompson, CPC
    Billing Supervisor
    San Diego, CA

  6. Default
    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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