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Student in need of help!!!!

  1. Default Student in need of help!!!!
    Medical Coding Books
    Hello everyone, I am a student in need of help. I have a question. Although I am a student I also am externing at a doctors office In class we did not learn exactly which insurances use modifiers. I want to cry because I do know that medicare doesnt use certain modifiers, while medi-cal does. But for PPO insurances such as Prudent buyer, bxbs, etc who does? I have a patient aged 10 who has taken the hpv and flu shots, do I use the modifier sl for this? I really like externing but I am also lost, is there a listing of some sort or rather a cheat sheet that can help me. Also how do I go about correcting medicare denials, these were made before I started but the manager wants me to correct them. This is also something I did not learn in class.

    Maybe I need to re-nroll in a different school

    thank you very much

  2. #2
    Location
    Longmont Colorado
    Posts
    22
    Default modifier help
    I just recieved an advertisement from Medicalcodingshop.com about webinars they are offering for the proper use of modifiers - this might save you from having to re-enroll in an entirely different program. If you want to email me directly (my email address is below in my signature line), I will forward the article to you - I tried to copy and paste it here but then the links didn't work.

    Good luck!
    Brad Howard, CPC, AHIMA Approved ICD-10 CM/PCS Trainer
    McKesson Specialty Health
    brad.howard@mckesson.com

  3. #3
    Location
    St. Cloud, MN
    Posts
    58
    Default Medicare denials
    I found that when I started, they threw me in denials (before I was certified and just starting) and that was the best thing that happened to me. You learn as you go from your mistakes, as well as others. They are very helpful to tell you what is wrong with your claim, not so much as to how to fix it but they will point you to their policies that you can find your answer. More and more insurance companies are turning to CMS/WPS for guidelines that I believe they all will end up following these guidelines. Good luck and remember, each day you will leave smarter than you came

  4. #4
    Location
    Columbia, MO
    Posts
    12,843
    Default
    All carriers recognize the CPT (HCPC Level I) modifiers. The HCPC level II modifers (like the sl) are definitely used for Medicare but are picked up by other carriers at their discretion. You must remember that carriers only build so many edits into the electronic edit system, it is cheaper that way. Just because a modifier comes back with a jection as invalid does not mean that carrier does not accept it. If it is a CPT (level I) modifer then yes they accept it (HIPAA says they accept it) but they cannot adjudicate it electronically whcich means it will have to be sent via a paper claim. I have run into this several times. You cannot query a payer as to which modifer you should use, but you can ask them if this modifier can be electronically adudicated which they will answer. I hope this has been of some assistance for you.

    Debra A. Mitchell, MSPH, CPC-H

  5. #5
    Default
    only medicaid insurance require you to use the SL modifier on the vaccines unless you are billing the H1N1 vaccine then there is no modifier...also if it is medicaid plan then you can only bill $15.43 and the vaccines are supplied from the state...any private insurance do not require to bill with a modifier at all but make sure with private insurance to bill your admin. codes 90471-90474 and if there is counseling then the admin codes are 90465-90468, but you cannot bill admin codes to medicaid....Hope I helped
    Kelly, CPC, CPEDC

  6. #6
    Location
    St. Cloud, MN
    Posts
    58
    Default H1n1
    Medicaid will pay the admin fee for H1N1 in MN anyway, I am not sure which state you can not bill them, but in MN they do pay it. They will not pay for the vaccine as -SL means state supply and they give it to you free of charge, but they will pay for the nurses time, etc... for administering.

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