All About curative Billing, Coding & Claims Modifiers

Health Insurance Claim Form 1500 - All About curative Billing, Coding & Claims Modifiers

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Importance of Using allowable Modifiers:

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Health Insurance Claim Form 1500

1. The doctor performed many procedures

2. The procedure performed was bilateral

3. The E/M service was done on the same day of the procedure

4. The procedure was increased or decreased

5. The procedure has both pro and technical component

6. The procedure was performed by other provider (Anesthesiologist, Surgeon physical Therapist, Speech Pathologists etc.)

7. procedure on either one side of the body was performed

8. The E/M service was provided within the postoperative period

9. The E/M service resulted to Decision of Surgery

10. Unusual Circumstance

Maximize your reimbursement for bilateral procedures by using the precise modifier.

Bilateral Modifier (-50)

Depending upon the assurance payer, processing claims with bilateral procedure should be paid 150%

Medicare Part B requires one single line of bilateral procedure code with Modifier 50. They ordinarily process the claim with 150% reimbursement. But again, you have to check on this in your state and in your region.

Some industrial assurance would prefer Two Lines of the same code, once with 50, second without 50. Then second modifier on the 1st line is Rt or Lt, modifier Rt or Lt on second line, with 1 unit of service each code. Must be reimbursed at 150%

Some industrial assurance would prefer two lines of the same code with modifier Lt or Rt on each line with 1 unit of service each code. Must be reimbursed at 150%

Always check on your Physician's Fee schedule if the procedure code is billable as bilateral J.

Using Lt & Rt modifier is used to specify which side of the body the procedure was done by the physician. Medicare Part B based on my feel requires specific modifier, either Lt or Rt. Example you may report procedure 64626 done on the Right C4-C7 Facet Joint Nerve Ablation as 64626-Rt.

Modifier -26. pro Component.

Example: report procedure code 77003 - Fluoroscopic advice and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures (epidural, transforaminal epidural, subarachnoid,, paravertebral facet joint, paravertebral facet joint nerve or sacroiliac joint) along with neurolytic agent destruction) with modifier -26 to indicate the physicians pro Component only reimbursement and not technical component. If the provider's office owns the fluoroscopic equipment, do not append -26 modifier.

Modifier -25. Significant, Separately Identifiable evaluation and supervision service by the Same doctor on the Same Day of the procedure or Other Service.

Example: report E/M code 99213 (Office or other sick person visit for the evaluation and supervision of an established patient) with Modifier -25 for procedure code 20610 Knee Joint Injection done on the same day of the procedure. Modifier -25 indicates importance and cut off identifiable E/M service exterior the procedure done on the patient. Do Not use modifier -25 to report E/M service that resulted for first decision for surgery.

Instead use modifier -57 for Decision for Surgery

Modifier -24. Unrelated evaluation and supervision service by the Same doctor while Postoperative Period

Example: report E/M code 99213 with Modifier -24 if the sick person came back while the postoperative period. The doctor must recognize this service as completely unrelated with the up-to-date procedure done on the patient. A detailed medical documentation is a good keep for medical necessity.

Modifier -51 for many Procedures.

Modifier -59 for confident Procedural Service

Modifier-Gp Services Rendered under sick person physical Therapy plan of care

Modifier-Go Services Rendered under sick person Occupational Therapy plan of care

Modifier -Gn Services Rendered under sick person Speech prognosis plan of care

Always check your up to date Cpt Book. Check the Cms Cci Edits. Check the assurance payor's policies and guidelines.

What You Don'T Know Might Hurt You. If You Don'T Know It, Don'T Make It Up. Find It.

I hope you will get new knowledge about Health Insurance Claim Form 1500. Where you may offer use in your everyday life. And above all, your reaction is passed about Health Insurance Claim Form 1500.