1500 Health Insurance Claim Form - All About healing Billing, Coding & Claims Modifiers
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1. The doctor performed many procedures
2. The course performed was bilateral
3. The E/M assistance was done on the same day of the procedure
4. The course was increased or decreased
5. The course has both pro and technical component
6. The course was performed by other provider (Anesthesiologist, Surgeon corporeal Therapist, Speech Pathologists etc.)
7. course on either one side of the body was performed
8. The E/M assistance was provided within the postoperative period
9. The E/M assistance resulted to Decision of Surgery
10. Unusual Circumstance
Maximize your repayment for bilateral procedures by using the accurate modifier.
Bilateral Modifier (-50)
Depending upon the assurance payer, processing claims with bilateral course should be paid 150%
Medicare Part B requires one single line of bilateral course code with Modifier 50. They regularly process the claim with 150% reimbursement. But again, you have to check on this in your state and in your region.
Some market 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 assistance each code. Must be reimbursed at 150%
Some market assurance would prefer two lines of the same code with modifier Lt or Rt on each line with 1 unit of assistance each code. Must be reimbursed at 150%
Always check on your Physician's Fee program if the course code is billable as bilateral J.
Using Lt & Rt modifier is used to specify which side of the body the course was done by the physician. Medicare Part B based on my experience requires exact modifier, either Lt or Rt. Example you may record course 64626 done on the Right C4-C7 Facet Joint Nerve Ablation as 64626-Rt.
Modifier -26. pro Component.
Example: record course 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) together with neurolytic agent destruction) with modifier -26 to indicate the physicians pro Component only repayment and not technical component. If the provider's office owns the fluoroscopic equipment, do not append -26 modifier.
Modifier -25. Significant, Separately Identifiable estimate and supervision assistance by the Same doctor on the Same Day of the course or Other Service.
Example: record E/M code 99213 (Office or other patient visit for the estimate and supervision of an established patient) with Modifier -25 for course code 20610 Knee Joint Injection done on the same day of the procedure. Modifier -25 indicates importance and detach identifiable E/M assistance exterior the course done on the patient. Do Not use modifier -25 to record E/M assistance that resulted for introductory decision for surgery.
Instead use modifier -57 for Decision for Surgery
Modifier -24. Unrelated estimate and supervision assistance by the Same doctor while Postoperative Period
Example: record E/M code 99213 with Modifier -24 if the patient came back while the postoperative period. The doctor must identify this assistance as fully unrelated with the up-to-date course done on the patient. A detailed medical documentation is a good hold for medical necessity.
Modifier -51 for many Procedures.
Modifier -59 for clear Procedural Service
Modifier-Gp Services Rendered under patient corporeal Therapy plan of care
Modifier-Go Services Rendered under patient Occupational Therapy plan of care
Modifier -Gn Services Rendered under patient Speech determination plan of care
Always check your up to date Cpt Book. Check the Cms Cci Edits. Check the assurance payor's policies and guidelines.
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