Coding Corner: Give Your Basic Modifier Use a Checkup

You can report LT/RT for cataract surgery

Make sure you’ve got your billing and coding compliance basics nailed down. One carrier is preparing to put you to the test.

Cahaba GBA imposed a new set of “audit trail” edits starting March 1. It looks to see if providers are following basic compliance on several billing and coding issues, including:

· Using modifiers LC/LD/RC for coronary procedures. If you bill for a coronary procedure without one of these coronary artery modifiers, you may face a denial. “RC” stands for right coronary artery, “LC” stands for left circumflex artery, and “LD” stands for left anterior descending coronary artery.

· Using modifiers LT/RT for cataract surgery codes. You need to use these modifiers to identify which eye the surgeon operated on, Cahaba says.

· Using modifiers QX/QZ for CRNA. If a certified registered nurse anesthetist (CRNA) serves as the assistant anesthetist during surgery, you need to apply modifiers QX (CRNA service: with medical direction by a physician) or QZ (CRNA service: without medical direction by a physician) to let the carrier know if the CRNA had a doctor’s supervision. If an anesthetist supervised the CRNA, you’d also attach modifiers QY (One CRNA) or QK (Two to four CRNAs) to the anesthetist’s claim.

· Name of facility. Providers are forgetting to attach the name and address of the facility where they rendered services.

· The billing and rendering providers must be in the same group. On some recent claims, providers have attached a provider number that’s not associated with the group number on the claim, Cahaba says.

· Unspecified-procedure codes. If you use a miscellaneous supply code, such as J3490, you need to include a description of the services the physician rendered, or you’ll receive a denial, Cahaba says.

Watch for more Edits to come
The Medicare carriers in New York and New Jersey don’t seem to have edits like Cahaba’s yet, says Jim McNally, third-party coding specialist with Health Care Consultant Services in Flushing, N.Y.

“It wouldn’t surprise me if other carriers had these edits,” says Cindy Parman, CPC, CPC-H, RCC, co-owner of Coding Strategies in Powder Springs, Ga. “Most of them look like common-sense issues.”

Cahaba’s new edits are good news for providers, McNally adds. “The more specific the edit/denial is, the better it is for the physician,” he says. These edits will give coders a specific explanation of what information they left out, instead of a standard “information is missing or invalid” message.

Providers do sometimes forget to apply basic modifiers, such as the CRNA, left/right or artery ones, McNally says. “That is why I stress the use of modifiers in educational presentations.”

- Published on 2007-05-24