Medicare Compliance & Reimbursement

You may have modifiers 59 and 25 committed to memory, but you’ve also got access to dozens of other, less-utilized modifiers that you may not even know exist. Such is the case with modifier PC (Wrong surgery or other invasive procedure on a patient), which the Centers for Medicare & Medicaid Services (CMS) recently highlighted during a May 12 podcast called “Clarification of the Use of Modifiers When Billing ‘Wrong Surgery on a Patient.’”

Unfortunately, some practices are erroneously assigning modifier PC to reflect the professional component of a service, which in actuality should be reported with modifier 26 (Professional component). “You need to be aware that the use of the PC modifier on Medicare claims will result in your claim being denied,” CMS reps said during the podcast.

Because modifier PC leads to claim denials, you should think of it as an informational modifier to tell the payer that you made a surgical mistake. If, however, you’re trying to report the professional component of a service (which would be vastly more common), stick to modifier 26.