Modifier Coding Alert
Calculate Your Pay
Using the previously mentioned example of a PA assisting in the open repair of a patient’s sternum (21825), here is the math behind the payments:
The MPFS assigns a total relative value unit (RVU) of $15.70 to code 21825.
When you multiply the RVUs by the 2014 unadjusted national conversion factor of 35.8228, you get the national allowable fee: $562.42. (Keep in mind that the conversion factor changes each year.)
The payment amount for a physician assisting at surgery is calculated as follows:
*The payment amount for a PA, NP, or CNS assisting at surgery is calculated as follows:
*Co-insurance or patient is responsible for the other 20 percent and any applicable deductible amounts.
Modifier Coding Alert
- Surgical Procedure:
Unjumble Assistant Surgeon Modifiers 80, 81, and 82
Multiply the MPFS calculation results by up to 85 percent. Coding a procedure can be [...] - Calculate Your Pay
Using the previously mentioned example of a PA assisting in the open repair of a [...] - Outpatient Modifiers:
Surprise! Modifier 59 for Repeat Procedures May Not Fly
Payers are jumping on board with CMS’s directive to use modifiers 76 or 91. When [...] - Specialty Focus:
Pediatrics: Match Modifier 63 to a Neonate Procedure
Look forward to a possible 20 percent increase in reimbursement. When your physician performs a [...] - You Be the Coder:
Attach Q0 to a Procedure in a Clinical Trial
Question: We’ve been billing Medicare implantable cardioverter defibrillator (ICD) implants (33249) with the Q0 modifier when [...] - Reader Question:
Include Modifier 25 with Smoking Cessation Counseling
Question: How should I bill for “smoking cessation” counseling (99406-99407) with 99214? Medicare denies my E/M [...] - Reader Question:
Turn Denials into Receipts with Modifier U8 or U9
Question: I am getting denials from a Medicaid Care Management Organization (CMO)Amerigroup, for deliveries stating the [...] - Reader Question:
Accept That Modifier 51 Isn't Appropriate With CMT Codes
Question: What modifier would I report for a patient who had a CMT (98940-98943) for three [...]
