Optometry Coding & Billing Alert

Question: We read lots of information about CPT 2011 code changes, but are there any modifier changes we should be aware of?

Kentucky Subscriber

Answer: This year it is important to know about a few new modifiers, as well as some revisions to existing CPT modifiers.

For example, three existing CPT modifiers now include nonphysician providers in the descriptors, as follows:

• 76 -- Repeat procedure or service by same physician or non-physician provider
• 77 -- Repeat procedure or service by another physician or non-physician provider
• 78 -- Unplanned return to the operating/procedure room by the same physician or non-physician provider following initial procedure for a related procedure during the postoperative period).

In previous years, some payers didn't allow non-physician providers to report their services with these modifiers since they specifically addressed "physician" care. Updating the descriptors should make it easier for you to report situations represented by modifiers 76, 77, or 78 to your payers.

In addition, CPT introduced modifier 33 (Preventive service), which allows you to tell your payer that you performed a preventive service and that the patient's deductible and coinsurance do not apply under the new Patient Protection and Affordable Care Act (PPACA) rules.

New ABN modifier: You have a new modifier GU (Waiver of liability statement issued as required by payer policy, routine notice) to use in some cases when you should not use the revised modifier GA (Waiver of liability statement on file; individual) for advance beneficiary notifications (ABNs). Medicare hasn't yet provided instructions for correctly reporting modifier GU.