Question: I’m new to coding, having switched from our practice’s accounts receivable department about six months ago. I’ve been able to pick up the procedure/evaluation and management (E/M) coding pretty quickly, but I have a lot of trouble with modifiers. I have received my share of denials for claims I coded, and payers return a majority of them because they are “unprocessable.” I review each unprocessable claim with our coding supervisor, and inappropriate modifier use is almost always the reason for the denial. How can I get better at coding with modifiers?
Indiana Subscriber
Answer: Your problem is not an uncommon one. According to JA MAC Part B, the Medicare contractor for Michigan and Indiana, inappropriate modifier usage is one of the most common reasons for claim denial. For example, adding modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) to a procedure code will always result in a denial.
In order to mitigate claim denials from inappropriate modifier usage, JA MAC recommends that you:
JA MAC also offers these documentation tips to make your claims containing modifiers as clean as possible: