Practice Management Alert

Brush up on your modifiers, billers: You are your practice's last line of defense against charging out claims that payers may deny because of modifier mistakes.

Modifiers "ensure that there is accurate reimbursement" for services rendered, says Catherine Brink CMM, CPC, president of Healthcare Resource Management Inc., in Spring Lake, N.J. Modifiers indicate to the payer that though the CPT code accurately applies to a procedure or service, the physician did something a little bit differently than normal. Sometimes this difference warrants increased reimbursement.

That's why everyone in your office needs an adequate knowledge of these coding "enhancements," says Victoria Jackson, administrator and chief executive officer of Southern Orange County Pediatric Associates in southern California.

Check your modifier knowledge before you post any more inaccurate claims: Take this short True/False test to see where you stand. Check your answers in article 8. Answers are provided by Jackson and Brink.

1. True or False: You can append modifier -22 to all services, including services that are not primary.
2. True or False: If your physician provided a preventive physical exam on the same day as an E/M service, you can't append modifier -25 to that service. (See "Reader Questions" for more modifier -25 info.)
3. True or False: Modifier -21 appended to an E/M code indicates a very prolonged service. Use it for time spent on an E/M service that doesn't warrant bumping up your code to a higher level.
4. True or False: If you have multiple procedures provided by the same provider on the same day, use modifier -51.
5. True or False: If the physician determines that he doesn't need to do the full procedure once the procedure has started and the patient is already under anesthesia, you should append modifier -52 to that procedure code.
6. True or False: If one physician sets a fracture for a patient who has been in a motor-vehicle accident and requests a plastic surgeon to repair the wound in the same session because it's so bad, append the second code with modifier -80.