modifier

  1. G

    Wiki G6024 and PT modifier.

    Okay, we know that Medicare is denying G6024 with a PT modifier. So my question is, how do I bill this so that they pay it?https://www.aapc.com/memberarea/forums/images/smilies/confused.png
  2. A

    Wiki Modifier TD

    Does anyone use modifier TD for services performed during an RN only visit? For example, patient comes in for a B12 shot which was ordered by the provider. Patient brings in product, the only service to bill is the 96372. Do you add the TD modifier to indicate this was a nursing visit billed...
    • arrana
    • Thread
    • modifier patient provider results visit
    • Replies: 1
    • Forum: Modifiers
  3. T

    Wiki 52 vs. 53 modifier

    When a physician is unable to insert an IUD what modifier is used?
    • teemarie1310
    • Thread
    • insert iud modifier physician unable
    • Replies: 1
    • Forum: OB/GYN
  4. J

    Wiki Help!!!! Ortho coding

    I have a patient that was seen in ER on 12/2/15 and then went directly to the office to be seen. The PA saw him and billed 25600 and then on the same day he went back according to the notes and was admitted for outpatient Surgery, The dictated operative report on 12/2/15 by the physician is...
  5. T

    Wiki Medicare - government funded

    Can we bill Medicare for the 22 modifier, asking for more money since they are government funded?
    • TishCpc
    • Thread
    • funded government medicare modifier money
    • Replies: 2
    • Forum: Modifiers
  6. A

    Wiki Breast Reconstruction with serratus fascia flap

    I have a physician who has been using a serratus fascia flap in lieu of alloderm on certain patients. He wants to bill 19357- for the insertion of the tissue expander and 15734- serratus flap. Now I know that there is a conflict with theses two codes without a modifier. I thought 19357 included...
  7. T

    Wiki Modifier 22 - Does anyone know if medicaid

    Does anyone know if medicaid and the hmo superior health will pay additional money for the modifier 22 on cpt?
    • TishCpc
    • Thread
    • additional cpt modifier money pay
    • Replies: 2
    • Forum: Modifiers
  8. J

    Wiki Modifier QW - Does anyone know

    Does anyone know if the new Medicare UDS codes of G0477/G0478 require the CLIA Waived modifier QW? I don't want claims denied for not adding the modifier or vice versa. Thanks!
  9. A

    Wiki Billing Endoscopy Codes

    Can CPT code 31276 Rt be billed with 31296 LT. I checked the CCI edits and it indicated that it could but required a modifier. Possibly -50 bililateral. Please advise
  10. J

    Wiki Modifier ET

    Hello everyone. Currently our office is out-of-network with UPMC. Our physician is plastics/hand specialist and is on-call at our local hospital. He often gets called for UPMC patients. Recently, he has found modifier ET and wants to affix it to all his codes because he thinks he should be...
  11. D

    Wiki question re allograft

    new office I work in (spine surgeon) constantly billing 22633 22842 63047 and 20930 - denial are indicating that 20930 is included, I know 20930 cannot take modifier 59 but is this true does anyone have any feedback on this thank you
  12. C

    Wiki Modifier 59 help

    IBC stopped paying my claims for 2 e/m's (an office visit and preventive visit) and a flu shot . The claims had a 25 modifier on them but now all of a sudden because of NCCI edits I am being told that I have to use a 59 modifier. Is anyone familiar with this modifier - can you tell me if...
  13. D

    Wiki cci edit

    i have a silly question, in the cci edits from medicare, when it says standard of medical/surgical practice does that mean you can add modifier 59 to the code in the second column, or if anyone knows where I can get a list of what they mean, thank you
  14. M

    Wiki Medicare denial for 88305 and 88342

    I got denial for 88305 and 88342 from Medicare. According to remittance advice modifier(S) was missing. Do I need to apply modifier 59 to 88305? I am confused I did not know that any modifier needed for those codes.
  15. P

    Wiki 97610

    Medicare is wanting a Therapy modifier on the 97610. This is performed in the office. Anyone know which modifier it should be?
    • PARKER
    • Thread
    • 97610 medicare modifier office therapy
    • Replies: 3
    • Forum: Modifiers
  16. R

    Wiki MUE of 1 but a bililateral procedure

    If Medicare has a MUE of 1 but the CPT can be billed bilaterally, can you bill this with a 50 modifier and get paid for both sides?
  17. D

    Wiki e/m and xray

    the new office I work in are putting modifier 25 on all office visits with xrays, is that necessary? please help :(
  18. L

    Wiki laparoscopic prostatectomy with open anastomosis

    Hello all, i have this patient who had laparoscopic prostatectomy with PLND...... anastomosis between urethra and bladder neck trails failed due to narrow pelvis, so open anastomosis was performed ..... how should i code this? i know that laparoscopic prostatectomy code is 55866, i was...
    • lbarbar
    • Thread
    • anastomosis code laparoscopic modifier prostatectomy
    • Replies: 1
    • Forum: Urology
  19. S

    Wiki Removal of benign lesion

    A patient was seen for removal of a benign skin lesion. I billed the insurance with CPT 11443 (excision benign skin lesion of face/ears/eyelids/nose/lips 2.1-3 cm). I received a denial stating a modifier is required for this code. I am unfamiliar with what modifier I am to use. I would really...
  20. D

    Wiki 73510

    hi i need help i am new to orthopedic and they keep getting denials that 73510 with a modifier is not valid procedure code and or modifier, something like that i am not 100% sure, can someone give me some info on this code please thank you
  21. T

    Wiki 58572/58660

    When coding 58572, is lysis of adhesions bundled in this or can you also report 58660 with modifier 51? Or should 58572 be reported with modifier 22? It does not say that 58572 cannot be reported with 58660. I am just confusing myself with the more I read.....
    • tracylc10
    • Thread
    • 58572 58660 modifier read reported
    • Replies: 4
    • Forum: OB/GYN
  22. O

    Wiki Anyone ever used the CR modifier?! (Catastrophe/disaster-related)

    Hey, y'all. Has anyone ever seen or used this 'CR' modifier?! I'm in Texas and even with our tornado and hurricane disasters, I've never seen this one before. I can find CMS info but would like to hear from someone who has actually used this and what was the result? Catastrophe/disaster...
    • orthotrauma
    • Thread
    • claims disaster hcpcs medicare modifier
    • Replies: 3
    • Forum: Modifiers
  23. N

    Wiki 2 providers 1 patient same day DIFF.SPECIALTIES

    What modifier can I use for denied claims when 2 providers see the same patient on the same day? Long term care setting. A NP sees pt then the physiatry doctor sees the patient. Same practice but one provider is a specialist and the other is a physicians assistant or NP... we get denials but I...
  24. J

    Wiki Modifier 59 - bariatric practice

    Our office is going back and forth regarding the following issue: We are a primarily bariatric practice, however my surgeon typically repairs a hernia (cpt code 43281) while she is there is she notices it. Can we bill cpt code 43770 with 43281 (with modifier 59)? or should this be modifier 51?
  25. A

    Wiki Vaccine for children

    Can somebody help me with the State supplied vaccine for children Modifier. I`ve been using the Mod SS for more than a year, all of the sudden mostly of the NJHEALTH claims have been denied for wrong Modifier. Can also somebody give an example on how to post a well visit with vaccines
  26. M

    Wiki Ear wash

    I billed 69210. Pt had bilateral procedure. The guidelines state to use modifier 50 for bilateral. It rejected stating "procedure is inconsistent with modifier." Do I bill each one separately with modifier 50 on one of line items? I first filed w/modifier 59, then saw that 50 was needed. TIA Judy
  27. I

    Wiki GC Modifier- we are getting denials

    Hello, we are getting denials from Medicaid when billing codes 99215, 99213 and 99214 with modifier GC when the services were provided by a resident under the supervision of a teaching physician. We are sending the claims with the teaching physician Medicaid NPI number. When we called Medicaid...
  28. L

    Wiki Modifier 79-Osteoarthritis

    Hello, Can anyone tell me if I have a fractured toe (still in global period) but the patient comes in for a bilateral routine knee injections do I put the modifier 79 on both injection codes or just one. Ex: M17.0 - B/L Osteoarthritis 20610 RT - 79 20610 - LT - 79 of do you only...
    • LLRodgers
    • Thread
    • 20610 codes injection modifier osteoarthritis
    • Replies: 2
    • Forum: Orthopaedics
  29. K

    Wiki Breast Reconstruction

    Bilateral mastopexy augmentation is the procedure performed. I think I might be reading into it too much and confusing myself. I was thinking 19316 and 19325 both with a modifier 50. However, I have been looking at 19342, however the patient did not have a mastectomy...
  30. K

    Wiki 77080 documentation

    When a provider has the Dexa Scan done in their office and they bill without a TC or 26 modifier are they required to have the scan AND interpretation report or is the scan enough documentation?
  31. G

    Wiki Is a modifier required for a shoulder injection when the ICD10 code is lateral?

    I was just informed by an auditor that I was missing the RT modifier attached to the 20610 but I'm not sure if this is right or not. The DX is M75.41 impingement syndrome of right shoulder. If the ICD10 clearly specifies which shoulder, I did not think a modifier was required. Anyone know the...
    • gr8gal61
    • Thread
    • icd10 impingement modifier required shoulder
    • Replies: 4
    • Forum: ICD-10
  32. btadlock1

    Wiki Drawing a blank...

    I don't think I should need a modifier, but I can't be sure, so I wanted to check... Patient comes in and sees Dr. A, and has laceration repair on their left shin. It's reported as: 99202/25, 12004/LT. 3 days later, he comes back in with another cut on the same shin, in pretty much the same...
  33. gost

    Wiki Modifier effective dates

    Does anyone know if such a creature exists as a comprehensive modifier list with effective and term dates?
    • gost
    • Thread
    • effective date modifier termination date
    • Replies: 0
    • Forum: Modifiers
  34. T

    Wiki Office Visit with GYGZ modifier...?

    Working in a chiropractic office... On an initial patient exam we have been billing the office visit, 99201 with the -25 modifier, and it has been rejected over and over by Medicare. We have since began billing the 99201 with GYGZ in the modifier box. " Modifier GY should be used when...
  35. krburke

    Wiki How best to report bilateral 20610 to Medicare

    One of my providers has given 20610 injections in both knees. How does Medicare want to receive these codes? These are the options I came up with: 20610-RT x 1 unit 20610-LT x 1 unit OR 20610-50 x _ units? Would this be billed as 1 or 2 units? Any other modifier besides -50? I have not had...
  36. M

    Wiki Discontinued Procedures

    Quick question - If a procedure is discontinued/cancelled due to contraindication do you use a modifier when billing the anesthesia for this procedure? Thanks Missy Heuer CPC
    • missyah20
    • Thread
    • anesthesia billing cpc-medical-coder modifier procedure
    • Replies: 4
    • Forum: Anesthesia
  37. D

    Wiki Mohs Reimbursment

    I am having trouble with Health Net Federal Services reimbursing Mohs procedures when multiple units are billed on one line. Also they are still applying modifier 51 to the first repair procedure. It's obvious their system edits are not correct and they have told me it does not matter what...
  38. J

    Wiki CPT codes 64475 and 64476

    If anyone has experience on coding for CPT codes 64475 and 64476, I will appreciate your help. When billing Medicare, I have a Pain Management provider who does MULTIPLE BILATERAL injections utilizing CPT codes 64475 and 64476. In the past, I used to bill these with a RT and LT modifier along...
  39. M

    Wiki Interventional Procedures

    Our vascular physicians have been told that they can bill for attempted angioplasty/stent placement. We have received conflicting information as to whether we can bill for this or not and what modifier is appropriate...52 or 53? Anyone doing this?? Thanks.
  40. S

    Wiki Radiology modifier 59 questions

    I have some questions on the proper use of modifier 59 in regards to Radiology. Is it correct that when you have multiple views of an area and single on the same day that modifier 59 is the appropriate modifier to use? Also, in regards to 72020 and for example 72100, is it appropriate to...
  41. M

    Wiki Discharge Question

    I have a patient whose surgery was performed by one physician and was then discharged by another. Can I bill for this, and if so do I need a modifier? The diagonsis for the surgery and the discharge diagnosis are different. Thanks.
  42. R

    Wiki Immunizations at the same time as Prevent Med

    We have an insurance company telling us that we have to put a 25 modifier on the prevent med codes 9938? - 9939? in order to get paid for the immunization administration code 90471-90472. They tell us that it is part of the CPT coding guidelines, page 369 of the professional edition. I have not...
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