Wiki WC bills for Anesthesia modifiers

[stephschmalzried@yahoo.com]

I am taking the CPB course and still learning and I am a biller for WC claims and I have been getting denials for the anesthesia cpt code 01638 that either coding has added one of the PHYSICAL STATUS MODIFIER's (P1 thru P6) or has not added it. For Work comp charges is the PHYSICAL STATUS MODIFIER's needed? I have work comp insurances that will deny the code because it has the either has one of the modifiers with the code and then I get some that will deny because it does not have one of the modifiers. My manager states that these modifiers are only for Medicare charges and we should not be billing them to work comp charges. I am confused on what payer should be billed with these and what payer should not be billed. My research I have found is conflicting. some say medicare doesn't accept them and others say medicare does. Does anyone know the real answer to whom and how to use the PHYSICAL STATUS MODIFIER's? hope this is not confusing.

 

[sls314]

I am taking the CPB course and still learning and I am a biller for WC claims and I have been getting denials for the anesthesia cpt code 01638 that either coding has added one of the PHYSICAL STATUS MODIFIER's (P1 thru P6) or has not added it. For Work comp charges is the PHYSICAL STATUS MODIFIER's needed? I have work comp insurances that will deny the code because it has the either has one of the modifiers with the code and then I get some that will deny because it does not have one of the modifiers. My manager states that these modifiers are only for Medicare charges and we should not be billing them to work comp charges. I am confused on what payer should be billed with these and what payer should not be billed. My research I have found is conflicting. some say medicare doesn't accept them and others say medicare does. Does anyone know the real answer to whom and how to use the PHYSICAL STATUS MODIFIER's? hope this is not confusing.

You would need to check the work comp billing roles for the state in question. Each state would have its own billing rules for workers compensation, and the rules can vary widely from state to state.

If you're billing workers compensation for Montana (guessing based on your profile location), you can start your research on this site: https://erd.dli.mt.gov/work-comp-claims/medical-regulations/montana-work-comp-fee-schedules

That link has the fee schedules for each provider type, and also the administrative rules for billing Montana Workers Compensation.

 

[sls314]

I did poke around that Montana Work Comp site, and they have a spreadsheet of modifiers they accept. P1-P6 are on that modifier list, which means that there are at least some circumstances where the P status modifiers are accepted by Montana WC.

You may have to dig a little deeper into the billing manuals to see if there are any further guidelines on how they want the modifiers to be used and under what circumstances.

 

[stephschmalzried@yahoo.com]

You would need to check the work comp billing roles for the state in question. Each state would have its own billing rules for workers compensation, and the rules can vary widely from state to state.

If you're billing workers compensation for Montana (guessing based on your profile location), you can start your research on this site: https://erd.dli.mt.gov/work-comp-claims/medical-regulations/montana-work-comp-fee-schedules

That link has the fee schedules for each provider type, and also the administrative rules for billing Montana Workers Compensation.

Thank you so much for your help.

 

[MH3550]

I am taking the CPB course and still learning and I am a biller for WC claims and I have been getting denials for the anesthesia cpt code 01638 that either coding has added one of the PHYSICAL STATUS MODIFIER's (P1 thru P6) or has not added it. For Work comp charges is the PHYSICAL STATUS MODIFIER's needed? I have work comp insurances that will deny the code because it has the either has one of the modifiers with the code and then I get some that will deny because it does not have one of the modifiers. My manager states that these modifiers are only for Medicare charges and we should not be billing them to work comp charges. I am confused on what payer should be billed with these and what payer should not be billed. My research I have found is conflicting. some say medicare doesn't accept them and others say medicare does. Does anyone know the real answer to whom and how to use the PHYSICAL STATUS MODIFIER's? hope this is not confusing.

Hi Steph, I am in Montana as well and have this same issue- Mostly we just keep track of what WC insurance needs the physical status modifier and add it accordingly. We do not have anesthesiologists at our facility, but our CRNAs document the physical status for us so it is easier for us to add if it is needed. Are you at Benefis?