Wiki Who can apply a modifier?

[amoskovich]

There is a discussion in my office. Legally speaking who is allowed to add modifiers to a claim?

I thought only Doctors and Certified Coders and/or Billers can apply the modifier.

There are many Doctors that have no clue what a modifier even is, forget about getting them to choose the correct one, can a non-certified biller or office manager apply a modifier to a claim if there is no CPC in the office.

Please advise (with a source if possible)
Thanks

 

[CodingKing]

If I'm not mistaken, I dont believe there is any requirement to be certified to assign any codes or to bill.

You would never code something just because the doctor tells you to. Their job is to practice medicine. Not to code, that's what office staff is hired to do.

Of course not having a certified coder does increase the risk of inappropriate billing which can lead to take backs or even worse prosecution

 

[ndebien]

Somebody who is well versed in modifier usage can apply one. You have to be careful because misuse can lead to red flags and trigger audits. It is very important to understand correct usage of modifiers, and not use them solely to get a service paid, or "un-bundling"
But you do not have to have a special certification in order to recognize when a specific modifier can be used..
Hope that's helpful

 

[honeybee]

I agree with the other posters also, you do not have to have a certification to apply modifiers and a doctor can apply them if necessary . It just depends on their level of knowledge and sometimes your specific office policy on how you do this. I work in PT and generally the coders apply modifiers but our therapists do have a flag that tells them when a patient has reached the medicare cap for therapy so they can decide if its medically necessary for them to continue and they actually apply the KX modifier themselves in most cases. Again this is based on specific info otherwise the therapists do not add other mods like 59 etc.