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Modifiers in Medical Coding: How to Avoid Billing Error

Numbers represent the codes for modifiers in medical coding.Modifiers in medical coding are essentially phrases added onto the end of the sentence formed by the normal code. Where coding provides the basis for the language that unites healthcare organizations and payers, modifiers provide an extension to that language as rules and regulations with Medicare and payers are added or changed.

Some medical practices incorrectly believe that modifiers in medical coding are unnecessary, but they are an important part of avoiding abuse, non-compliance, and fraud. No medical practice wants to face huge HIPAA fines. But it’s also good to note that modifiers in medical coding often cause more mistakes; in fact, it’s one of the biggest causes of billing error overall.

Most modifiers in medical coding are designed to represent the item or service given. However, they all fall into one of two levels (one for each level of HCPCS codes): Level I are updated annually by the AMA (American Medical Association). Level II are updated instead by CMS. Both levels are two-digit modifiers.

If you are added modifiers in medical coding, here are a few facts to remember:

  • Calling in to review adding a modifier just because a service was denied is not always appropriate.
  • A review will be requested when adding the following modifiers to a denied service: 24, 25, 26, 58, 59, 76, 78, or 79.
  • If a modifier does not result in a paid claim, it isn’t appropriate to try another one.
  • To support a modifier, you can say that “additional documentation is available upon request.” (Don’t forget to follow up with the documentation when requested. Lack of documentation is a big reason for denial.)
  • Report modifiers 24, 25 and 57 only on procedural and management codes.

 

Inappropriate code/modifier combinations will be denied as unable to be processed and required that the claim be resubmitted. Avoid this extra work by outsourcing the coding and billing needs of your medical practice. Billing Advantage experts take the responsibility of these tasks off of your shoulders so that your clinic can focus on practicing medicine. Find out if you quality for our affordable standard services.


Donna Whipple Donna Whipple

Donna Whipple, Psy.D. is a clinical psychologist with over 30 years of management experience. She has particular interest and expertise in HIPAA and ethical treatment and business practices in a changing high tech industry. She has a particular talent in boiling down complex regulations so providers can understand and comply with them. As co-owner of Billing Advantage Inc., Donna is involved in all aspects of the company but her particular contributions to the business is in mentoring upper level managers and helping them be more effective in their leadership.


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