Accuracy matters! I recently saw where Novitas Medicare Intermediary receives nearly 1.7 million requests from Part B providers each year to correct minor errors or omissions of claim-specific information, which costs time and money for providers and the Medicare Program. Did you know the most requested claim correction is adding, changing, or deleting a modifier?
A modifier provides the means to indicate that a service or procedure that was performed has been altered by some specific circumstance, but not changed in its definition or code. Modifiers can be two digit numbers or two character alpha-numeric indicators. The purpose of using a modifier is to enable health care professionals to effectively respond to payment policy requirements.
1. Ensure the most current CPT and HCPCS coding manuals are used
2. Review modifier definitions in the CPT and HCPCS manuals to select the appropriate modifier
3. Determine if there is documentation to support the services reported
Achieve bullseye-accuracy by using our Modifiers Page to ensure proper coding when indicating a service has been altered by a specific circumstance.
Please review the top modifiers of concern to ensure correct billing and coding of services.
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Modifier
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Definition
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59
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Distinct Procedural Service
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25
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Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service
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24
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Unrelated Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional During a Postoperative Period
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79
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Unrelated Procedure by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period
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50
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Bilateral Procedure: Unless otherwise identified in the listings, bilateral procedures that are performed at the same operative session should be identified by adding the modifier 50 to the appropriate five digit code
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