Proper use of CPT code modifiers - Practice Management Clinic

Ear, Nose & Throat Journal, Sept, 2003 by Steven F. Isenberg

CPT code modifiers provide additional details regarding various services. There are three ways to ensure that you are using modifiers appropriately:

* Use modifiers to improve reimbursement and avoid denials. Software technology is available that will prompt physicians to select all appropriate modifiers at the time of service (figure). (1)

* Know your payers' policies regarding the use of modifiers. Rules may differ among payers. (2)

* If the modifier is likely to reduce the amount of payment, leave the amount as is and let the payer reduce it when the payer receives the claim. If the modifier is likely to increase the payment, increase the amount on the claim before you file it; do not expect the payer to do it for you.

For example, you should assign modifier "-24" to any CPT code to designate any "unrelated evaluation and management service" that you provide during a postoperative visit. This would apply to, say, an office visit by a patient with serous otitis media (ICD 381.01) during the postoperative period following a procedure with a global period (e.g., laryngectomy, parotidectomy, or tonsillectomy). (3) If you do not attach the modifier, you will not be paid for that encounter.

Physicians are ultimately responsible for appropriate billing and coding. You may choose to continue to rely on another party to do your CPT coding and assignment of modifiers, but you are subject to their errors and omissions as well as their availability or lack thereof. Learning how to assign modifiers is easier than learning how to perform neck dissections and stapedectomies. There are a limited number of modifiers, and most are fairly straightforward, although there will always be some differences of opinion.

Technology is available that will remind you and allow you to assign appropriate modifiers at the time of each encounter and teach you which modifier to use as it displays the options in front of you.

References

(1.) Isenberg SF. Electronic "superbills." Ear Nose Throat J 2002;81:439.

(2.) Isenberg SF. Reimbursement basics. Ear Nose Throat J 2003;82:260.

(3.) Isenberg SF. Ensuring proper global payments. Ear Nose Throat J 2003;82:502.