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Outpatient Surgery E-Weekly

Malpractice Verdicts Often Favor Physicians

Physicians come out on the winning end of 80% of malpractice claims that end in jury verdicts, according to researchers at Massachusetts General Hos...

Study: CT Colongraphy Effective in Finding Polyps

A CT-scan-based, laxative-free "virtual colonoscopy" may be as effective as standard colonoscopy in finding potentially cancerous polyps, according ...

Wrong-Site Prevention Video Shows the Right Way

Wrong-site, wrong-patient and wrong-procedure surgery must be prevented at all costs. The 3 steps of the Joint Commission's Universal Protocol make ...

Archive > May, 2005 Vol. VI, No. 5

Coding & Billing

Six Common Modifier Errors

Lisa Weston, CPC-H, LHRM

Modifiers are an integral part of coding, used to indicate that some specific circumstance altered a service or procedure you performed, but didn't change its definition or code. Modifiers not only expand the information CPT codes provide, but payers also rely on them to maintain their claims and underwriting databases. Here are the six most common modifier errors we've uncovered in coding audits.

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1. Using modifiers with unlisted; 2. Using the Medicare required modifier ?SG on non-Medicare claims.; 3. Appending site-specific modifiers to multiple-site CPT codes.; 4. Using the multiple-procedure modifier in an ASC.; 5. Using toe and finger modifiers instead of foot and hand modifiers.; 6. Failing to report modifiers on the UB-92.; AMA CPT Assistant, April; ASC; ASC.The; American Medical Association; Appending; April; Assistant, April; Association; Bill; Brachytherapy ASCs; CMS; CPT; CPT Assistant, April; Coverage Determinations; Depending; Determinations; Failing; HCPCS; Local Coverage D... show all keywords
1. Using modifiers with unlisted; 2. Using the Medicare required modifier ?SG on non-Medicare claims.; 3. Appending site-specific modifiers to multiple-site CPT codes.; 4. Using the multiple-procedure modifier in an ASC.; 5. Using toe and finger modifiers instead of foot and hand modifiers.; 6. Failing to report modifiers on the UB-92.; AMA CPT Assistant, April; ASC; ASC.The; American Medical Association; Appending; April; Assistant, April; Association; Bill; Brachytherapy ASCs; CMS; CPT; CPT Assistant, April; Coverage Determinations; Depending; Determinations; Failing; HCPCS; Local Coverage Determinations; Local Medicare Review Policies; Medical Association; Medicare; Medicare Review Policies; Medicare. Medicare; Modifier; OPPS; Policies; Prostate Brachytherapy ASCs; Review Policies; Unit; access; accommodate; add; alter; altered; anatomical; and/or; answer; anterior; append; appended; apply; applying; approved; arthroscopic; assigned; basal; bilateral; bill; billable; biller; billing; bones; box; brachytherapy; bumped; carcinoma; carried; carrier; carrier-specific; cell; centrally; change; cheek; chondroplasty; circumstance; claim; claims; claims.You; cm; code; coders; codes; codes.Don't; coding; collateral; common; compartment; components; contract-mandated; contractually; correct; cruciate; debridement; definition; delays; denials; describes; description; descriptor; device; discontinued; due; ears; effort/skill; error; evaluation; excision; excludes; expand; fact; finger; fiscal; flap; foot; form; hand; head; identify; important; inappropriate; include; incorrect; individual; information; inserted; insertion; integral; knee; language; lateral; laterality; left; lesion; level; ligament; listed; loss; maintain; make; making; management; mandated; meaning; medial; medical; meniscectomy; metacarpals; metatarsal; metatarsals; mind; modifier; modifiers; modifiers.Another; multiple; multiple-procedure; multiple-site; necessity; non-Medicare; operative; osteotomy; paid; part; patellofemoral; payer's; payers; payment; perform; performed; performing; performs; phalanx; physician; place; policy; port; port-a-cath; priced; procedural; procedure; processing; programs; prostate; provider; rely; repair; repaired; report; reported; reporting; require; requirements; revenue; rotation; secondary; separate; service; services; site-specific; sites; software; space; specific; specifically; specifies; subcutaneous; submitting; time; toe; uncovered; underwriting; unit; unlisted; unnecessary; usual; values; vendor; venous; verify; writing

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