DON SELF & ASSOCIATES
USING THE RIGHT MODIFIERS TO GET PAID
The Number one reason we have seen claims denied, needlessly, is because of the lack of a modifier on the claim by the physician's staff. There are certain modifiers that almost every office should be using on a daily basis and if they are not using them, they are either losing money or they are not billing for all of the services they should be billing for.
Probably, the modifier that should be used most often is Modifer 25. Modifier 25 denotes the evaluation and management service is separately identified from any procedures performed or rendered on the same day. Many practices are still not using this modifier, but they do not realize it is a problem, since they do not charge for an office visit, if they are doing a procedure on the same day, WHICH MEANS THEY ARE LOSING THOUSANDS OF DOLLARS. If you do a procedure in your office for a different reason than the office visit, then you should be charging for the office visit AND the procedure, and making sure you pay attention to 2 (two) things:
Modifier 25 is on the Office Visit, and
You use a different ICD9 code for each service
If you are performing OMT (Osteopathic Manipulative Therapy), you may charge for both, using the same ICD9 code, in many states, depending upon your Medicare intermediary. Even if you are in one of those states, you must use modifier 25 on the office visit, in order to be paid for both.
A good example is a patient coming into your office for diabetes management and you discover that a minor procedure needs to be performed during the same session (such as Ear Lavage, Debridement of nails, Trigger Point Injection, Joint Injection, etc). You would use the 25 modifier on the visit code and charge for the visit and the procedure and be paid for both.
Another modifier that should be used quite often, and often it is not, thereby causing denials, is modifier 24. Modifier 24 should be used on evaluation and management services to denote they are not included as part of a global fee, when the patient has had a procedure performed prior to the visit. In other words, let's say the patient had a Hip Replacement surgery 80 days ago (which carries a 90 day global fee period). They come back into your office today for soreness in a knee joint, due to a fall they had getting out of the bath. If you filed a claim to Medicare for the office visit, for examining the knee and concluding it was a bruise, you wouldn't be paid for the visit, unless you used a modifier 24 on the visit.
Along the same lines, Modifiers 79 and GB should be used on procedures, when the...........
That's it for tonight. I think I am once again giving away too much information for free, and since all I have to sell is myself, I need to hold some back. If, after reading these articles, you are interested in talking to us about either performing and analysis of your practice or teaching a workshop in your area, please drop us an email. If you would like to talk to doctors that have had us perform an anlysis of their practice, who have also increased their monthly income by thousands of dollars per month, due to our recommendations, then drop us an email. If you would like to talk to folks who have either attended our workshop or state medical associations that have had us teach workshops at their conventions for years, drop us an email. In other words, we would like to hear from you, so ..... you got it.. drop us an email.
btw (which is chat language for By The Way), thanks for reading this. Whether you need our services our not, we would like to hear your opinion on these articles. -Don Self