Respiratory Question for the Week of March 6, 2017

Question:

Can you provide any guidance as to when it is appropriate to assign a modifier to a CPT code for RT?

Answer:

Modifiers are used to clarify the actual studies performed. Ask yourself the following questions regarding modifier usage. If you answer “yes” to the question, then it is appropriate to use the applicable modifier:

• Will the modifier add more information regarding the anatomic site of the procedure?
• Will the modifier help to eliminate the appearance of duplicate billing?
• Would a modifier help to eliminate the appearance of unbundling?

Best practice is that modifiers are “appended” by the billing office or medical records staff and not “hard coded” on the chargemaster. However, modifiers may be appended by the technical staff when the health information system (HIS) provides an option for selection of the appropriate modifier at the point of order entry or result entry.

Medicare has observed abuses of modifiers and requires strict adherence to documentation guidelines. Improper use of modifiers is a compliance risk.

 

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