Sunday, September 26, 2010

Teaching Physician and other Medicare modifier

Teaching Physician
GC This service has been performed in part by a resident under the direction of a teaching physician.
GE This service has been performed by a resident without the presence of a teaching physician under the primary care exception.


Other Modifiers for Medicare Claims

AP Determination of refractive state was not performed in the course of diagnostic ophthalmological examination. No effect on payment.
AR Physician Scarcity Area
AT Acute treatment (chiropractic claims) - This modifier should be used when reporting CPT codes 98940, 98941, 98942 or 98943 for acute treatment. No effect on payment.
CB Services ordered by a dialysis facility physician as part of the ESRD beneficiary's dialysis benefit.
CC Procedure code change- CARRIER USE ONLY - Used by carrier to indicate that the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed. No effect on payment. Payment determination will be based on the "new" code used by the carrier.
EJ Subsequent claims for a defined course of therapy, e.g., EPO, sodium hyaluronate, infliximab.
EM Emergency reserve supply (for ESRD benefit only) - No effect on payment.
ET Emergency treatment - Use to designate a dental procedure performed in an emergency situation. No effect on payment.
GA Waiver of liability statement on file - Use to indicate that the physician's office has a signed Advance Beneficiary Notice (ABN) retained in the patient's medical record. The notice is for services that may be denied by Medicare based on the service not being medically necessary and/or reasonable . No effect on payment; however, potential liability determinations are based in part on the use of modifier.
GG Diagnostic Mammography - Use to indicated performance and payment of a screening mammography and diagnostic mammography on same patient, on the same day.
GH Diagnostic mammogram converted from screening mammogram on same day.
GJ "Opt Out" physician or practitioner - Use to indicate services performed in an emergency or urgent service.
GV Attending physician not employed or paid under agreement by the patient's hospice provider.
GW Service not related to the hospice patient's terminal condition.
GY Use to indicate when an item or service statutorily excluded or does not meet the definition of any Medicare benefit.
GZ Use to indicate when an item or service is expected to be denied as not reasonable and necessary. Used when no Advanced Beneficiary Notice (ABN) signed by the beneficiary.
G7 Pregnancy resulted from rape or incest or pregnancy certified by physician as life threatening
KX Specific required documentation on file.
KM Replacement of facial prosthesis - including new impression/moulage.
KN Replacement of facial prosthesis - Using previous master model.
KZ New Coverage not implemented by managed care.
LR Laboratory Round Trip - No effect on payment.
QA FDA Investigational device exemption (IDE) - The IDE project number must be included on the claim when modifier QA is billed.
QB Physician service in a rural HPSA - No effect on payment but generates a quarterly bonus payment.
QC Single channel monitoring - No effect on payment.
QD Recording and storage in solid state memory by a digital recorder - No effect on payment.
QJ Services/items provided to a prisoner or patient instate or local custody, however the State or Local government, as applicable, meets the requirements in 42 CFR 411.4(B)
QV Item or service provided as routine care in a medical qualifying clinical trial
QT Recording and storage on tape by an analog tape recorder - No effect on payment.
QU Physician service in an urban HPSA - No effect on payment but generates a quarterly bonus payment.
Q3 Liver Kidney Donor Surgery and Related Services - No effect on payment.
Q4 Service for ordering/referring physician qualifies as a service exemption -No effect on payment.
Q5 Service furnished by a substitute physician under a reciprocal billing arrangement - No effect on payment.
Q6 Service furnished by a locum tenens physician - No effect on payment.
SK Member of high risk population (Use only with codes for immunization).
UN Portable X-ray Modifiers; two patients
UP Portable X-ray Modifiers; three patients
UQ Portable X-ray Modifiers; four patients
UR Portable X-ray Modifiers; five patients
US Portable X-ray Modifiers; six patients
32 Mandated services - Services related to mandated consultations and/or related services (e.g., PRO, third party payer, governmental, legislative or regulatory requirement) may be identified by adding the modifier -32 to the base procedure.
59 Distinct Procedural Service - Under certain circumstances, the physician may need to indicate that a procedure or service was distinct or independent from other services performed on the same day. Modifier -59 is used to identify procedures/services that are not normally reported together, but are appropriate under the circumstances. This may represent a different session or patient encounter, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same physician. However, when another already established modifier is appropriate it should be used rather than modifier -59.  Only if a more descriptive modifier is not available, and the use of modifier -59 best explains the circumstances should modifier -59 be used. Correct Coding Initiative (CCI) Modifier -59 does not replace modifiers 24, 25, 50, 51, 78, 79, RT and LT.  Modifier -59 is not used on Evaluation and Management CPT codes.
99 Multiple modifiers - Under certain circumstance two or more modifiers may be necessary to completely delineate a service.  In such situations modifier -99 should be added to the basic procedure, and other applicable modifiers may be listed as a part of the description of the service (Medicare paper claims define in Item 19, electronic claims define in the free form field-narrative).  Use only when more than two modifiers are needed to describe a service. No effect on payment; however, the individual modifiers listed will apply, including any potential effect they may on payment.

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