by Lori | Jun 3, 2011 | CPT modifiers
Modifier 78 – Unplanned return to the operating room by the same physician following the initial procedure for a related procedure during the postoperative period It may be necessary to indicate that another procedure was performed during the postoperative...
by Lori | May 30, 2011 | CPT modifiers
Modifier 24 – Unrelated evaluation and management by the same physician during a postoperative period The following rules apply: * Modifier 24 is applied to only two possible code sets: evaluation and management (E/M) services (99201-99499) or...
by Lori | May 30, 2011 | CPT modifiers
Place of Service Crosswalk Type of Bill Type of Bill Position 1 (Type of Facility) Type of Bill Position 2 (Bill Classification) Place of Service* Place of Service Description 11X Hospital Inpatient 21 Inpatient Hospital 12X Hospital Inpatient 21 Inpatient Hospital...
by Lori | May 26, 2011 | CPT modifiers
Introduction Documenting the events of a patient visit is not always the simplest and most straightforward of processes. Many variables affect which information must be included in order to report a procedure or service accurately. Global periods are one of those...
by Lori | May 22, 2011 | CPT modifiers
REIMBURSEMENT GUIDELINES Oxford will reimburse a CPT or HCPCS code only once during the Defined Treatment or Monitoring Period. Multiple submissions of the same CPT or HCPCS code by the Same Physician, Hospital, Ambulatory Surgical Center or Other Health Care...
by Lori | May 18, 2011 | CPT modifiers
Renewed Moratorium on Outpatient Therapy Codes Section 4541(a)(2) of the Balanced Budget Act (BBA) (P.L. 105-33) of 1997, which added §1834(k)(5) to the Social Security Act (the Act), required payment under a prospective payment system for outpatient rehabilitation...
by Lori | May 16, 2011 | CPT modifiers
Modifier SG Fact Sheet Definition: • Services Performed at an Ambulatory Surgical Center* (ASC) facility Appropriate Use: • Do not use for dates of service January 1, 2008 and after. • Use on claims for the ASC facility services. • Claims must be submitted as assigned...
by Lori | May 13, 2011 | CPT modifiers
Q & A about modifiers Should modifier -52 (reduced services) be used for a procedure that is defined as bilateral by the CPT/HCPCS code when the provider was able to perform only one side of the procedure or service? Yes. It is appropriate to use modifier...
by Lori | May 11, 2011 | CPT modifiers
Modifier GY Fact Sheet Definition: • If the service provided is statutorily excluded from the Medicare Program, the claim will deny whether or not the modifier is present on the claim. Example: Patient transport is for a non-covered condition that does not meet the...
by Lori | May 6, 2011 | CPT modifiers
Modifier 79 – Unrelated procedure by the same physician during the postoperative period The physician may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. This...
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