MODIFIERS in healthcare / Basic Medical Billing / Basic RCMS

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  • Опубліковано 20 сер 2024
  • MODIFIERS in healthcare / Basic Medical Billing / Basic RCMS/ What are modifier codes?/ Medical billing Tips CPT Modifiers / Modifier 26, Modifier TC, Modifier LT, Modifier RT, Modifier 24, Modifier 25, Modifier 50, Modifier 51, Modifier 52, Modifier 54, Modifier 57, Modifier 59, Modifier 76, Modifier 77, Modifier 99, Modifier GV, Modifier GW, Modifier 80, Modifier AS, Modifier 62, Modifier XE, Modifier XP, Modifier XS, Modifier XU, Modifier QW, Modifier JW, Modifier 99,Concept of CCI and MUE table.
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    MOD : Giving additional information about treatment/procedure to the insurance company to process the claim. )
    26 - Professional component (Read Report)
    TC - Technical component (Using Equipment)
    LT - Left side
    RT - Right side
    50 - Bilateral
    24 - Unrelated E/M code performed during GLOBAL PERIOD or post operating period.
    25 - Unrelated E/M code performed ON SAME DAY.
    57 - DECISION Making Surgery
    51- Multiple Surgery
    59- DISTINCT PROCEUDRE ( CCI guidelines says : CORRECT CODING INITIATE: (Combination of procedure code performed or not i.e., YES or NO. ex: 36415 (VENIPUNCTURE=A collection/Draw of Venus blood ), 82565 59 (Lab test )
    Note: for Medicare Instead of 59 mod we use , XE,- Separate Encounter, XU-Non overlapping service , XP-Separate Provider, XS-Separate Structure
    76- Repeated procedure on same day by same doctor
    77- Repeated procedure on same day by diff doctor (@ diff Times) , MUE (Medically Unlikely Unit) Table says: Per MR , We can see diff times at TOS.
    GV- Service related to hospice but provider not employee of hospice.GW - Provider related or employee of Hospice but, service not related to Hospice.GA - Waver of liability statement of a file (indicates that an ABN on file allows the provider to bill patient if not covered by Medicare.80 - Assistant Surgeon (if MD/Dr works directly).AS - Assistant at Surgery (if NP/PA/AA/Mid-level providers works as an Assistant for Surgery).62 - Co-surgery (Combine together and get 50-50%).52 - Reduced Services (when a physician performs a bilateral procedure on one side only). 54 - Surgical Care only.91 - Repeat lab services on same day.QW - Described CLIA wave test (used for lab tests).99 - 2 or more than 2 modifiers one CPT.JW - For Medicare Part B drugs claim ( A & Q cpt codes).95 * - Telemedicine service done via audio & videos. Note that MCR & MCD will not recognize 95 mod.
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