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In some cases, procedure codes alone do not provide sufficient detail to convey the exact service or procedure performed to the payer. In these situations, Medicare or private insurers may require physicians to append a modifier to the procedure code listed on the claim to clarify the nature of the service. Physicians may use either … Read more
Modifiers 33 and PT are used to inform payers that a service provided was either initiated as or fully performed as a screening. These modifiers are essential when the HCPCS code used does not explicitly describe the service as a screening. Modifier -33 and Medicare Modifier -33 is not recognized by Medicare, which instead requires … Read more
Modifier -GG is used to indicate that both a screening mammography and a diagnostic mammography were performed on the same patient, on the same day. This modifier is added to the diagnostic mammography code to show that the procedure transitioned from a screening to a diagnostic test. Most payers will reimburse both the screening and … Read more
What is RVUs, wRVUs & RVU Calculator ? RVU stands for Relative value unit. It is a cost or value assigned for each CPT and HCPCS code by CMS (Centre for Medicare and Medicaid) for providing a service. It has majorly three components, physician work, physician expenses and malpractice overhead. The values of cost of … Read more
Basics of GERD ICD-10 CM code Gastroesophageal reflux disease (GERD) is a chronic digestive disease, which happens when a muscle at the end of the esophagus does not close. It occurs when the stomach content flows back into the food pipe(esophagus). This reverse flow causes reflux, that irritates the lining of your esophagus and hence … Read more
What is GP Modifier? The GP modifier indicates that a physical therapist’s services have been provided. It’s commonly used in inpatient and outpatient multidisciplinary settings. It’s also used for functional limitation reporting (FLR), as physical therapists must report G-codes, severity modifiers, and therapy modifiers. Be aware that some payers require use of a therapy modifier … Read more
Basics of Modifiers Modifier plays a key roles in modification of procedure and also in the proper payment. Modifiers helps in changing or altering the procedure based on the scenario or situation the exam is performed. We all know their are different payment and instructional modifiers. Payment modifiers direct affect the payment hence should be … Read more
Basics about modifier -27 and 25 Many times, we get multiple visit cases of same day for same patient in Emergency Department. In such scenarios, we have to use modifiers to avoid them as duplicate claims. I have already posted previously how and which modifiers are used in medical coding. We already know the most … Read more
Basics of PET scan CPT code 78815 & 78816 PET scan CPT code (Positron emission tomography) is coded very frequently in Radiology facility coding. PET scan is done to diagnose a condition or to check how condition is developing. Neoplasm can be in there initial stage or Restaging phase. These exams are not painful. PET … Read more
We have learnt about HCPCS level II modifiers in my previous post. Today, we will checkout the list of HCPCS ambulance modifiers used by medical coders in medical coding. Code(s) Description DD Diagnostic/therapeutic site other than P/H to another Diagnostic/therapeutic site other than P/H DE Diagnostic/therapeutic site other than P/H to a Residential/Domiciliary/Custodial fac. … Read more