Whether a person is looking to become a partner in a medical practice or already owns one, knowing the nuances of medical billing can help avoid costly fines or denials. PracticeForces specializes in managing all aspects of medical finances and offers the following insights into how a coding modifier in medical billing can improve accuracy and thus reduce delays and denied claims.
What Are HCPCS Modifiers?
Part of the Healthcare Common Procedure Coding System, modifiers are two alpha-numeric characters the billing specialist adds to the Level I or II CPT codes established by the American Medical Association. They provide additional details about the associated expense without affecting the HCPCS code's meaning.
A provider can use modifiers to indicate that the service differed slightly from the traditional code set or offer details the code descriptor doesn't include. As such, they increase the accuracy of medical billing and reduce the likelihood the health insurance company denies a claim based on lack of detail or apparent conflicts.
Important Modifiers and HCPCS Codes for Improved Billing Accuracy
Medical billing specialists should memorize the following modifiers to help increase the accuracy of their billing.
24
This Level I code stands for a significant yet separately identifiable evaluation of management service by the same physician on the same day of the procedure or other service.
26
Experts call this Level I code the professional component. The PC indicates a professional performed an interpretive service (such as reading X-rays) but didn't perform the actual test.
59
Identified as the distinct procedural service code, modifier 59 describes any procedures performed at different places on the body when they're not traditionally done on the same day. For example, the code could describe a provider that takes an X-ray of the chest and then the foot. Billing coders can use modifier 59 for both surgical and non-surgical procedures.
91
Coders can use Level II modifier 91 when a provider uses same-day repeat tests. The tests must use individual samples taken at different times and don't include repeated tests performed because of problems.
E1
This Level II code stands for the upper left eyelid. It's just one example of extremely specific codes billing specialists should remain aware of for more complete accuracy.
XS
Also, a Level II code, XS, stands for a separate structure. The billing specialist uses this when a provider performs a service on a separate structure (bone, organ, etc.) of the body.
For quality medical financial management and billing, contact PracticesForces. Speak with a team member by calling (727) 202-5429 to learn more about HCPCS modifiers.
