Know Your Modifiers!

August 23, 2009

If you are in private practice, you MUST be familiar with the following three modifiers- otherwise, you are losing lots of money:

-24: This is added to the EXAM code (ie, 92012) during the post-op period (often 90 days after the procedure), when you are examining someone for a different diagnosis (i.e., conjunctivitis 1 month after cataract surgery). Without this modifier, the exam will be denied, as it will be assumed it’s a post-op visit.

-25: Add this to the EXAM code when you do a procedure on the same day- otherwise, you’ll be paid for the procedure only and the exam will be denied (ie, 92014-25  for cataract when you bill for insertion of collagen plugs for dry eye, too, on same day).

-79: Add this to any PROCEDURE CODE you do during the post-op period when it’s unrelated to the original procedure. Otherwise, it will be denied as part of the global fee for the original procedure (ie, removal of chalazion 1 month after cataract surgery).

There are other modifiers, but these three are the most important and come up very often. Make sure your biller understands what you are doing, and that each exam and procedure MUST be attached to a different diagnosis on separate lines.




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