Want More Cash? Better Pay Attention To Your Modifiers! It’s extremely difficult, especially when you combine the CPT modifiers with Medicare’s ever-changing regulations, to use modifiers accurately for a provided/ordered service. Therefore, if you’re not up to date on your modifier coding practices, you’re not only at risk of losing deserved pay, but it could also slow down your cash flow! To avoid this, take a look at our top four tips about modifiers.
1. Modifier 26
You can bill separately for an interpretation on a radiological service by using a modifier 26. Typically, a hospital/imaging center will bill for the equipment, room, film and technician. However, the physician’s interpretation often goes uncollected. If the physician who renders the interpretation is not employed by the hospital (where the test was completed) and is part of a different professional group, then the physician is entitled to his/her share of the reimbursement. In order to prevent losing this earned compensation, you should report the service with a modifier 26.
2. Modifier 58 and 78 – Difference?
Understanding the difference between modifier 58 and modifier 78 can substantially increase your collection rate and altogether avoid endless appeals with Medicare. Use modifier 78 when conditions arise from the initial surgery or, in other words, when a complication requires a return to the operating room for a related surgery during the postoperative period. A rule of thumb: Modifier 78 should be used when a postoperative procedure is performed unexpectedly. When a procedure is planned or anticipated at the time of the original procedure, or when it represents postoperative therapy, it is appropriate to use modifier 58. According to Medicare, the patient does not need to return to the operating room to report modifier 58, but the patient must return to the OR to qualify for modifier 78!
**Always check the op notes for clarification. The physician should dictate if the procedure was planned.**
3. Modifier 59
The Correct Coding Initiative (CCI) forbids billing two bundled codes on the same date. However, in some legitimate cases, CCI allows the use of modifier 59 to override an edit! You should only use modifier 59 when the services are separate, distinct, and medically necessary! Make sure you’re aware of all the opportunities to use modifier 59.
4. Modifier 50
Even though most procedures are unilateral and therefore ineligible for full reimbursement under its bilateral version, appending a modifier 50 to certain surgical procedures might alter how Medicare pays for the service. To determine if the procedures you perform qualify for a modifier 50, review the Medicare Physician Fee Schedule’s Column Z.
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By Scott Shatzman
