Modifiers– What is the big deal?

What happens when routine encounters or procedures are not so routine after all?  Things don’t always go as planned we have to have a way to say when something out of the ordinary happens during a routine encounter or procedure.  Remember that

Things don’t always go as planned we have to have a way to say when something out of the ordinary happens during a routine encounter or procedure.  Remember that

Remember that coders are storytellers, relaying the story of the encounter to insurance companies so that providers get optimum reimbursement for services rendered to the patient.  How do we as coders explain to the insurance company if a procedure took twice as long or perhaps did not take as long to complete as it typically does?

Modifiers are the answer to our question! typically 2 digits sometimes alphanumeric and sometimes numeric and sometimes only letters.

Modifiers are used to further explain the encounter or procedure, modifiers explain if a procedure went beyond the typical time, didn’t take as long as it normally does, or maybe the radiological exam was completed on both sides, the ear surgery to place eustachian tubes was only performed on one side when typically it is a bilateral procedure.

One of the most common reasons for rejecting a medical claim is the misuse of modifiers. You can find a list of modifiers in the front of your CPT book, HCPCS book. A description of modifiers is found in Appendix A of the CPT book.

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