7 Common Medical Billing Modifiers

The Complexity of Modifiers

Modifiers become even more complex, with Level I Modifiers (CPT) updated by the AMA and Level II Modifiers (CMS) updated by the CMS. These coding modifiers in healthcare billing are used for a variety of reasons including:

• Some medical claims are incomplete or inaccurate.
• Some claims need a higher level of code specificity in order to properly submit the claim to insurance providers.
• The proper use of a claim modifier can quickly lower a healthcare practitioner's claim denial rate.
• The correct use of a modifier can increase the rate of reimbursement from an insurance provider.

The staff at RevUp Billing has put together seven common modifiers that are often encountered when delivering medical billing services. The following list is by no means exhaustive, but these are some of the most common medical billing modifiers.

Our 7 common medical billing modifiers include:

1. Modifier 24=Unrelated E/M service by the same doctor during a post-operative period.
2. Modifier 25=(Very common) The medical provider did extra work on the spot.
3. Modifier 26=Technical component (TC). There is both a professional and technical component to this procedure.
4. Modifier 27=(Not as common) Patient has multiple visits on the same day, by the same or different physician.
5. Modifier 51=Multiple procedures by the same provider at the same session.
6. Modifier 59=Linked services by the medical provider.
7. Modifier 76=Repeated by the same medical provider on the same day, but in separate sessions (excluding surgical codes).

Code modifiers are used in medical billing to provide additional information about a service or procedure. This information can be used to determine the correct reimbursement rate for the service or procedure. If modifiers are missing or not used correctly, claims are quickly denied or rejected by insurance payers. Healthcare practices will suffer from aged accounts, write-offs and revenue leakage if they do not have a firm grasp on the proper use of modifiers.

Proper use of code modifiers is essential for accurate medical billing. Omitting or using the wrong modifiers can lead to claims being denied, which can result in lost revenue for providers. Here are three general tips to follow in order to use code modifiers correctly:

• Always use the most current version of the CPT or HCPCS code book.
• Consult with a coding expert if you are unsure about which modifier to use.
• Document the reason for using a modifier in the patient's medical record.

Again, these are just a few of the many code modifiers that can be used. It is important to consult with a medical coding professional to determine the correct modifier for a particular healthcare service. They can help ensure that practices are using the correct modifier and that medical claims are processed correctly.

About Our Company

RevUp Billing provides experienced and professional revenue cycle management services for healthcare professionals. Our other services include insurance credentialing as well as billing/software services for I-DD provider agencies.

If you have additional questions about medical billing best practices and the use of code modifiers – contact us.

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Updated from original article published on October 26, 2016