office visit cpt 99211

1. Understanding The List Of Medicare Modifiers Most people do not understand the list of medicare modifiers and when they should be used. A Medicare modifier should not be used just for getting higher reimbursement. Modifiers should not be added on just to get a particular code paid. In fact, modifiers should only be used when it is required to describe the service rendered or procedure performed more accurately. Among the modifiers included in the list of medicare modifiers, Modifier-59 is considered to be very crucial. Modifier-59 is described as under some circumstances; the doctor may have to imply that a particular service or procedure was independent or distinct from any other services which were performed on the same day. Among the several modifiers under the list of medicare modifiers, Modifier-59 is the most misused modifier. The correct reason to use Modifier-59 is to show that more than two procedures were done on the same visit but on different parts of the body. However, it is unfortunate that many times, it is being used to prevent or delay a service/procedure from being added or bundled in with the other services on a similar claim. Modifier-59 should not be used to prevent a procedure or service from being added/bundled or for bypassing the insurance’s edit system. To use Modifier-59 to imply a separate and distinct service, proper documentation must be present in a patient’s medical file for substantiating its use. The insurance carriers may sometimes request the medical records to verify whether the Modifier- 59 was used appropriately. If the provider is thinking of billing using Modifier-59, then they have to make sure to document the services which were provided in the particular patient’s file to show that the procedures and services were separate and distinct. Billers should not add the Modifier-59 to a claim even after knowing that billing the procedures/services without it would result in a denial or bundling. But, the Modifier- 59 should be added only by a coder or provider who can access a patient’s chart. For more information please visit http://www.medicalbillingcptmodifiers.com/2011/05/modifier- 79-with-example-usage.html