HCPCS Modifiers Right and Get the Reimbursements You Deserve

Modifiers are certainly important for reimbursement and compliance; if you use them correctly, you can have a positive impact on your reimbursement. Modifiers are two digit codes that modify a service or procedure under certain circumstances. These modifiers may add information or change the description and give more specificity to the service or procedure provided. Append the right modifier and see how your reimbursement heads for the better.

Modifier assignments can be quite intriguing to coders. When trying to understand if a modifier is correct, ask if the following apply:

Was the same service carried out more than once on the same day?

Will a modifier do away the appearance of duplicate billing?

Will the modifier add more information on the anatomic site of the procedure?

If these circumstances apply, then it may be just right to go ahead and append a modifier to the procedure code. Also see to it that the documentation in the medical record supports the use of the modifier.

The modifiers are divided into two levels:

Level I

Level II

The Level II modifiers are called HCPCS modifiers and are annually updated. These HCPCS modifiers are alphanumeric or two letters. Sometimes insurers ask suppliers that a HCPCS code must be accompanied by code modifier to provide added information regarding the service identified by the HCPCS code.

Normally, HCPCS Level II modifiers are required to add specificity to the reporting of procedures carried out on eyelids, fingers, coronary arteries and toes.

Using the HCPCS modifiers the right way will certainly see your reimbursements look up.