Friday, April 29, 2011

New modifiers? Stay alert!

Modifiers play a key role in your day to day coding life. As such, you stand a better chance of getting the payments if you are well-versed with everything relating to modifiers. As an orthopedic coder, you need to stay on top of all modifier changes which in turn will have an impact on your orthopedic coding practice.

In 2011, it's important that you are aware of a few just-in modifiers as well as some changes to the present CPT modifiers.

This year add several just-in modifiers to your coding armory and update the descriptors for various others you might use regularly. Say for instance, you can use modifier GU (Waiver of liability statement issued as required by payer policy, routine notice) for dates of service (DOS) January 1, 2011 and after that.

There may be times when it's proper to report modifier GU in place of the revised stamdby modifier GA (Waiver of liability statement on file; individual).

In addition, three existing CPT modifiers (Source CPT http://www.supercoder.com/cpt-codes) now cover non-physician providers in the descriptors, as follows:




  • Modifier 76 -- Repeat procedure or service by same physician or non-physician provider
  • Modifier 77 -- Repeat procedure or service by another physician or NPP
  • Modifier 78 -- Unplanned return to the operating/procedure room by the same doctor or NPP following initial procedure for a related procedure during the postoperative period).
  • Modifier 78 -- Unplanned return to the operating/procedure room by the same physician or NPP following initial procedure for a related procedure during the postoperative period).

    In earlier years, some payers did not allow non-physician providers to report their services with these modifiers as they purposely addressed “physician" care. If you update the descriptors, it should be much easier for you to report situations represented by modifiers 76, 77, or 78 to your payers.