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Don’t jump the gun with modifier 53 – wait for the anesthetic

04/15/2019

Question: Our doctors sometimes have to cancel a procedure because of patient prep non-compliance, patient emergency, a fever, etc. Is it okay to just stick modifier 53 (Discontinued services) on the claim?

Modifier 53 looking good denial-wise, but 52’s a minefield

04/15/2019

by: Roy Edroso

Looking at Part B denial rates for modifiers 52 (Reduced services) or 53 (Discontinued procedure), it appears easier to get contractors to buy your reasons for stopping a procedure than your reasons for curtailing it, according to claims data from 2017, the most recent available.

Tech tools, financial help and ‘high touch’ can turn med-avoiding patients around

04/08/2019

by: Roy Edroso

Results of a new survey suggest patient medication adherence can be a problem for even day-to-day long-term therapies. While there are some novel tech solutions for the problem, provider involvement remains a powerful tool to keep your patients taking their pills.

Part B services in the hospital demand attention, offer counseling opportunity

04/08/2019

by: Richard Scott

When it comes to services rendered within a hospital setting, you should be prepared to explain to your patients the financial nuances of the billing process and how that may impact their out-of-pocket costs. In some cases, your patients may be looking to their trusted physicians for guidance.

Meet strict definitions when reporting modifier 50 for bilateral services

04/08/2019

by: Richard Scott

Sharpen your modifier reporting when you conduct bilateral procedures to know when you should turn to — or avoid using — modifier 50 (Bilateral procedure) to avoid claims issues that will impact your payments.

Say hello to new claims adjustment, remittance advice remark codes

04/08/2019

by: Richard Scott

You may have noticed new codes on your claims from two families of remark codes: claims adjustment reason codes (CARCs) and remittance advice remark codes (RARCs). Effective March 1, CMS introduced two CARCs and modified one RARC to help explain your claims changes and denials.

‘Do-over’ on this split procedure is probably a start-over, too

04/08/2019

by: Roy Edroso

Question: An emergency department physician treated a dislocated shoulder reduction (23655) and billed with modifier 54 (Surgical care only), as the patient’s orthopedist would be handling follow-up care with modifier 55 (Postoperative management only). The patient returned to the ED two months later having fallen and dislocated the same shoulder. Our ED physician once again reinserted the shoulder using closed manipulation. How should the second service be reported?

Eye docs most likely to report surgery-only modifier 54 for strict surgical care

04/08/2019

by: Richard Scott

Select few specialists, most notably ophthalmologists, report the bulk of procedural services with modifier 54 (Surgical care only), which denotes the work tied to the pre-operative and intraoperative pieces of the surgical puzzle.

Many providers feel unready, balk at mental health, substance screenings

04/01/2019

by: Roy Edroso

A recent study suggests your non-psychiatric providers may need some help delivering proper screening and care to patients with mental health and substance abuse issues. Fortunately, it’s not hard help to give.

Find updated coverage terms for genetic sequencing tests; beware restriction risk

04/01/2019

by: Richard Scott

Brush up your pathology policies involving genomic testing to keep pace with the latest testing options covered under Medicare, which recently revised a national coverage determination (NCD) for next generation sequencing (NGS).

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