Billing: Lock modifiers into your system

Q. How do modifiers work?
Friday, February 24, 2017

A. It is said that "big things come in small packages." This is true when it comes to modifiers. It's hard to imagine that two digits can stop you from getting reimbursed on your expensive custom rehab chair or re-rental of lifesaving equipment, but it happens.

Let's talk about modifiers and how to use them. It’s important to understand modifier basics.  For example, for equipment, the first set of modifiers gives specifics related to the condition of the equipment provided: NU identifies a new product being purchased and RR identifies a rental product. When dealing with orthotics, or single use equipment, there is generally no need for the NU as it is assumed the equipment is new and it would not be rented. For capped rental items, the second modifier position indicates the month in which the equipment is being rented. For non-rental equipment/items that are not month specific, a second modifier may be required for informational purposes. For example LT or RT (left/right) or the KX modifier which indicates that “requirements specified in the medical policy have been met" and are on file.

Equipment/supplies may require different modifiers based on the payer, so checking the payer’s policies is imperative; getting the modifiers wrong will result in a denial of payment. The best place to start when determining modifier requirements for Medicare is the Local Coverage Determination (LCD) found on your DMERC's website. In some cases, the LCDs will make it very clear which modifiers are required, while in other cases the usage may be a bit ambiguous; reading the LCD in detail several times is important to get a clear comprehension of when and where to use a specific modifier. 

Remember once you get paid with a set of modifiers lock them into your system when billing the same services in the future. Don’t let two characters keep you from getting paid.

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