Health Information Management

Tip: Beware of hard-coding modifiers in the chargemaster

APCs Insider, June 25, 2010

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Determine which modifiers, if any, you have hard-coded into your chargemaster. In some situations, hard-coding may be useful, but it also can lead to trouble. When you hard-code the modifier into the chargemaster, it will append that particular modifier to a specific code every time you report it.

If a modifier always applies to a procedure (e.g., modifier -GO for rehabilitation services), you may hard-code the modifier into the chargemaster for particular CPT codes. Don’t hard-code your chargemaster if the modifier is used only occasionally or if someone needs to decide about the appropriateness of the modifier.

If you hard-code modifiers into your chargemaster, be sure you enter them into the chargemaster correctly and the entry screen or line item is explicit. Otherwise, every bill you send with that code could be incorrect.

Never hard-code modifier -59 into your chargemaster. Some wound care clinics and rehabilitation departments hard-code modifier -59 into the chargemaster to avoid NCCI edits. In some but not all cases, bypassing the edit or unbundling a service is appropriate.

This tip is adapted from "Reduce coding and billing errors by knowing who appends modifiers, always reviewing documentation" in the June issue of Briefings on APCs.



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