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Four approaches for dealing with radiology modifiers

HIM Connection, September 10, 2003

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TOPIC: Four approaches for dealing with radiology modifiers

Hospitals take a number of different approaches to managing radiology modifiers. Here are four primary methods hospitals can take.

1. Addition of line items--Some hospitals are simply adding line items to their radiology chargemaster. These hospitals identified radiology procedures that were typically performed bilaterally and where there wasn't an existing CPT bilateral radiology code and added another line item with this CPT code with the -50 bilateral modifier. The person entering the charge for the bilateral radiology procedure doesn't have to be concerned with the modifier -50, because the system will now select the appropriate line item. Unfortunately, this process only helps with certain modifiers. For example, repeat procedures using modifiers -76 and -77 would cause complications because the chargemaster would then triple in size. The hospital would need three line items for every procedure just for the modifiers -76 and -77.

2. Dedicated coders--A few hospitals have designated coders that work solely in the radiology department, report directly to the radiology director, and are not affiliated with the Health Information Management (HIM) department. Generally, these coders are in place to report the radiology codes for the professional component of the radiologist's billing as opposed to the facility claims. Under APCs, some hospitals are asking coders to append modifiers as appropriate for the facility claims. Although specialized coders are probably stronger in their clinical and technical knowledge of radiological procedures, information system revisions or upgrades may be needed in order for the modifiers to appear on the facility claims.

3. Built-in software logic--Some hospitals built logic into their charge entry or order entry software that asks the user whether a modifier was required after entering certain codes. The technicians are queried about modifiers almost immediately after the procedure or test is performed, which allows for more accuracy. This process is almost real-time, less intensive than other procedures, and almost fully automated. Although some department heads feel that this is too time-consuming for technicians, others can argue that it in fact saves time by integrating the modifier-assignment on a case-by-case basis. An alternative limiting the technicians to only handling the modifiers for Medicare patients is also an option.

4. Retrospective modifier assignment--Some hospitals are doing exactly what they did prior to August 1, 2000, but each night they download a report of all the radiology transactions charged during the day that are likely to require a modifier. The next day, someone reviews the report, checks for situations that may require a modifier, reviews on-line or hard copy radiology report data, and then appends modifiers as appropriate into the charge entry or patient accounts system. The hospital's clinical staff patient care duties are not disrupted, but there is someone responsible for working those transactions the next day. To take this approach the hospital usually has to hire at least one full-time person to review the reports daily.

This week's HIM Connection was adapted from an excerpt of the book, "The Modifier Clinic: A guide to hospital outpatient issues," by Lolita Jones, RHIA, CCS. Go to http://www.hcmarketplace.com/Prod.cfm?id=1527 for more information or to order and save $19.90 off the regular price.

Check out the Editor's Choice section below for a kit for training coders on the 2004 ICD-9-CM codes.

Sincerely,

Kate Alvarez
Editorial Assistant
kalvarez@hcpro.com

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