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Editor's note: Correction to this week's coding tip

Ambulatory Surgery Reimbursement Update, September 4, 2007

Editor's note: Due to an editing error in today's issue of Ambulatory Surgery Reimbursement Update, this week's coding tip included a mistake. Below we have included the tip as it was submitted to HCPro by Ellis Consulting. We apologize for the error.

Be aware that the verbiage changed for the -GY Modifier effective July 1, 2007. Prior to July 2007, the -GY Modifier stated it is to be used when providers need to indicate that the item or service they are billing is statutorily non-covered or is not a Medicare benefit. As of July 1, 2007, the description states it is to be used when physicians, practitioners, or suppliers want to indicate an item or service is statutorily excluded, does not meet the definition of any Medicare benefit or for Non-Medicare insurers, is not a contract benefit. Use this modifier when billing for a service that you know is not covered by that payor. The Fluoroscope is a great example of this. Medicare does not cover Fluoro., but if you want to bill everyone the same, for example, you would bill Medicare for this CPT code 77003 in the following manner: Code 77003-GY-TC. This lets the payor (Medicare, in this case) know that you are aware they do not cover this service and you expect a denial.

This tip is brought to you by Ellis Medical Consulting, Inc.

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