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Coding tip: Modifiers in general

Ambulatory Surgery Reimbursement Update, September 11, 2007

Modifiers are extremely important and can have a significant impact on the ASC's reimbursement.

It is important to append the appropriate -RT and -LT Anatomic Modifiers to CPT codes on your claims, when they are needed.

When a patient has a bilateral problem, a physician may perform the surgeries to correct the problem at different times. This can occur with orthopedic, podiatry and ophthalmology services.

If the first claim is submitted without the correct modifier and the payor receives the claim for the second (identical) surgical procedure, they might deny the second claim as a duplicate claim.

It will save you time and money to append the correct anatomic modifier on the claim the first time, thereby avoiding unnecessary denials. There are some modifiers that physicians can use, some modifiers that ASCs can use, and some are for use by both provider types.

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

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