Health Information Management

Tip: Get to know the new modifiers

APCs Insider, March 18, 2011

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CMS added 13 modifiers as part of its I/OCE edit update. One of the new modifiers pertains to the oil spill in the Gulf of Mexico and is effective retroactively to April 20, 2010. Modifier –CS denotes an “item or service related, in whole or in part, to an illness, injury, or condition that was caused by or exacerbated by the effects, direct or indirect, of the 2010 oil spill in the Gulf of Mexico, including but not limited to subsequent cleanup activities.” The remaining modifiers became effective January 1.

Six of them— -4P, -4Q, -4R, -4S, -4T, and -4U—are additions to CPT® Professional Edition Appendix I (genetic testing coder modifiers).. These modifiers fall within the histocompatibility/blood typing/identity/microsatellite section and are used for genetic fingerprinting.

The other new modifiers are:

• -AY: Item or service furnished to an end stage renal disease (ESRD) patient that is not for the treatment of ESRD
• -AZ: Physician providing a service in a dental health professional shortage area for the purpose of an electronic health record incentive payment
• -DA: Oral health assessment by a licensed health professional other than a dentist
• -GU: Waiver of liability statement issued as required by payer policy, routine notice
• -NB: Nebulizer system, any type, FDA cleared for use with specific drug
• -PT: Colorectal cancer screening test; converted to diagnostic test or other procedure

The tip was adapted from “I/OCE edits: CMS switches around packaged, separately payable drugs, changes some APC status indicators” in the March issue of Briefings on APCs.



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