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Q&A: You’ve got questions! We’ve got answers!

Physician Practice Insider, February 21, 2017

Submit your questions to Associate Editor Nicole Votta at nvotta@hcpro.com and we will work with our experts to provide you with the information you need.

Q: Is modifier -PN used instead of or in addition to modifier -PO in a non-excepted department? Do we still need to add modifier -PO in general?

A: Yes, you would still need to add modifier -PO to off-campus services, however, modifiers -PO and -PN would not apply to the same services. The modifier -PO requirement has not been removed, but its definition was change to include only “excepted” department services. Modifier -PN is used for “nonexcepted” departments.

Start by asking yourself, is the department off-campus? If yes, then you can ask, is the department an “excepted” department? If yes, modifier -PO will likely apply. However, you have to be careful because there are some “excepted” department services that CMS has clarified you would not use the modifier -PO, such as therapy or lab when paid separately. If you are off-campus in a non-excepted department on the other hand modifier -PN would apply. CMS did not exempt services such as therapy and lab from application of modifier -PN. This means you would use -PN on those services if they are provided in a “nonexcepted” department even though you would not use -PO if they are provided in an “excepted” department.

Editor’s note: This question was answered by Kimberly Anderwood Hoy Baker, JD, CPC, director of Medicare and Compliance for HCPro, a division of BLR, in Middleton, Massachusetts. This information does not constitute legal advice. Consult legal counsel for answers to specific privacy and security questions. Email your questions to Associate Editor Nicole Votta at nvotta@hcpro.com.

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