Modifier 66 indicates that a provider was part of a surgical team performing a highly complex or challenging procedure. In this article, we will explain modifier 66, including its definition, when to use it, documentation requirements, billing guidelines, common mistakes to avoid, related modifiers, and additional tips for medical coders. 1. What is modifier 66?…
Modifier 63 describes a procedure performed on infants less than 4 kg. This article will explain modifier 63, including its definition, when to use it, documentation requirements, billing guidelines, common mistakes, and related modifiers, and end with additional tips. 1. What is modifier 63? Modifier 63 is a CPT® modifier used to indicate that a…
Looking for the United healthcare physical therapy billing guidelines? The modifier GN, modifier GO or modifier GP will be required on Always for “Therapy codes” to align with the Centers for Medicare & Medicaid Services (CMS). According to CMS, certain codes are “Always Therapy” services regardless of who performs them, and always require a therapy…
From January 1, 2020, marks the start of the Appropriate Use Criteria (AUC) program educational and operations testing period, at which time Medicare Administrative Contractors (MACs) will begin accepting AUC related modifiers on claims for advanced diagnostic imaging services furnished to Medicare Part B patients. The voluntary participation period ends December 31, 2019. During this…
The new Molecular Pathology coding guidelines changes will be effective from dates of service on and after Sept. 1, 2019. American Medical Association (AMA) guidance provides Claim Designation codes in the Molecular Pathology coding guidelines Gene Table that represent specific genes that are being tested. UnitedHealthcare will require care providers to append the AMA Claim…
In mostly the documentation for assistant surgeons consisted of only the name of the assistant surgeon in the operative note header. Most often there was no mention of the role of the assistant surgeon in the body of the operative note; it was assumed the assistant surgeon provided an extra set of hands to execute…
Medicare pays a monthly fee schedule amount for oxygen and oxygen equipment per beneficiary. For stationary oxygen equipment, this monthly fee schedule amount covers the oxygen equipment, contents and supplies and is subject to adjustment depending on the amount of oxygen prescribed (liters per minute (LPM)) and whether or not portable oxygen is also prescribed….
Information for the 340B Modifier – CMS established two Healthcare Common Procedure Coding System (HCPCS) Level II modifiers to identify 340B-acquired drugs: 340B Modifier “JG” Drug or biological acquired with 340B drug pricing program discount. 340B Modifier “TB” Drug or biological acquired with 340B drug pricing program discount, reported for informational purposes. When applicable, providers…
CMS published an article to alert providers that they should identify if a beneficiary is enrolled in hospice. Providers can ask the beneficiary or his/her legal representative if he or she is enrolled in Hospice. This information should be documented in the beneficiaries medical record. Providers should educate beneficiaries and their families that once the…
The following information is for therapy G codes 2019. The functional data reporting and collection system is effective for therapy services with dates of service on and after January 1, 2013. However, a testing period will be in effect from January 1, 2013, through June 30, 2013, to allow providers to use the new coding…
