Sometimes, the most important charges are lost because of incorrect modifiers. Make sure your billing team is well-versed on code addendums to correctly explain services to payers to get correct reimbursements.
Misstep 5: Choosing Incorrect (or Forgetting!) Code Modifiers
What are HCPC and CPT modifiers? HCPC modifiers begin with a letter and can be combined with numbers. Common samples of HCPC modifiers in urgent care include NU, RT, TC, and LT—along with Q5 and Q6. Medicaid has state-specific requirements for the use of modifiers beginning with U. CPT modifiers are always numeric, and modifiers 25, 26, and 59 are frequent in urgent care. As of 2015, the Centers for Medicare and Medicaid Services have subset requirements to clarify the 59 modifier for a more accurate service description.
Advice: Ensure coders understand the proper use of modifiers. Run a report on your most used CPT codes and corresponding modifiers and include these for easier selection on your superbill or in your EHR. Use code scrubbing software to automate repetitive modifier and code selections. Audit periodically to ensure modifiers are correctly correlated to provided services.
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