Medical Billing Forum

Coding => Coding => Topic started by: dfranklin on August 21, 2009, 08:26:09 AM

Title: Chiro Modifiers
Post by: dfranklin on August 21, 2009, 08:26:09 AM
I just got a new account and took over billing for a chiro.  They are sending me some of the recent EOB's and I see the previous outsourced biller is using modifier 59 allot and I know they are doing this on their own and is not by the provider.  Procedures like 97110, 98943, 97014, 97010, 97012,97140.  Seems like just about all of them they are automatically throwing 59 on except for 98940 and 98941.  Is this correct?  THe provider's superbills don't show these codes on all of these.  Was the old biller doing it correctly?  Can we or should we decide if we should change or add a modifier? 

I feel I need to be certified in coding in order to know if the correct modifiers are being used and when I should advise to add or change or delete a modifier.  Is there something I can study to learn more about Chiro codes and their modifiers?

Title: Re: Chiro Modifiers
Post by: Steve Verno CMBS, CEMCS on August 21, 2009, 09:42:42 AM
Some people without any coding training like to misuse modifier 59 as a means of bypassing an insurance company's electronic claims edits.  A modifier is used per their descriptor as the situation allows.  Modifiers are not specialty oriented.   Modifier 59 is on the OIG hitlist due to its misuse.

I have a guide to using modifiers I used in my classes.  If you wish a copy, let me know and your e-mail address in a private message to me here.

The best way to learn modifiers is to undergo coding training.  The CPT guidelines in the manual let you know some of the modifiers that pertain to that section of the code book.   
Title: Re: Chiro Modifiers
Post by: Michele on August 21, 2009, 11:03:04 AM
You are right, you should not be deciding which codes get the modifiers.  It doesn't sound like the previous biller was doing it correctly.  I would ask the Dr. if he/she instructed the biller to add the 59 modifier.  If they did then ask to add a spot on the superbill that they can check if they want you to use it so that you are sure it is at the request of the dr.

Title: Re: Chiro Modifiers
Post by: PMRNC on August 21, 2009, 12:46:41 PM
It should also be in the chart!! If it wasn't documented it wasn't done.
Title: Re: Chiro Modifiers
Post by: Pay_My_Claims on August 21, 2009, 03:41:18 PM