Medical Billing Forum

Coding => Coding => Topic started by: mindy167 on June 10, 2014, 03:51:04 PM

Title: Updating CPT with Modifier -- Documentation Compliance
Post by: mindy167 on June 10, 2014, 03:51:04 PM
If a billing modifier is added to a CPT® code at the billing/claims processing stage, what is the compliance that must be met? Is it mandatory that the chart be updated with the added modifier? I believe so, however, I have not found this clarification in any compliance documentation. If anyone can direct me to this, very much appreciated.

(The only compliance I've read relates to updating DXs and changes in root CPT®, not modifier addition.)

Thank you!
Title: Re: Updating CPT with Modifier -- Documentation Compliance
Post by: PMRNC on June 10, 2014, 07:06:12 PM
This is just a GUESS but wouldn't it be common sense that it be added to the record? I was always taught "If it wasn't documented, it wasn't done" I would think that would apply to "modification(s)".
Title: Re: Updating CPT with Modifier -- Documentation Compliance
Post by: Michele on June 12, 2014, 06:41:46 AM
I don't know where you will find it in writing, but I agree with Linda that it's a given.  But actually, if the modifier is being added at the billing/claims stage, it should already be supported in the documentation.  If not, why is it being added?
Title: Re: Updating CPT with Modifier -- Documentation Compliance
Post by: shanbull on June 12, 2014, 09:19:51 AM
I don't know where you will find it in writing, but I agree with Linda that it's a given.  But actually, if the modifier is being added at the billing/claims stage, it should already be supported in the documentation.  If not, why is it being added?

Is it being changed before it gets submitted or by the payer? If it's not by the payer disregard this, but it does happen to us sometimes and we have to go back and change the claim's modifier or CPT to reflect a lower level because that is the rate it was paid at. For example, if we bill 98941 (spinal manipulation of 3-4 regions) sometimes the ERA payment will "correct" it to be 98940 (spinal manipulation of 1-2 regions) because only 98940 was pre-authorized. The fee schedule amount applied is that of 98940 so it messes up our whole claim until we change the claim itself.

If it is being added prior to submission to the payer then yes, we always need an addendum to be added to the chart by the provider before the claim can be billed.
Title: Re: Updating CPT with Modifier -- Documentation Compliance
Post by: mindy167 on June 21, 2014, 10:09:41 AM
Thanks for all replies and clarification to this post.