Can anyone working ina billing office make the decision to add a modifier?

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« on: May 21, 2009, 11:53:46 AM »
Do you have to be a physician, nurse, or have coding credentials to add modifiers to global surgeries?  Can anyone in the billing office review the medical records and make the decision of which modifier to use?


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Re: Modifiers
« Reply #1 on: May 21, 2009, 12:19:47 PM »
I've added modifiers plenty of times without asking the provider first. My understanding is the modifier conveys something to the insurance company, it is not a medical decision or something of that nature. For example, when a PT renders manual therapy in addition to other services, I add a 59 modifier, when an MD see a patient for a routine physical and on the same day for a sick office visit, I add the 25 modifier, however in certain cases I wouldn't take the iniative like adding a 22 modifier because the notes indicate the patient was obese. If you're unsure as to whether it's appropriate, ask a supervisor or the provider however I wouldn't think most modifiers especially one indicating you're billing for a global service would require a doctor to add it.


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Re: Modifiers
« Reply #2 on: May 22, 2009, 06:21:49 AM »
I wouldn't say 'anyone in the billing office' could review the charts and add modifiers.  Personally, I don't allow my billers to just add modifiers without training them on what needs to be present.  I sit down with the provider when I start billing for them, and then periodically throughout the year to go over his services, procedures, and how he indicates those in his notes.  I make sure that the way I interpret it is the way it is done in the office.  That way I know that I am using the modifiers correctly.  Most drs don't understand modifiers and how they are used, so the coder/biller must. 

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Re: Modifiers
« Reply #3 on: May 22, 2009, 10:54:24 AM »
I agree and I wouldn't attach a modifier or even a code unless the doctor signs off the change. He's the one in the room with the patient, ultimately it's his responsibility. Even CPC's will have the doctor sign off on any changes/additions to coding.
Linda Walker
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