Webinar "Unbundling Modifiers" Q&A 5/8/18

Post here your questions regarding auditing ,coding, documentation, and compliance. Also, join in on the conversation- help your fellow auditors and compliance professionals in the industry.

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Wed May 09, 2018 8:32 am

1. How do I know what code is col 1 or col 2?

Go to this link: https://www.cms.gov/Medicare/Coding/Nat ... Edits.html
click on the Practitioner P2P edits for April 2018 (there are four zipped Excel files). Download and open them and the Column 1 code is in column A; Column 2 codes are in Column B and the Indicator codes are in column F (listed as 0, 1 or 9). Another, quicker way to do it, is to get a Find-A-Code free trial (no credit card required) by going to findacode.com. Once you've created your username and password, simply type any code in the search bar and then scroll down the page to "NCCI edits" and click on the plus "+" symbol to open it. A table will appear (like the screenshot I showed you in the webinar), and the column 1 code will be on the left side and the column 2 on the right with an indicator next to it. If you create a trial account, the customer service department will show you exactly how to find them if you just chat them by clicking on the "HELP" button in the upper right corner. The NCCI Validator Tool on Find-A-Code also is the fastest way to identify which codes can be billed together, which cannot, and which edits have a status indicator of "1" that are eligible for edit override under the right circumstances. Customer service will help you with that tool also and we have demo videos to teach you how also.

2. Where can I find information on how to appropritately assign modifiers in the correct order? For example I've had issues with modifier 24 and 25. Claims have been denied if the modifiers are not placed in the correct order. How can I tell which one goes first? (For example 99214-24,25)

Here is a link to the Medicare MAC (WPS) site on modifiers https://www.wpsgha.com/wps/portal/mac/s ... RUJAOJFEUA!/

If it takes you somewhere else, look up on the WPS site search bar "modifiers" and it will give you a result titled "Modifiers." Open it and the first three links will give you detailed instruction on modifier usage and direct you to list pricing modifiers first (with a list of what they consider to be pricing modifiers).
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