Understanding Modifiers in Medical Billing

modifiers in medical billing

Is there a best practice for using modifiers in medical billing? This is an essential skill for healthcare professionals because using incorrect coding modifiers can lead to numerous issues ranging from audits to returning money to third-party payers. 

Don’t worry; PracticeForces, Florida’s leading medical billing and coding services, has constructed a short guide on the correct use of modifiers when handling medical billing. We specialize in helping healthcare clinics improve their medical billing procedures for higher efficiency levels and diminished employee workload.

What Are Medical Billing Modifiers?

Medical billing modifiers add to the Current Procedural Terminology or Healthcare Common Procedure Coding System codes. They signify supplementary information to process a claim after a medical procedure. 

For example, these modifiers might include additional services performed or adjustments made during the process. They cover everything from identifying doctor changeovers during a procedure to signifying an unrelated procedure or service conducted by a medical professional. However, third-party payers and insurance companies’ modifier rules vary from mainstream CPT and HCPCS billing codes. 

Why delve deeper to understand how to use modifiers when handling medical billing? It is vital if your practice wants to avoid fines and audits. Fines often reach in the tens of thousands for each modifier error, which could significantly reduce profits or paint your clinic in an unprofessional light.

Types of Modifiers Used in Medical Billing

Procedure code modifiers come in many forms and signify specific information. Medical professionals categorize modifiers into two classifications: Level I modifiers and Level II modifiers.

  • Level I modifiers (also called CPT modifiers) consist of two numeric digits. 
  • Level II modifiers (also known as HCPCS modifiers) use Alphanumerics or letters.

Although both identify additional information about a medical service, they have specific meanings. Below are some common modifiers professionals might see in medical billing:

Modifier 24

Modifier 24 signifies an unrelated evaluation and management service performed by a doctor after a surgical procedure. However, the same doctor that performed the surgery must provide the service to qualify for Modifier 24. The service must also be unrelated to the procedure.

Modifier 95

Medical professionals use Modifier 95 to code identifiable evaluations, treatments, or diagnoses performed through Telemedicine. Doctors can’t use Modifier 95 for services in person.

Modifier GO

Modifier GO identifies treatments and diagnoses of patients after they suffer an acute stroke.

Modifier 25

Modifier 25 identifies additional services performed by a medical professional on the same day as a major surgery, which was executed by the same doctor or practitioner. It’s one of the most common modifiers used by pediatricians.

Contact PracticeForces for High-Quality Medical Billing and Coding Services in Florida

Enhance your medical practice’s coding, billing, and more with PracticeForces! We can help you improve your Florida healthcare practice’s medical billing efficiency, as we’ve done for countless others over the past 20 years. Our first-class services from experienced professionals can help you understand how to use modifiers more confidently in medical billing for a smoother operation.

Do you want to know more about modifiers in medical billing and other essentials? Call PracticeForces at (727) 499-0351 today to see what we can do for your medical practice!

Parul Garg, CEO and co-founder of PracticeForces, has significantly contributed to the growth of over 1,000 U.S. medical practices through her expertise in medical billing and coding since the company’s inception in 2003. With a background in Computer Science and an MBA in Human Resources, her leadership and AAPC-certified coding skills have been pivotal in managing the company’s operations effectively.

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