What is the difference between HCPCS modifiers JW and JZ?

HCPCS Level II modifiers JW, Drug amount discarded/not administered to any patient, and JZ, Zero drug amount discarded/not administered to any patient, are required by the Centers for Medicare & Medicaid Services (CMS) to report drugs and biologicals that are separately payable under Medicare Part B. Modifier JW must be reported on a claim for the amount of a drug that is discarded and eligible for payment. Modifier JZ is reported to attest that no amount of drug was discarded. Effective July 1, 2023, either modifier JW or JZ is…

Read More

What are Concurrent Modifiers?

Introduction Concurrent Modifiers? Some third-party payers require additional modifiers to indicate how many cases an anesthesiologist was performing or directing at one time. Certified registered nurse anesthetists (CRNAs) may administer anesthesia to patients under the direction of a licensed physician, or they may work independently. An anesthesiologist may medically direct up to four cases at the same time (concurrently). If a physician directs more than four cases, it is referred to as medical supervision. Medical direction means the directing anesthesiologist is present at the induction and emergence from anesthesia, for…

Read More

CPT assistant for July (CPT Modifiers 25, 51, 59 and 76)

Reporting CPT Modifiers 51 and 59 A modifier is used to report or indicate that a performed service or procedure was altered by some specific circumstance and noted by the physician or other qualified health care professional (QHP) but not changed in its definition or code. Modifiers enable health care professionals to effectively respond to payment policy requirements established by Medicare and other third-party payers, and their definitions are listed in Appendix A of the Current Procedural Terminology (CPT) code set. This article discusses and provides examples of the appropriate…

Read More

When to use Anesthesia and HCPCS Modifiers?

When to use Anesthesia and HCPCS Modifiers?

What are Modifiers?  Modifiers are two-character suffixes (alpha and/or numeric) that are attached to a procedure code. CPT modifiers are defined by the American Medical Association (AMA). HCPCS Level II modifiers are defined by the Centers for Medicare and Medicaid Services (CMS). Modifiers should be used carefully with CPT or HCPCS codes, because they directly affect the dollar value of the procedure codes. Modifiers altered the service or procedure performed, without changing the definition of the procedure. For example, the use of 26 or TC modifier with Radiology procedure codes, or the…

Read More

When to use Hospice GV and GW Modifier

When to use Hospice Modifiers GV and GW

Basics of Modifier GV and Modifier GW Hospice is a specialized type of care for those facing a life-limiting illness, their families and their caregivers. Hospice care addresses the patient’s physical, emotional, social and spiritual needs. Hospice care also helps the patient’s family caregivers. There are few modifiers which are to be used only when the patient is enrolled in a Medicare certified Hospice. These modifiers play an important role in the payment process or medical billing/claims. Use of modifier GV or GW is only for the hospice patients. Read also: Sample CPC Questions and Answers for…

Read More

CPT/HCPCS STATUS INDICATORS for Medical Coders

Medicare has assigned every CPT/HCPCS code with a specific status indicator. These indicators help in the payment of reimbursement process for different facility. For example, status indicator identifies whether the service described by the HCPCS code is paid under the OPPS (Outpatient Prospective Payment System) and if so, whether payment is made separately or packaged. You can refer the below image to understand about Read also: When to use 26 & TC modifier with CPT code Below are the list of status indicators of OPPS A Services not paid under…

Read More

GP Modifier: When to use them with therapy CPT codes?

What is GP Modifier? The GP modifier indicates that a physical therapist’s services have been provided. It’s commonly used in inpatient and outpatient multidisciplinary settings. It’s also used for functional limitation reporting (FLR), as physical therapists must report G-codes, severity modifiers, and therapy modifiers. Be aware that some payers require use of a therapy modifier when billing for a designated therapy code. The Medicare GP modifier refers to a Medicare billing code under the current Healthcare Common Procedure Coding System. This coding system is an industry standard for billing Medicare.…

Read More

Avoiding Common Mistakes in Dual Surgeon Coding with 62 Modifier

62 modifier

Basics of 62 Modifier When two surgeons work together as primary surgeons performing distinct part(s) of a single reportable procedure, each surgeon should report his/her distinct operative work by submitting CPT modifier 62. Each surgeon should report the co-surgery once using the same procedure code. Do not submit this modifier for assistant at surgery services like HCPCS modifier AS and CPT modifiers 80, 81 and 82. This modifier may only be submitted with surgical codes. Documentation must be submitted upon request, or you may submit documentation with your initial claim,…

Read More

What is RVU Calculator & Relative Value Units?

How to Calculate RVUs (Relative Value Units)?

What is RVUs, wRVUs & RVU Calculator ? RVU stands for Relative value unit. It is a cost or value assigned for each CPT and HCPCS code by CMS (Centre for Medicare and Medicaid) for providing a service. It has majorly three components, physician work, physician expenses and malpractice overhead. The values of cost of RVU is used for calculating the actual cost for a procedure in Facility and Non-facility setting. wRVU stand for work RVU, which remain constant for all the facilities across the different geographic location. Work RVU…

Read More

PET scan CPT code 78815 & 78816 Coding Tips

Remember coding Modifiers with PET scan CPT code

Basics of PET scan CPT code 78815 & 78816 PET scan CPT code (Positron emission tomography) is coded very frequently in Radiology facility coding. PET scan is done to diagnose a condition or to check how condition is developing. Neoplasm can be in there initial stage or Restaging phase. These exams are not painful. PET exams help in diagnosing cancer, heart disease and epilepsy. The best advantage of PET stage compared to CT or MRI is it can tell how the patient’s body is functioning rather than just how it…

Read More