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What modifiers should we be using for billing insurance claims?

A:

Ambulatory Surgical Center, modifier SG should be billed only for ASC services (not x-rays, injections, etc.) Physician Assistants and Nurse Practitioners should bill modifier 81. Multiple surgeries should bill - 51. Bilateral surgeries should bill - 50 Professional component - 26 Separately identifiable services - 25 Unusual procedural service - 22 Post-surgical follow up visits no related to surgery - 24 Returned trip to operating room - 78 Unrelated procedure by same physician during post-operative period - 79 Decision for surgery made within a global surgical period - 57 Staged procedure - 58 AA Anesthesia performed by anesthesiologist AD Supervised by physician, > 4 concurrent anesthesia procedures AE Direction of residents/interns NOT > 2 concurrent AF Anesthesia complicated by total body hypothermia AG Anesthesia for emergency surgery AH Psychiatric services by clinical psychologist AJ Psychiatric services by Clinical Social Worker AK Nurse practitioner team member services AL Nurse practitioner, non-rural, team member AM Physician team member service AN Physician Assistant services for other than assistant-at-surgery, non-team member outpatient AP No refraction - for use with certain vision services AS Physician Assistant services for assistant-at-surgery AT Acute treatment (USED WITH 98940 ONLY) AU Nurse practitioner, team member AV Nurse practitioner, rural setting, non-team member CC Procedure code changed by carrier EJ EPO - Subsequent claim EM ERSD method II emergency rescue supply (for ERSD benefit only) ET Emergency treatment - dental procedures only E1 Upper left, eyelid E2 Lower left, eyelid E3 Upper right, eyelid E4 Lower right, eyelid FA Left hand, thumb F1 Left hand, second digit F2 Left hand, third digit F3 Left hand, fourth digit F4 Left hand, fifth digit F5 Right hand, thumb F6 Right hand, second digit F7 Right hand, third digit F8 Right hand, fourth digit F9 Right hand, fifth digit GA Waiver of liability statement on file GC Service performed by resident under direction of teaching physician GE Service performed by resident without the presence of a teaching physician G1 Most recent URR reading of less than 60 G2 Most recent URR reading of 60 to 64.9 G3 Most recent URR reading of 65 to 69.9 G4 Most recent URR reading of 70 to 74.9 G5 Most recent URR reading of 75 or > KO Single drug unit dose formulation KP First drug of a multiple drug unit dose formulation LC Left anterior descending coronary artery LD Left circumflex coronary artery LR Laboratory round trip LS Food and Drug Administration monitor intraocular lens implant LT Left side of body PL Progressive addition lens QB Physician providing a service in a rural HPSA QC Single channel monitoring QD Recording and storage in solid state memory by a digital recorder QH Anesthesia - Medical direction of own employees QK Medical direction of 2, 3 or 4 concurrent anesthesia procedures involving qualified individuals QP Documentation on file for profile codes 80049 - 80092 QR Repeat clinical DX lab test on the same day, separate specimens taken QS Monitored anesthesiology QT Recording and storage on tape by an analog tape recorder QU Physician providing a service in an urban HPSA QW CLIA waived test QX Anesthesia - CRNA with medical direction by a physician QZ Anesthesia - CRNA without medical direction by a physician Q3 Live kidney donor. Services related with post operative complications directly related to donation Q4 Lab ownership exception Q5 Service furnished by a substitute physician under a reciprocal billing arrangement Q6 Service furnished by LOCUM TENENS physician Q7 One class A finding Q8 Two class B findings Q9 One class B and class C findings RC Right coronary artery RT Right side of the body TA Left foot, great toe T1 Left foot, second digit T2 Left foot, third digit T3 Left foot, fourth digit T4 Left foot, fifth digit T5 Right foot, great toe T6 Right foot, second digit T7 Right foot, third digit T8 Right foot, fourth digit T9 Right foot, fifth digit TC Technical component VP Aphakic patient WC Chronic condition (used with CHIROPRACTIC services only) WE Nurse practitioner team visit, rural area WU Technical component - purchased test XC Acute manifestation of chronic condition (used with procedure A2000 only) XO Live donor

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