As medicine advances, medical procedures become more complex. Due to the complexity of many medical procedures, it is not enough to offer one billing code when submitting a billing claim to an insurance company. So, Code Modifiers become necessary.

A CPT Code Modifications Will Ensure the Medical Practice Receive Accurate Compensation

Just as we use modifiers in the English language to provide additional information about a particular situation such as the who, what, where, when and how, CPT Code Modifiers provide additional information about the care a patient receives such as whether or not a specific procedure was medically necessary, how many specialists were involved and where on the body the procedure was performed. The more accurate information is provided to the insurance company, the chances are better that the proper compensation will be paid to the medical practice.

Example of How a CPT Code Modifier Works

Let’s say you are managing a patient who lives with two or more chronic illnesses and needs ongoing care. Often, there are many treatments and procedures that are provided to manage the health of such a patient, and multiple specialists may need to work together to provide care. One billing code for chronic care management will not always be sufficient for submitting a claim and getting the necessary compensation from the insurance company for the care provided. A billing code for chronic care management will need to be modified. Let’s say that you have a patient who has two plus chronic medical conditions, and this patient needs two different types of care on the same day. This patient needs to receive 20 minutes of care that is not face-to-face, but this patient requires an office visit later in the day to address additional medical concerns. You obviously want to be compensated for both types of care that you provided. You can use the CPT code 99490 reimbursement medical code to be compensated for the 20 minutes of time you provided helping with care management though this did not take place face to face, and then you add a 25 modifier to the CPT code 99490 reimbursement code.

Medical insurance billing is a full-time job, and it is difficult for staff to juggle in addition to their other responsibilities. To maximize your cash flow and allow your staff to put all their focus on serving patients, contact J3 Revenue Cycle Management straight away. We understand that denied claims and overdue payments are detrimental to your business, and we are here to help you to ensure that. We have extensive knowledge of medical billing codes and have been providing quality solutions to physicians for over 30 years. We are your trusted resource for medical billing in Fort Lauderdale.