Intricacies of Medical Billing: Modifier Codes

Synapse’s Expert Knowledge On Modifiers

Healthcare practitioners depend on medical coding professionals to accurately assign codes, diagnoses, procedures, and treatments provided by them. These codes are critical for billing purposes because it facilitates communication between healthcare providers and insurance companies. Thus, it ensures correct payment. Here at Synapse, we have a thorough understanding of medical terminology, anatomy, and various coding systems. Below you will find what modifiers are and their important role in your RCM.

What are Modifiers?

Modifiers are composed of two characters (letters or numbers) appended to a CPT® or HCPCS Level II code. Essentially, it provides additional information about the medical procedure, service, or supply involved without changing the meaning of the code. Think of it as a storytelling of a particular encounter. As a result, the reporting physician can indicate that a service or procedure that has been performed has been altered by some specific circumstance but has not changed in its definition or code.

Modifiers Examples

You will find the following overview of common modifiers used in medicine. The modifier guidelines continue to change so be prepared with the most updated copy of the CPT book produced by the AAPC or AMA.

Modifier 25

Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service

Modifier 26

Professional component

Modifier 59

Distinct procedural service
Knowing the correct situations can lead to more accurate claims while gaining all the payments you’ve earned. Please provide your contact information for some quick tips or to see how a certified coder from Synapse can help your practice.

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