Are modifiers your friend or foe? If you have a conflicted relationship with them, you are not alone. This was demonstrated during AAO 2015’s CodeFest instruction course, in which 2 competing teams and the audience were quizzed about their use of modifiers. When the audience was asked the 7 questions below, 63% of those who responded got at least 4 answers wrong.
Savvy Coder is addressing this knowledge gap with 2 articles that focus on the correct use of modifiers. Start by tackling these questions from the CodeFest modifier quiz.
Test Your Knowledge
Can you outperform your colleagues? Questions 1-3 were answered correctly by at least 60% of respondents, but fewer than 40% knew the correct answers to questions 4-7.
Q1. Many ICD-10 diagnosis codes include laterality or liderality. Because of this, HCPCS modifiers –RT and –LT are no longer submitted on the claim for CPT codes. This statement about modifiers –RT and –LT is: A. True; or B. False? (At the AAO 2015 CodeFest session, 88.9% of respondents answered this correctly.)
Q2. Which of the following modifiers should never be appended to exam codes? A. –GA, –RT, and –LT; or B. –24, –25, and –57. (Answered correctly by 88.6%.)
Q3. A functional bilateral upper lid blepharoplasty was performed on a Medicare Part B patient. Which CPT code and modifier should you submit? A. 15823–50; B. 15823–RT and 15823–LT; or C. 15823–RT. (Answered correctly by 60.0%.)
Q4. A patient with bilateral keratoconus has a contact lens fitting for both eyes. What is the appropriate claims submission? A. 92072; B. 92072–50; C. 92315–50; or D. 92072–RT and 92072–LT. (Answered correctly by 36.8%.)
Q5. A patient with Medicare Part B insurance had several corneal foreign bodies removed from the left eye. The practice submitted CPT codes 65222–LT (for the foreign body removal) and 92071–LT (for the bandage contact lens). Payment for the bandage contact lens was denied. What should you do next? A. Charge the patient for the fitting of the bandage lens (92071); B. Resubmit the claim using 92071–59–LT; C. Write off 92071 because CCI edits bundle the fitting of the lens with the foreign body removal when performed during the same surgical session; or D. Appeal the denial. (Answered correctly by 27.5%.)
Q6. A patient with commercial insurance underwent a YAG capsulotomy on the left eye the same day as cataract surgery was performed on the right eye. This was done as a convenience for the patient. What modifier(s) should be appended to the YAG code? A. –59–LT; B. –79–LT; C. –LT; or D. –59, –XS, and –LT. (Answered correctly by 25.4%. This question is also the number one question that is missed on the Ophthalmic Coding Specialist Exam—www.aao.org/ocs.)
Q7. When there is no physician documentation to support medical necessity for antireflective coating, tints, and oversize lenses, which modifier should you use? A. –EY; B. –GA; or C. –GY. (Answered correctly by 18.9%.)
1. B (false). 2. A (–GA, –RT, and –LT). 3. A (15823–50). All bilateral surgical procedures should be submitted on 1 line with modifier –50 and a 1 in the unit field, according to Medically Unlikely Edits (MUEs) published on April 1, 2013. Correct payment is 150% of the allowable. Incorrect claims submission means payment was only 100% of the allowable, which is a tremendous loss of income. 4. A (92072). Payment for 92072 is inherently bilateral. 5. C (write off 92071). 6. A (–59–LT). Because the YAG and cataract surgeries are bundled in CCI, you must append modifier –59 to unbundle. Because this is a commercial insurance, modifier –XS (separate structure) is not recognized. 7. A (–EY). Without a physician order, this is not a covered benefit for durable medical equipment and the patient is responsible for payment.