Denial – Incorrect diagnosis or Required Modifier not billied”
As per Medicare newsletters “Incorrect Diagnosis” and “Required Modifier Not Billed” accounted for a large percentage of the provider/supplier billing errors. Lab services, radiology, physical therapy/occupational therapy, injections, cardiology, chiropractic services and surgery are the top specialties associated with diagnosis related appeals.
The information below demonstrates specialties most often associated with the specific modifiers omitted on the initial claim. Modifier 59 represents the majority of the missing modifier errors, which are often related to National Correct Coding Initiative (NCCI) bundling edits.
Modifier 24
– Unrelated E/M Service by the Same Provider, during a Post-Operative Period
Modifier 25
– Significant Separately Identifiable E/M Service by the same Provider on the Same Day of Procedure
Modifier 59 – Distinct Separate Procedure
Modifier 76 – Repeat procedure by the Same Provider
Modifier 79
– Unrelated Procedure or Surgery, by the Same Provider, during the Post-Operative Period
Modifier GW – Service Unrelated to Hospice Patient’s Terminal Condition by a non-hospice physician
CPT billing codes
CPT codes and HCPCS codes
What is Medical coding
