馃攳
ChiroSecure & HJ Ross CPT modifier update - YouTube
Channel: Chirosecure Malpractice Insurance
[15]
[Music]
[51]
hi everyone and welcome this is Samuel
[55]
Collins the coding and billing expert
[56]
for chiropractic and the HTI Ross
[59]
company insurance information network
[61]
and seminars with another episode of
[63]
Kairos secures growth without risk and
[66]
to make sure this is without risk is to
[68]
make sure we're always doing and billing
[69]
properly so today's topic is going to be
[72]
on chiropractic improper use of
[74]
modifiers because of course there have
[76]
been some changes occurring recently and
[78]
I'm sure some of you have gotten some
[79]
denials for not having the proper
[81]
modifier so let's make sure we have the
[83]
right ones let's go to the slides and as
[85]
always you can see here on the opening
[86]
slide we give our title and of course my
[88]
email address that being said let's go
[91]
into what our modifiers modifiers are
[94]
Percy PT and the modifiers are referred
[97]
to as level one modifiers meaning just
[99]
simple type and they're used to
[101]
supplement information to adjust care
[102]
descriptions to provide extra details so
[105]
by example you might use a modifier 25
[107]
to indicate that there is a separate
[109]
distinct exam or maybe modifier 59 so
[112]
the modifier helps to tell us something
[114]
specific about the code being billed
[116]
that it's not included or something
[118]
special about it that being said these
[121]
modifiers are used for these reasons a
[123]
service has been increased or decrease
[125]
has professional and technical component
[128]
only part of the services performed
[129]
something was independent or it's
[131]
expected to be denied and these are the
[133]
common ones we run into chiropractic
[135]
however at the end of the day just keep
[137]
it simple a modifier is nothing more
[139]
than a two digit code or number that
[142]
allows us to tell something specific
[144]
about the care for the most part it's
[146]
going to be numbers but recently we're
[148]
running to many more that have letters
[150]
for instance I'm sure you're familiar
[151]
with modifier 84 Medicare so here's what
[155]
we want to cover though what's new or
[158]
maybe better stated what is confusing
[160]
and I think that's really the issue
[162]
we're running into so here's one of the
[164]
things going on if you're familiar with
[165]
the VA Choice Program or pc3 program
[168]
there is a requirement for modifiers of
[170]
for claims in fact I'm given a direct
[173]
code from the direct quote from the
[176]
chiropractic section under the Tri West
[178]
Alliance and it says
[180]
chiropractic care codes such as physical
[182]
therapy modalities frequently need
[184]
modifiers when providers submit claims
[187]
without these modifiers claims and
[189]
payment will be denied and providers
[191]
will have to submit with Corrections if
[193]
you're unsure what modifiers to use
[195]
please refer to your coding resource now
[197]
what I find funny about this is they're
[199]
telling you you need a modifier but
[202]
won't tell you what it is so what is
[203]
this modifier in fact if you call them
[206]
they will not tell you so I bet many of
[208]
you when you first build a VA program
[210]
we're never paid for therapy because you
[212]
didn't know the modifier they needed so
[215]
what the heck is this modifier
[217]
well the modifier is GP GP for physical
[221]
therapy is required modifier for all VA
[224]
claims the GP modifier by Medicare
[227]
refers to a service delivered under
[229]
outpatient therapy plan of care this
[232]
means that that service is being
[234]
delivered as part of a plan of care
[235]
that's not in a hospital or an
[237]
outpatient so all fara P codes notice
[240]
nine seven two zero one zero through
[243]
nine seven seven nine nine meaning all
[246]
physical medicine codes must be appended
[248]
with GP now notice how I made that
[250]
statement I said physical medicine codes
[253]
and the reason I make that distinction
[255]
is physical medicine is the service
[257]
physical therapy is when a physical
[259]
therapist delivers it so I always like
[262]
to refer to it properly as physical
[264]
medicine codes bottom line is when
[266]
billing to the VA always include GP on
[269]
the physical medicine code or it will be
[272]
denied the GP does not change the price
[275]
it just simply indicates it as a payable
[277]
service now GP in a sense is kind of
[280]
like the 80 modifier that we use for
[283]
Medicare for physical therapy it's just
[284]
now required on federal claims well
[287]
where else is federal claims we'll of
[288]
course Medicare I'm sure you've noticed
[291]
over the past year because this became
[293]
true in 2018 Medicare claims by a doctor
[297]
of chiropractic where there is billing
[298]
for physical medicine services must also
[300]
have modifier GP if there is no GP
[304]
Medicare will not process with patient
[306]
responsibility for a secondary payer to
[308]
make payment in other words it simply
[310]
will be denied now physical medicine
[312]
services that
[313]
course everything nine seven zero one
[314]
zero four nine seven seven nine nine
[316]
must be appended with modifier GP but
[319]
because it's Medicare you also need a
[322]
chi by now the gy is a specific only
[325]
medicare modifier to indicate that it's
[327]
an excluded service just because we put
[330]
a GP with it doesn't mean Medicare is
[332]
going to pay it simply indicates that
[334]
Medicare knows that we know it's an
[336]
excluded service so you can notice the
[339]
examples at the bottom I put the code
[340]
for exercise nights and one one zero and
[342]
you'll notice there's a Gy GP and a GP
[345]
Gy the order of the modifiers doesn't
[349]
matter if you put Gy first or GP first
[351]
it does not matter to Medicare they just
[353]
simply must appear but there can be some
[356]
instances for instance is the code nine
[358]
seven one four zero manual therapy
[360]
you'll notice this one has three
[362]
modifiers 59 Gy and GP and of course
[366]
that 59 is the modifier we use to
[368]
indicate a separate distinct service
[370]
we'll talk more about that in a moment
[372]
but I just want to highlight that if you
[374]
need three modifiers there are spaces
[376]
for them in fact on a standard 1500
[378]
claim form you may now place up to four
[381]
modifiers
[381]
but again emphasis towards making sure
[383]
they appear the order is not as
[385]
important as making sure they're there
[387]
well where else is this GP required well
[390]
on any other federal claims and that
[392]
includes so-called Medicare Advantage
[394]
plans
[395]
so when billing a Medicare Advantage
[397]
plan any physical medicine code must to
[399]
have GP these plans because they're not
[403]
medicare direct don't require the gy or
[406]
exclude service code but they do require
[408]
the GP and the good news is many of
[411]
these Medicare backs funds are covering
[413]
and paying for therapies so that's
[415]
certainly a good advantage for us in
[417]
these not only a medicare advantage but
[419]
an advantage to the provider where it
[420]
can be paid so federal claims Medicare
[424]
federal claims va and actually any
[428]
federal claim should have modifier GP on
[431]
the physical medicine services but where
[434]
else is this required and this is new
[436]
for this year from United Healthcare and
[438]
beginning in June for optimal and their
[441]
new policy says to ensure accurate
[443]
adjudication of claims physical therapy
[445]
occupational therapy
[447]
and speech therapy services providers
[448]
are required to append the claim with
[450]
the hick pick specialty modifier when
[453]
physical therapy occupational therapy
[454]
services provided the claim must include
[456]
these modifiers to identify the benefit
[458]
now realize this goes to all therapy
[460]
providers don't be fooled when you see
[462]
the term just physical therapy
[464]
occupational therapy they're actually
[466]
indicating any provider of a service
[468]
within scope when billing for United
[471]
healthcare or Optum health which of
[474]
course is affiliated those two need GP
[477]
so make sure federal claims United
[479]
Healthcare optimal all get a GP on
[482]
physical medicine service however what's
[485]
the one modifier we all use well let's
[487]
make sure this is a hundred percent
[488]
usage doctors of chiropractic that do
[490]
exams which of course is all of us
[492]
whenever you do an exam with treatment
[494]
you have to append to 25 modifier so the
[496]
most common modifier for chiropractic
[498]
claims is modifier 25 this modifier
[501]
appended to the evaluation of management
[502]
code indicates the E&M being reported
[505]
and i've underlined this is separate and
[507]
distinct from the inherent evaluation
[509]
associated with a chiropractic
[511]
adjustment or other treatment of the day
[513]
so notice the examples 99203 new patient
[516]
or 99213 established patient both have
[520]
modifier 25 to indicate that it is a
[522]
separate distinct service from
[525]
manipulation but I do want to emphasize
[526]
it's not just if you're billing
[528]
manipulation if you are also billing any
[531]
therapy even if there's no manipulation
[533]
that day it still requires the twenty
[536]
five it does not change the price it's
[538]
just separate and distinct do be careful
[540]
of course you cannot bill an E&M daily
[543]
but certainly can bill and E&M when
[545]
appropriate which of course is first
[546]
visit and on re exams however there's
[549]
another problem modifier this problem
[552]
modifier is modifier 59 it's not the
[554]
problem the problem is how they include
[556]
it so you notice the three services I
[558]
have listed here nine seven one one two
[560]
neuromuscular education nine seven one
[563]
two for massage and nine seven one four
[566]
zero manual therapy the modifier needed
[569]
for any of these codes is modifier 59 so
[572]
you must append it to any of these codes
[574]
in order to distinguish that it is
[576]
separate and distinct the bigger problem
[579]
though is look at bullet
[580]
the reason this modifier is required is
[583]
to demonstrate that the services noted
[585]
above were provided to a region that is
[587]
not part of the spinal CMT so it
[591]
literally means for it to be paid you
[593]
have to use a modifier 59 but in
[595]
addition it must be to a region you're
[597]
not manipulating as far as fine so for
[600]
instance if the adjustment was done to
[602]
the cervical spine only and myofascial
[605]
release to the lumbar spine then it
[608]
would be payable and you simply would
[609]
include modifier 59 notice this now
[612]
includes massage in neuromuscular
[614]
education so be very careful to make
[616]
sure are you demonstrating in your chart
[618]
notes that it is a separate area because
[620]
the 59 is your statement that it is and
[623]
I've had a lot of offices recently
[625]
particularly with Blue Cross Blue Shield
[626]
of Illinois and other blues as well as
[630]
Aetna being very strict to look at your
[632]
notes to make sure that it's separate
[634]
when possible certainly do diagnosis is
[636]
pointing there are subsets though of
[638]
modifier 59 and this might have been
[640]
helpful these subsets were established
[642]
by CMS some four years ago and they are
[645]
modifiers XS x e PS in you and so you'll
[650]
notice I have all of them listed XE SS
[652]
separate encounter which means it's a
[654]
separate visit or XS a separate
[656]
structure XP a separate practitioner or
[658]
X you that it's not overlapping well i
[661]
highlighted the XS and blue because
[663]
notice that one is the specific one that
[665]
a doctor of chiropractic abused because
[667]
notice it says a service that is
[669]
distinct because it was performed on a
[672]
separate organ structure so in other
[674]
words I did the myofascial to the
[676]
shoulder and I adjusted the neck I did
[680]
myofascial to the lumbar spine but I did
[682]
myofascial to the cervical spine be very
[686]
clear that you are following that simply
[688]
not billing for the adjustment you have
[690]
to not have done the adjustment to the
[692]
area the tricky part here is it only
[695]
involves the spine if you were to
[698]
provide a manual therapy to a knee and
[701]
adjust the knee that would not need a
[703]
separate area it's the spine only but if
[706]
you prefer you can use these modifiers
[708]
instead the obviously most common would
[710]
be XS in addition another modifier that
[714]
courses common is for Medicare in this
[716]
monocot fire is 80 or I like to think of
[719]
active treatment or acute treatment but
[721]
technically it means simply pay the
[723]
chiropractic claim is medically
[724]
necessary spinal manipulation that is
[726]
corrective must have the 80 modifier on
[728]
the adjustment code or the claim will
[730]
automatically be denied so that's a
[733]
modifier that's exclusive to Medicare
[735]
notice I did not indicate to use it
[737]
anyplace but Medicare however what about
[741]
Medicare Advantage plans Medicare
[743]
Advantage plans are so-called Medicare
[745]
Part C but these are plans persons will
[747]
buy or trade their Medicare benefits for
[749]
these can be plans like Sakura rise ins
[752]
or Kaiser or other types that sell them
[754]
I mean United another sell them and on
[757]
these plans you're gonna build just like
[759]
Medicare subluxation and secondary
[761]
diagnosis but also as far as modifier is
[764]
concerned you're going to use modifier
[766]
80 so again for Medicare Advantage plans
[769]
you're going to use the modifier 80 as
[772]
well again I'm going to focus you in the
[775]
newest modifier that we're having issues
[776]
is putting the GP on the physical
[778]
medicine codes for federal plans VA
[781]
Medicare and all the others but also
[783]
making sure that for Medicare we're
[786]
using gy or 81 necessary and then of
[789]
course modifier 80 when it comes to
[791]
corrective care for Medicare but what
[794]
about one other one for Medicare and
[796]
this is why I wanted to make sure to go
[797]
through these there's another modifier
[799]
for Medicare and this is common a
[802]
patient that's undergoing maintenance
[805]
care let's say you have a patient that
[807]
enjoys getting chiropractic care in
[809]
their Medicare age and they're done with
[811]
your acute party care and they say hey
[813]
doc this feels really good can I come
[815]
once a week well that's certainly
[817]
acceptable but what you have to use to
[819]
make sure that the patient understands
[821]
that's not going to be covered because
[822]
that type of care is maintenance is
[823]
modifier G a modifier GA is used when a
[827]
voluntary waiver or so-called advanced
[829]
beneficiary notice or ABN is used to
[832]
inform the patient the CMT to the spine
[834]
is not going to be covered by Medicare
[836]
in other words we are informing the
[838]
patient beforehand that it's not cover
[840]
when billing Medicare if they chose an
[843]
option one on the ABN you would then
[845]
bill with modifier G
[847]
and what GA indicates the Medicare is
[849]
the patient's accepted responsibility
[851]
and of course Medicare will give patient
[853]
patient responsibility that the patient
[855]
is paying the good news is when a
[858]
patient has signed this waiver I want to
[860]
be aware that Medicare no longer
[862]
dictates the fee if you have a Medicare
[864]
patient that's on maintenance and you
[866]
indicate such on the Medicare waiver or
[868]
ABN you may at that point charge your
[871]
normal fee you certainly can't continue
[874]
to charge the Medicare rate if you
[875]
prefer but you're not limited to the
[877]
Medicare rate but one thing to know this
[879]
G a modifier does not apply to Medicare
[882]
Advantage plans they do not accept it
[884]
for Medicare Advantage plans you're
[886]
either billing the service as correct it
[887]
was 80 or you're not they do not accept
[890]
the GA modifier and frankly they can
[892]
often be potentially a little more
[893]
generous and allowance of services so at
[896]
the end of the day make sure you have
[897]
your correct modifiers and what I want
[898]
to emphasize again make sure you have
[900]
the GP I want to be compliant always
[902]
have your office up and running to make
[904]
sure you know all the rules and strategy
[906]
well one of the easiest ways go to HJ
[909]
Ross we are your resource we will help
[912]
you get a contact with us go to our
[914]
website go to send us an email come to a
[917]
seminar here's all our information here
[919]
just go to those pages we have your
[921]
answers I thank you for your time and
[922]
I'll see you again on Cairo Secours
[925]
let's grow without risk
[931]
[Music]
[962]
you
[964]
[Music]
[973]
you
Most Recent Videos:
You can go back to the homepage right here: Homepage