Do away with your orthopaedic modifier confusions to get your claims right

Confused over which modifier to list first when several are required on the claim? Orthopaedic practices have more questions than answers. If you’re always in the question mode, your claims will start to suffer.

Are you often mixing up your E/M modifiers? If so, reading this article will certainly give you more insight on orthopaedic coding and modifiers, and you’ll be able to apply the correct modifier each time, every time.

Modifier 24

For post-op cases, pick modifier 24. When you report modifier 24, the E/M service must meet the following criteria:

• The E/M service takes place during the postoperative period of another procedure
• The present E/M service is not related to the previous procedure
• The same physician who performed the previous procedure provides the E/M

Modifier 25

Appending modifier 25 means the E/M service must meet the following:

• The E/M is significant and separately identifiable from any inherent E/M component included with other services you report on the same day.
• The E/M may or may not be related to other procedures/ services you report on the same day
• The service the surgeon renders on the same day as the E/M service should have a zero-day, 10-day or “XXX” global period
• The same physician bills the E/M and other procedures/services on the same day.

To learn the latest modifier options for orthopaedic claims, you can try attending orthopaedic coding conferences and learn how to append them correctly. When you do so, you’ll not only update yourself with the latest on orthopaedic coding, but also speed up your claims processing time.

In fact there’s a 2010 Coding Update and Reimbursement Conference taking place in Orlando, FL this December, where you can head to and choose your specialty.

Gain knowledge about medical coding by attending proper medical coding conferences along with premier coding experts, CDs, tapes and transcripts of coding training information by specialty.

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