Procedure Code Modifiers

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athenaOne for Hospitals & Health Systems   

This page allows you to add, update, and delete procedure code modifiers used in your organization. A procedure code modifier is a two-digit code added to a CPT code that further qualifies the code (for example, 99215,25). Procedure code modifiers can provide more specific information about a procedure, and they can also affect the fee for the procedure. Modifiers can be used for billing purposes and revenue tracking.

 

On the Main Menu, click Settings > Billing. In the left menu, under Practice Links — Fee and Allowable Schedules, click Procedure Code Modifiers

 

 

 

  1. Display the Procedure Code Modifiers page: On the Main Menu, click Settings > Billing. In the left menu, under Practice Links — Fee and Allowable Schedules, click Procedure Code Modifiers.
  2. Modifier — Enter the modifier number.
  3. Modifier Description — Enter a description of the modifier. (Required for HCPCS codes.)
  4. Fee affecting — Select Yes or No. If a modifier affects a procedure code fee, you must enter the "procedure code,modifier" combination separately in the fee schedule.
  5. Appears on the claim — Select whether the modifier should print on the claim form.
  6. Click Save.

 

  1. Display the Procedure Code Modifiers page: On the Main Menu, click Settings > Billing. In the left menu, under Practice Links — Fee and Allowable Schedules, click Procedure Code Modifiers.
  2. Locate the procedure code modifier that you want to update. (The list is sorted by ID number.)
  3. Click the edit link. The details appear in the fields at the top of the page.
  4. Edit the fields as needed.
  5. Click Save.

 

  1. Display the Procedure Code Modifiers page: On the Main Menu, click Settings > Billing. In the left menu, under Practice Links — Fee and Allowable Schedules, click Procedure Code Modifiers.
  2. Locate the procedure code modifier that you want to delete. (The list is sorted by ID number.)
  3. Click the delete link.
    You can restore the procedure code modifier by clicking the undelete link immediately after you delete it. Also, you can click Show deleted on the Procedure Code Modifiers page to display the modifier that you deleted and then click the undelete link to restore it.

 

 

 

If you use procedure code modifiers to sort procedure codes into procedure code groups, you must configure the procedure code modifiers as fee-affecting on the Procedure Code Modifiers page; athenaOne recognizes a procedure code-modifier combination only if the modifier is set to Fee affecting = Yes).

 

For example, if CPT code 99213,25 is assigned to procedure code group A and CPT code 99213,59 is assigned to procedure code group B:

  • Modifier 25 and modifier 59 must be configured as fee-affecting on the Procedure Code Modifiers page.
  • Each procedure code-modifier combination must be entered in the fee schedule for the correct procedure code group.

Note: If you update a fee schedule after claim creation, an incorrect procedure code group is not retroactively corrected in the claim or in the Transaction Activity and Transaction Aging reports that you can run using the Report Builder.

 

 

Modifier

The actual modifier (for example, 80, OB, etc.).
Description

A description of the modifier (required for HCPCS codes).
Fee affecting

Indicates whether the modifier affects the fee for the procedure.

Yes — Requires two separate entries in the fee schedule, one with only the CPT code and a second with the CPT code followed by the modifier.

No — Indicates only one entry in the fee schedule is required.

 

If the modifier does affect the fee, an entry for that "procedure code,modifier" combination must appear in the practice's fee schedule.

Multiple fee-affecting modifiers are handled via multiple commas (for example, 99215,OB,25,80).
Appears on the claim

(For athenaCollector only) Indicates whether the modifier appears on the claim form.
Column Headings on Procedure Code Modifiers List
ID

System-assigned unique numeric ID.
Description

Description of the modifier. For reference purposes only.
Affects Fee

Indicates whether the modifier affects the fee.
Appears On Claim

Indicates whether the modifier should be printed on the claim.

 

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