Right CPT Modifier Will Bring in the Right Cash Flow

Current Procedural Terminology (CPT) codes consist of five-digit numbers that represent individual services and procedures. The CPT is currently identified by the CMS as level I of Healthcare Common Procedure Coding System (HCPCS).
CPT codes may be further defined by starred designations for certain minor surgical procedures and by modifiers to explain an unusual circumstance associated with a service or procedure.
What is a CPT modifier?
CPT modifier is an added feature of the CPT to indicate that certain circumstances have changed the performance service.
To cite an example - 51: When several surgeries are performed during the same operative session. Normally, most payers pay 100 percent for the first procedure, but decrease the reimbursement on the second, third, and fourth procedures.
There are three ways to ensure that you are using modifiers correctly:

Firstly, there are software technologies available that will prompt physicians to select the right modifiers at the time of service.

Secondly if the modifier is likely to reduce the amount of payment, leave the amount as it is and let the payer reduce it when he receives the claim. And if there’s likelihood of the modifier increasing the payment, increase the payment on the claim before you file it; don’t expect the payer to do it for you.

Thirdly, you’ll do well to know the payers’ policies regarding the use of modifiers. Remember that rules may differ among the payers.

Keeping pace with the CPT code list and modifiers can be a daunting challenge. This year saw around 700 CPT code changes and with just a few months to go before the year comes to an end, you’ll do well to gear yourself up for additional changes in the coming year.