Medicare is a federally-administered health insurance program in the United States. Most people who use Medicare are age 65 or older. Medicare Part A, often called traditional Medicare, only covers hospital services, so Medicare has grown to include parts B, C and D. Part B expands on Part A to include doctor’s services, home health and outpatient care. It may also include preventive services. Medical billers and coders have to be exact when preparing Medicare claims. Medicare Part B has a large number of its modifier codes to help explain exactly what procedure or service has been rendered.
Medicare Part B modifier 24 is common modifier used when an unrelated evaluation and management service offered by the same doctor during a post-operative period. This covers a service or evaluation performed by the same doctor to the same patient he operated on, but is unrelated to the original procedure. The diagnosis code supporting modifier 24 must be different than the diagnosis code for the surgery performed.
Assistant at Surgery Modifiers
If one physician actively assists another, the physician in charge, while performing a surgical procedure, a modifier is needed. There are several that can handle this situation. The modifier 80 should be used when the surgical assistant was another medical doctor. However, 82 should be used if the assistant was an MD and there was no other resident qualified to do the procedure available. Documentation must be provided in this case. AS is the modifier if the assistance was given by a nurse practitioner or a physician assistant.
Hospice Services Modifiers
GV and GW are Medicare Part B modifiers for hospice services. Hospice services are performed for a person who is in the last stages of a terminal illness. Modifier GV is added when the service was performed at the time of the patient’s enrollment in the hospice program by a person designated as the attending physician. The modifier cannot be used if the service was given by a doctor employed by the hospice. If neither the attending physician nor a hospice physician provided the service, the modifier cannot be used. The GW code is used when a hospice patient receives services unrelated to the terminal condition.
Modifier 50 is another common Medicare Part B code. It covers a situation when two separate procedures are done on the same day, to the same patient, but in different sessions, for different injuries, different sites or different patient encounters. Modifier 50 cannot be used for the exact same procedure performed twice in the same day or if the documentation does not support two separate and distinct services.
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