How to Delete a Modifier CPT Code

Current Procedural Terminology, or CPT, codes are short codes that hospitals, doctors' offices and other health care facilities use. These codes are condensed medical techniques and information the facilities give to insurance providers for proper billing and compensation for health care services. Unfortunately, according to the Heart Rhythm Society, since different health care facilities will modify CPT codes to address certain medical circumstances, coding errors can occur with improper insurance payments or no compensation given. The National Correct Coding Initiative (NCCI) provides correct coding tools to prevent improper coding, including modifier codes added to CPT codes.

Instructions

• 1

  Pull medical records to review how long the coding error has been used by performing a compliance audit. Check the incorrect modifier with the NCCI database to see what Medicare program restrictions are imposed for using the CPT code modifier. The NCCI will indicate incorrect coding by assigning a number code of "0" for coding modifiers that are not associated with NCCI or are not to be used under any circumstances, or "9" where the modifier code is not applicable with any appropriate edited code.

• 2

  Evaluate medical records and delete the modifier CPT code whenever a "0" appears by it. For NCCI "9" restrictions, the modified code was deleted retroactively the moment it was inputted into the system. Append all medical records with the deletion and conduct meetings with the medical staff about the incorrect modifier to prevent improper coding in the future.

• 3

  Ensure proper modifier codes have been used, even when coding edits do not register on the NCCI database as an incorrect code combination. Contact the Medicare Carrier, Medicare Administrative Contractor or Fiscal Intermediary concerning errors. Receive corrected coding information concerning potential adjustments to proceed with the billing procedure.