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Back  RFI # 221: Inst Claims Proc Code Modifier

Formal vs. Informal Help Informal Formal

Submitter

joanne hoagland

Description

The Institutional Claim 004010X096A1 trans refers you to the UB92 manual for procedure code modifiers (loop 2400, SV202-03 - SV202-06). The proc code modifiers in the UB92 are limited. We are interpreting the guide to mean that the modifiers listed in UB92 manual are the only ones we should be allowing for inst claims. However, we are receiving negative feedback from our providers indicating that the list is not comprehensive enough, and that we are rejecting claims that contain valid modifiers. The providers indicare they are coding the modifier using a different list. Pls advise if our interpretation is correct.

Submitter Assigned Keywords

Instititional Claim Procedure Code Modifiers

Response

Modifiers are to be used as indicated by the standard industry procedure and
modifier code set. Guidelines on valid codes for given situations are
covered by the code set and not by rules in the 837 implementation guide.
The 837 calls for use of HCPCS modifier codes; the source and documentation
of that code set give details of reporting requirements including those
documented as part of CPT and thereby incorporated into HCPCS.

Recommendation

The UB-92 Manual contains an appendix which lists modifiers for use on
hospital outpatient and ambulatory surgery claims. The NUBC recognizes that
the list is outdated and incomplete, and plans to replace it with a
reference to Appendix A in the CPT book. Problems or questions with what
are valid modifiers must be pursued with the maintainers of these codes: AMA
(CPT modifiers) and CMS (HCPCS Level II modifiers).
Submission 3/17/2005
Status Date 5/16/2005
Status F - Final
Primary References
Document 004010X096A1
SectionLp 2400
Page445
Set ID?