Modifiers
E/M modifier used to indicate a decision for surgery
What is modifier -57?
This organization created the NCCI policy initiative
What is CMS?
The abbreviation for the overall organization encompassing Medicare.
What is CMS?
What is 10?
The healthcare law stating physicians cannot refer patients to an entity where they have a financial relationship.
What is Stark (physician self-referral)?
Procedure modifier used to indicate an unrelated procedure during a postoperative period
What is -79?
The period of time each edit is effective before a new edit is published.
What is quarterly or every quarter?
The alphabetic character applied to indicate a beneficiary only has hospital coverage with Medicare.
What is A?
The modifier to use for a provider performing the preoperative management only of a procedure with a 90-day global period.
What is modifier -55?
An example of this rule would be knowingly submitting false claims to obtain Federal health care payment.
What is fraud?
Procedure modifier used to indicate bilateral procedures performed.
What is -50?
This number listed in a column indicates a modifier is not allowed or cannot be used when two services are performed on the same date.
What is 0?
The percentage Medicare will reimburse for the allowed amount for a service, with the patient/secondary responsible for the remaining percentage.
What is 80 (80%)?
The amount of days in a global period for a major surgery?
What is 90?
This type of insurance has a rule requiring a referral from the primary care for a patient to see a specialist.
What is an HMO?
Procedure modifier used to indicate a staged procedure performed in the postoperative period.
What is -58?
This abbreviation means a maximum unit of service that can be reported for a HCPCS/CPT code on the vast majority of appropriately reported claims.
What is MUE?
The typical age a patient will be when they are eligible for Medicare coverage.
What is 65?
This post-operative service is inclusive within the global period when a patient is following up after surgery.
What is E/M (evaluation and management) (Office visit)?
This rule under HIPAA establishes national standards to protect individuals' medical records and other individually identifiable health information (PHI).
What is the privacy rule?
E/M modifier used to indicate an unrelated E/M during a postoperative period
What is -24?
The frequency of release for the NCCI policy manual.
What is annually or every year?
The box or item on the CMS-1500 claim form Medicare requires to be completed when there is an ordering physician.
What is box or item 17?
The number of day(s) before a major surgery/procedure that are included with the 90 day global period.
What is 1?
This rule indicates in cases of more than insurance carrier for a minor or child, the policyholder with the birthday first in the calendar year is primary.
What is the birthday rule?