Most Common Modifiers for Radiology Billing Services

Most Common Modifiers for Radiology Billing Services

The medical billing Process in radiology requires extensive knowledge of CPT codes and their modifiers. As a radiologist, you may be bound by diagnostic priorities that limit your medical costs. Also, clinical priorities are no excuse for unsuccessful medical claims that lead to claims being delayed, denied, or resubmitted.

Why Are Modifiers Essential?

Modifiers provide a way to report or indicate that a service or procedure has been performed and changed due to specific circumstances in medical billing services, but not the overall definition. It can also provide detailed information about services that have run multiple times or have occurred abnormally.

Below are some of the most common modifiers.

Modifier 24:

Modifier 24 is in addition to independent evaluation or management services (independent E/M) provided during the postoperative period of major surgery performed within 90 days by the same Physician. While outsourcing medical billing services or another way of medical billing, this modifier is not taken into the claims processing.

Modifier 26 (Professional Component): This modifier is used when the Physician does no editing in the procedure or service and only interprets or imagines the film. It ideally takes place at an ASC or a hospital where the center provides the equipment, and the radiologist gives reports based on image interpretation.

Modifier 26: Modifier 26 is used for billing the professional component when a service has both professional & technical components. Such components are observed in radiology services where the Physician's note on the scans is considered a professional component. In contrast, the machinery used is counted as a technical component and comes under radiology billing services.

Modifier 27: Modifier 27 is used when a patient is offered multiple E/M services at various outpatient facilities such as the emergency department, pharmacy, and primary care clinics on the same day by the same or different Physician Modifier 50 (Bilateral Procedure): This modifier relates to circumstances in which both sides of the body are imaged.

As the procedure or service is expected to be performed on both sides, this modifier should not be used. Also, "both sides" do not mean front and back pointing to the right and left.

Modifier 52, (Reduced Benefits): In certain circumstances, benefits or procedures may be reduced or eliminated at the Physician's discretion. For example, you may only want part of the Service; CPT best describes this scenario. If the code requires oversight and interpretation, the

surgeon oversees, and the radiologist only interprets. In such cases, do not forget the modifier 26 when you provide an interpretation.

Modifier 53 (Discontinued Services): In certain circumstances, physicians may decide to terminate a surgical or diagnostic procedure, often in the interest of patient or staff health. If not, do not use this modifier.

Modifier 59: Modifier 59 is one of the most used modifiers. Qualifier 59 should only be used when there is no better qualifier to describe the relationship between the two procedural codes. Qualifier 59 identifies procedures/services not normally reported together.

Modifier 76: Modifier 76 is used to report repeat procedures performed by the same Physician on the same day and is also the result of the original procedure.

Modifier 79: It is not uncommon for postoperative claims to be paid incorrectly or not, especially if the second eye surgery occurred during the global period of the first eye surgery.

If you use modifier 79 correctly, you can pay the claim for the second eye.

Remember that each eye's overall duration (postoperative) is independent of the other eye.

If any modifier is missing or used improperly, the payer's claim will immediately be dismissed. Without a thorough understanding of the proper use of modifiers, healthcare practitioners suffer from stale accounts, write-offs, and lost revenue.

Outsource medical billing services to avoid these errors.

Wrapping up: Our radiology billing services are recognized as being affordable and efficient.

Large-scale surgeries allow us to conduct business at doctor-friendly rates. At the same time, our unwavering commitment to quality ensures that medical billing, coding, filing, and implementation are performed with maximum efficiency. The

result is significantly improved billing efficiency, revenue, and clinical efficiency.

Contact MHRCM to experience the best features.