CPT modifiers are systems of coded information that help healthcare workers label their practice decisions. Among the many modifiers provided under Medicare, there are at least two that I use in my practice. For example, I often use modifier 77, which is commonly used to denote a “repeat procedure by another physician” (“Modifier definition,” n. d., para. 20). It is applicable when it is necessary to indicate that a patient is under a repeated treatment and the procedure is undertaken by a different doctor. Another example of a modifier that is often used in my workplace is 55 55, which means “postoperative management only” (“Modifier definition,” n. d., para. 29). This modifier implies that “reimbursement is limited to the post-op management services only” (“Modifier definition,” n. d., para. 29). Thus, modifiers are essential in the work of a medical specialist.
When explaining the reasoning behind the use of modifiers, one might refer to the necessity of ensuring clarity in the justification of nurses’ actions at each stage of working with a patient. Indeed, when a procedure is altered due to particular circumstances, it should be justified and labeled to demonstrate the reason and signify the through-through decision-making. Indeed, the use of modifiers allows for minimizing fraud and ensuring that healthcare practitioners make deliberate actions to prioritize practices that are beneficial for patients and yet do not breach the principles and rules. According to the article, “Correct modifier use is an important part of avoiding fraud and abuse or noncompliance issues, especially in coding and billing processes involving government programs” (“Modifier definition,” n. d., para. 4). Thus, applying modifiers in a correct manner helps the whole healthcare system to remain standardized and functional through the use of the efficient coding system.
Reference
Modifiers definition. (n. d.). Web.