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How Well Do You Know Your Modifiers?

McNicholas, Faith C. M.

Journal of the Dermatology Nurses' Association:
doi: 10.1097/JDN.0b013e31826af5e5
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Abstract

ABSTRACT: Current Procedural Terminology and Healthcare Common Procedure Coding System codes define medical and surgical procedures performed on patients. Some procedure codes are very specific in defining a single service, whereas other codes define procedures consisting of many services. Because many dermatology procedures can be performed by different approaches, different methods, or in combination with other procedures, there are often multiple Healthcare Common Procedure Coding System and/or Current Procedural Terminology codes defining similar or related procedures.

To assist dermatology providers with the capability to bill multiple services provided to the same patient on the same date of service during the same encounter, Centers for Medicare and Medicaid Services developed the National Correct Coding Initiative edits to prevent inappropriate payment for services that should not be reported together during the same encounter. This article addresses the correct and appropriate use of National Correct Coding Initiative edits to avoid claim denials should a dermatology healthcare provider report two codes of an edit pair that are clinically appropriate.

Author Information

Faith C. M. McNicholas, CPC, CPCD, PCS, CDC, Coding and Reimbursement/Government Affairs, American Academy of Dermatology, Schaumburg, Illinois.

The author declares no conflict of interest.

Correspondence concerning this article should be addressed to Faith C. M. McNicholas, CPC, CPCD, PCS, CDC, American Academy of Dermatology, 930 E. Woodfield Road, Schaumburg, IL 60173. E-mail: fmcnicholas@aad.org.

© 2012 Lippincott Williams & Wilkins, Inc.