tci Medicare Compliance & Reimbursement - 2015 Issue 11

Industry Notes: Wrong Surgery On A Patient? There's A Modifier For That

You may have modifiers 59 and 25 committed to memory, but you’ve also got access to dozens of other, less-utilized modifiers that you may not even know exist. Such is the case with modifier PC (Wrong surgery or other invasive procedure on a patient), which the Centers for Medicare & Medicaid Services (CMS) recently highlighted during a May 12 podcast called “Clarification of the Use of Modifiers When Billing ‘Wrong Surgery on a Patient.’” Unfortunately, some practices are erroneously assigning modifier PC to reflect the professional component of a service, which in actuality should...

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