Medicare Compliance & Reimbursement - 2015 Issue 11
Reader Question: Append Modifier to 43239 to Reap More RVUs than 43249
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Article Overview
This article answers a subscriber question about whether modifiers are used with two gastroenterology CPT services and discusses how CCI edits and Medicare processing relate to the scenario. It is aimed at coding professionals who handle endoscopy billing, modifier assignment, and RVU-related comparisons between professional and facility claims.
Why This Topic Matters
Coding staff need to know when a modifier is or is not needed, and how payer edit logic affects claim reporting. The article helps readers understand the general billing context for these endoscopy services without relying on the premium content.
Article Sections
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Question
A subscriber asks about modifier usage on two endoscopy-related CPT services and references Medicare claim processing.
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Answer
The response discusses CCI edit considerations and the general reporting context for the services in professional and facility billing.
What You Will Learn
- How the article frames modifier use in relation to endoscopy claims
- How CCI edits are discussed in the context of these services
- How the article distinguishes between professional and facility billing considerations
- How the article places the question in a Medicare processing context
Who Should Read This
- Medical coders
- Coding auditors
- Billing staff
- Gastroenterology practice managers
- Revenue cycle professionals
Codes Discussed
Modifiers Discussed
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