tci Medicare Compliance & Reimbursement - 2012 Issue 20
Reader Question: You Can Now Use Modifier PD
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Article Overview
This short article addresses a Medicare billing question about modifier PD in the context of hospital ownership, outpatient diagnostic or related non-diagnostic services, and inpatient admission timing. It is aimed at coders, billing staff, and practice administrators who need to understand whether a freestanding entity is affected and how Medicare payment is handled when the modifier is applied. The discussion also notes the implementation timing and points readers to CMS guidance for additional detail.
Why This Topic Matters
Understanding the scope of modifier PD helps practices determine whether the requirement applies to their organization and avoid misapplied billing on services connected to a nearby inpatient admission. It also highlights the Medicare payment implications associated with the modifier.
What You Will Learn
- How modifier PD is discussed in a Medicare billing context
- Which types of entities are affected by the modifier requirement
- How the article frames the relationship between outpatient services and an inpatient admission within three days
- Where to find CMS guidance for additional information
Who Should Read This
- Medical coders
- Billing specialists
- Practice managers
- Revenue cycle staff
- Compliance staff
Modifiers Discussed
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