Outpatient Facility Coding Alert - 2016 Issue 6
Modifiers: Follow 32's Rules When Coding Mandated Services
Subscribe or sign in to view the full article.
Article Overview
This premium article reviews how modifier 32 is presented for services that are required by an outside authority, including second opinions and other mandated encounters. It is intended for coding professionals who need to understand the general situations covered, the organizations or entities involved, and the special caution noted for Medicare-related federally mandated visits. The article also places the discussion in the broader context of E/M and non-E/M services, without providing a substitute for the full guidance.
Why This Topic Matters
Correctly recognizing when a service is externally mandated can affect how a claim is categorized and understood by a payer or internal billing team. The article is relevant for coders and auditors who handle E/M and other services that may involve third-party, legal, or government-driven requirements.
Article Sections
-
Q&A on modifier 32 for mandated services
An interview-style discussion covering when the modifier is considered, who may require a service, and how the topic relates to second opinions and other mandated care scenarios.
-
Medicare-related warning
A cautionary note describing a Medicare-specific limitation and referencing CMS publication material related to federally mandated visits in facility settings.
-
Applicability beyond E/M services
A short discussion noting that the topic is not limited to one service category and can extend to other types of services as well.
-
Who can mandate services
A discussion of the kinds of entities or authorities that may require a service under a contract, legal process, or other formal obligation.
What You Will Learn
- How the article frames the use of modifier 32 in mandated-service scenarios
- Which broad situations are discussed as examples of externally required services
- What general Medicare-related caution is highlighted
- How the article distinguishes between different kinds of authorities that may require a service
Who Should Read This
- Medical coders
- Coding auditors
- Billing staff
- Compliance personnel
- Revenue cycle professionals
Modifiers Discussed
Subscribe or sign in to view the full article.
Quick, Current, Complete - www.findacode.com