BadgerCare Plus & Medicaid SSI Provider Manual - Group Health ...

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BadgerCare Plus & Medicaid SSI Provider Manual - GHC of Eau Claire May 2012 Modifier Description GHC Claims Processing Policy 82 Assistant surgeon (when qualified resident not available) Reimbursed at Forward Health fee. Assistants at surgery are covered when an assistant is considered medically necessary and appropriate. Documentation must support why assistant was needed. 90 Reference (outside) laboratory Does not impact reimbursement 91 Repeat clinical diagnostic laboratory test In the course of treatment of the patient it may be necessary to repeat the same laboratory test on the same day to obtain subsequent test results. This modifier is not appropriate when different specimens from different anatomical sites are tested. 99 Multiple modifiers Does not impact reimbursement AA Anesthesia services performed Does not impact reimbursement personally by anesthesiologist AS Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery P1 P2 P3 P4 P5 P6 QK QX QY QZ A normal healthy patient (anesthesia modifier) A patient with mild systemic disease (anesthesia modifier) A patient with severe systemic disease (anesthesia modifier) A patient with severe systemic disease that is a constant threat to life (anesthesia modifier) A moribund patient who is not expected to survive without the operation (anesthesia modifier) A declared brain-dead patient whose organs are being removed for donor purposes Medical direction of two, three, or four concurrent anesthesia procedures involving qualified individuals CRNA service: with medical direction by a physician Anesthesiologist medically directs one CRNA CRNA service: without medical direction by a physician Reimbursed at Forward Health fee. Assistants at surgery are covered when an assistant is considered medically necessary and appropriate. Documentation must support why assistant was needed. Does not impact reimbursement Does not impact reimbursement Provider may bill one additional unit when appropriate Provider may bill two additional units when appropriate Provider may bill three additional units when appropriate Does not impact reimbursement Reimbursed at Forward Health fee Reimbursed at Forward Health fee Reimbursed at Forward Health fee Does not impact reimbursement [28]
BadgerCare Plus & Medicaid SSI Provider Manual - GHC of Eau Claire May 2012 Supporting Notes Are Required For The Following: • 59 modifier • 62 modifier • 66 modifier • Corrected claims • Prolonged services (99354-99355, 99356-99357, 99358-99359) • Unlisted CPT codes Supporting Notes May Be Required For The Following: • 22 modifier • 24 modifier • 25 modifier • Consultation codes (99241-99245, 99251-99255) This is not an all-inclusive list. Notes may be requested for other services and or other modifiers. Category III codes are not reimbursable. Separate procedures: If provided as part of a more comprehensive procedure, “separate procedure” codes should not be submitted with their related and more comprehensive codes. Unless meets criteria of modifier 59 and billed with modifier 59. [29]
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