What is a Modifier?
Coding modifiers are often used in medical billing. They add extra information about the procedure, without changing the inherent description of the procedure code. Modifiers for medical billing are created by both the American Medical Association (AMA) and the Centers for Medicare & Medicaid Services (CMS).
Where Does a Modifier Go On a CMS1500 Form?
If billing on a CMS1500 form, modifiers go in box 24D, next to the CPTⓇ or HCPCS code. The form has spaces available for up to four modifiers.
How Many Coding Modifiers are There?
There are dozens upon dozens of medical modifiers. However, registered dietitians (RDs) will not need to be familiar with all of the types of modifiers.
For example, there is a whole group of anatomical modifiers with an individual modifier for each toe and finger. While this is important when coding and billing for a surgeon, this would not apply to any dietitian services.
When To Use a Modifier
Modifiers are not always required. Rather, they are only used in specific situations to make billing as specific and accurate as possible.
For example, if the appointment was conducted via telehealth, a modifier, such as 95 or GT, should be added to indicate this. Otherwise, it would be assumed that both the clinician and patient were present at the location indicated on the billing form.
Medical Modifiers of Potential Interest for Dietitians
Advanced Beneficiary Notice of Noncoverage (ABN) Modifiers
Medicare recipients must sign ABNs in cases where Medicare will not pay for a service. In these situations, a modifier must be used to give more information. These modifiers include:
- GA – Waiver of Liability Statement Issued, as Required by Payer Policy
- GZ – Item or Service Expected to Be Denied as Not Reasonable and Necessary
- GX – Notice of Liability Issued, Voluntary Under Payer Policy
- GY – Item or Service Statutorily Excluded or Does Not Meet the Definition of Any Medicare Benefit
When services are being provided via telehealth, a modifier must be put on the claim to indicate this. There are several different telehealth modifiers, including:
- 93 – Synchronous Telemedicine Service Rendered Via Telephone or Other Real-Time Interactive Audio Only Telecommunications System
- 95 – Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications System
- FQ – A telehealth service was furnished using real-time audio-only communication technology
- GQ – Via asynchronous telecommunications system
- GT – Via interactive audio and video telecommunications systems
Dietitians generally do not need to use CPT modifiers, but modifier 33 could potentially be used when billing certain insurance companies. This modifier is defined as “Preventive Services.”
Modifier 33 can be used when the primary purpose of the service is considered preventive, based on ratings from the US Preventive Service Task Force (USPSTF). Preventive services are of no cost to the patient.
For example, the USPSTF recommends adults with a body mass index (BMI) of 30 or greater be referred to intensive behavioral interventions with a B rating. Therefore, nutrition counseling should be covered at no cost to the patient.
Some dietitians add modifier 33 to claims in this situation to let the insurance company know that the patient’s responsibility, such as a copay, should be waived. However, using the correct ICD-10 codes, such as E66.9, is generally what the insurance companies require instead of using a modifier. Other insurance companies want Z71.3 to be used as the diagnosis code to show the claim should be processed as preventive.
Modifier AE is a HCPCS modifier and stands for “Registered dietician.” While this seems like the most important modifier for RDs to be familiar with, it is not. I personally have sent thousands of claims to dozens of different insurance plans and have never used this modifier.
There is no need to add this modifier as claim forms have a spot to put a taxonomy code, which indicates the provider specialty. This is already letting the insurance company know a dietitian provided the service, so there is no need to add this information again with a modifier.
The main taxonomy code for dietitians is 133V00000X.