HCPCS Level II modifiers and transportation origin/destination modifiers
have been overlapping for several years - this is not a new problem. The
logic lies in the combination of procedure code and modifier; e.g. GN with a
HICPCS transportation code does not mean the same as GN with a therapy code.
Barb Hollerung
Minnesota Medicaid
Ph. 651-297-7222
Fax 651-297-3230
[EMAIL PROTECTED]
-----Original Message-----
From: Stuart Beaton [SMTP:[EMAIL PROTECTED]]
Sent: Tuesday, March 19, 2002 5:36 PM
To: [EMAIL PROTECTED]
Subject: RE: 837P - Ambulance Modifiers
Jonathan,
Only valid HCPCS modifiers are allowed to be sent in the 837 in
association with a HCPCS code. That would eliminate your duplicates, but
now it sounds like that creates another challenge for you, what valid HCPCS
modifiers to replace the proprietary madifiers with.
Stuart
-----Original Message-----
From: Jonathan Fox [mailto:[EMAIL PROTECTED]]
Sent: Tue 3/19/2002 4:14 PM
To: [EMAIL PROTECTED]
Cc:
Subject: RE: 837P - Ambulance Modifiers
Stuart,
Thanks for replying. The only problem I have with your
response is that there are codes that already exist for those combinations.
For example:
EM - Emergency reserve supply (for ESRD benefit only)
EP - Service provided as part of medicaid early periodic
screening diagnosis
and treatment (EPSDT) program.
GE - This service has been performed by a resident without
the presence of
a teaching physician under the primary care
exception.
GG - Performance and payment of a screening mammogram and
diagnostic
mammogram on same day
GH - Diagnostic mammogram converted from screening mammogram
on
same day.
GJ - OPT OUT physician or practitioner emergency or urgent
service.
GN - Service delivered personally by a speech-language
pathologist or
under an outpatient speech-language pathology plan
of care.
GP - Service delivered personally by a physical therapist
or under an
outpatient physical therapy plan of care.
How do we accommodate these "duplicate" codes?
Thanks.
Jon
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>>> [EMAIL PROTECTED] 03/19/02 01:55PM >>>
Jon,
Your first example is the correct way to send modifiers to
HCPCS codes.
SV1*HC:A0090:HR*540*UN*1***1**N~
There is also an example with the SV1 segment in the 837P
(X098) Implementation Guide with a modifier on page 400.
Hope this helps,
Stuart Beaton
Vice President
Washington Publishing Company
Co-chair X12N/TG2/WG1 (Eligibility)
-----Original Message-----
From: Jonathan Fox
[mailto:[EMAIL PROTECTED]]
Sent: Tue 3/19/2002 9:00 AM
To: [EMAIL PROTECTED]
Cc:
Subject: 837P - Ambulance Modifiers
I am part of the wnyhealthenet Consortium, LLC and
we need clarification regarding the work that was done by Sarah Lanthier on
ambulance HCPCS codes and modifiers. I looked in the free stuff section of
Claredi's website and did not find an ambulance claim WITH a modifier. So I
pose this question to you.
Our question is related to how the codes and
modifiers should be represented in the 837P.
Please indicate which example is correct:
1.) SV1*HC:A0090:HR*540*UN*1***1**N~
2.) SV1*HC:A0090:H :R *540*UN*1***1**N~
3.) None of the above.
This is not intended to be a trick question.
Please advise.
Thanks,
Jon Fox
Co-Chair, wnyhealthenet Consortium, LLC
Transactions Workgroup
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are hereby notified that any disclosure, copying, or distribution of this
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delete the e-mail and its attachments from your computer. Thank you for
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