The only overlapping modifiers I can find are AS and EP. AS for transportation is
defined as ambulance trip out of state and otherwise defined as PA, CRNP or CRNS for
assistant at surgery. EP for transportation is for a trip from an extended care
facility or nursing home to a physician's office. Otherwise transportation modifiers
are made by combing the one digit modifier that signifies the place of origin with a
second one digit modifier which signifies the place of destination. G is not one of
the valid transportation modifiers there should be no problem with any of the
modifiers listed below (except EP). Since the transportation modifiers are used in
association with different procedure codes than the other Level II modifiers it should
always be possible to discern their meaning
Sue A Thompson
350 Capitol Street, Room 251
Charleston WV 25304-3709
Phone: 304-558-1752
Fax: 304-558-4397
[EMAIL PROTECTED]
>>> [EMAIL PROTECTED] 03/20/02 08:40AM >>>
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
e-mail and its attachments, if any, may be unlawful and may subject you to
legal consequences. If you have received this e-mail and attachments in
error, please contact Independent Health immediately at (716) 631-3001 and
delete the e-mail and its attachments from your computer. Thank you for
your attention.
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