International Classification of Diseases or the ICD-10 system is utilized to code signs, symptoms, injuries, diseases and conditions. The relationship between ICD-10 and Current Procedural Terminology (CPT) is critical in that the diagnosis supports the medical necessity of the procedures or the Evaluation and Management (E&M), i.e., the service being provided.
The provider’s documentation must be specific, and the diagnosis code selected must be to the highest specificity that the documentation supports. ICD-10 codes may be 3 to 5 digits depending on the level of specificity required.
Abdominal pain – R10.00
Abdominal pain, right upper quadrant – R10.11
A level I modifier is a two-digit code that modifies a service or procedure under certain circumstances. Level I modifiers are updated annually by the American Medical Association (AMA). These modifiers add information and change the description of a service or procedure rendered. Appending an appropriate modifier will effect reimbursement of the service.
Some examples of commonly used modifiers are:
25 – Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure of other service
57 – Decision for surgery
59 – Distinct procedural service
82 – Assistant Surgeon (when qualified resident surgeon not available)
Are your providers utilizing modifiers correctly, and does their documentation support the use of the modifier?
Click below if you are interested in our Billing/Coding Compliance Program.