Every CPT code has been assigned a relative value unit (RVU) and they are determined on the basis of the resources necessary to the physician's performance of the service. Assigning these services in the proper sequence based on a highest to lowest RVUs can ensure proper payment. When submitting the claims, listing the codes in the wrong order may lower your reimbursements. Here are some examples which illustrates how a change in sequence may affect the way you are reimbursed. Case 1: During … [Read more...]
Using Modifiers -GY and -GZ
The Center for Medicare and Medicaid Services (CMS) created two modifiers that allows you to distinguish between services that are statutorily not covered or otherwise not a Medicare benefit because Medicare does not consider them "reasonable and necessary". Modifier -GY: Appending -GY modifier to the CPT code enables one to identify an "item or service is statutorily excluded or the service does not meet the definition of Medicare Benefit". This will automatically create a denial and … [Read more...]