Tips for Modifiers use in an Ambulatory Surgery Center

Modifiers have had reporting relevance since the implementation of the Centers for Medicare & Medicaid Services (CMS) payment methodology for procedures performed in ambulatory surgery centers (ASCs), and hospital-based ASCs. On the basis of approval by the National Uniform Billing Committee, CMS instructed its Medicare fiscal intermediaries to accept those approved CPT (HCPCS Level I) and HCPCS (HCPCS Level II) modifiers applicable to outpatient reporting.

A modifier provides the means by which a reporting facility can indicate that the service or procedure represented by a specific code does not exactly meet the standards for that code. A procedural circumstance requires an alteration of the code’s meaning. The individual circumstance depicted by each modifier has reimbursement or tracking relevance to the carrier, and for payment to the provider. The use of the modifier enables the insurance carriers to appropriately pay for the procedure and any associated postoperative services performed within or subsequent to the global period (same day for ASCs). In addition, it allows the carrier to differentiate instances in which duplicate billing or duplicate services may have been reported.

The facility should apply the CMS-endorsed coding policy/instructions when outpatient services are billed, and these should apply to all payers, unless other carrier-specific directives have been received.