CPT code modifiers are the two-digit codes attached to the five-digit CPT code, and they give more detail to a medical service. For example, 80 is the CPT code modifier that explains a surgical assistant and/or physician assistant offered services, and payment is usually far less than the full amount.
Mark Ryberg, senior consultant of physician services at Integrated Healthcare Strategies, wrote that CPT code modifiers could affect both reimbursement and work relative value unit productivity. “To the extent organizations rely upon wRVUs in a physician cash compensation model, there is the potential for overpayment,” he said.
For example, if an assistant surgeon performed a procedure but did not have the CPT code modifier attached to the claim, the physician would receive full cash compensation instead of the reduced compensation, which could be roughly 16 percent of the original value.
“Organizations with wRVU-based production elements in their compensation formula need to ensure appropriate application of CPT code modifiers in calculating wRVUs for purposes of determining physician cash compensation,” Mr. Ryberg said. “Failure to do so creates a potential risk of overpayment to a physician, as well as a possible disconnect between the practice’s financial performance and physician cash compensation.”
CPT copyright 2010 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.
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