According to the report, modifiers -PA, -PB and -PC, used to identify wrong site, wrong surgery or wrong patient errors, are commonly misused. For example, some providers are using -PC to bill for the professional component of a service, when it stands for “wrong surgery on a patient.”
As a result, CMS has issued the following actions by Medicare contractors to prevent claims from being processed with these errors. According to the report, contractors will:
- Suspend, review and develop all claim lines that are submitted with the -PA, -PB or -PC modifiers; and
- Contact the provider to determine whether the claims are related to one of the adverse events as described by the modifiers -PA, -PB or -PC.
If the contractor determines that the modifiers are incorrect, he or she will do the following:
- Reject (return to provider) Part A outpatient claims; or
- Return Part B claims as unprocessable with Claim Adjustment reason Code 4 and Remittance advice Remark Code MA130.
Read the MLN Matters article about misuse of adverse event modifiers (pdf).
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