At your facilities, who attaches the modifiers 59 and 91 for lab visits? Is
this built into your chargemaster for lab to monitor or do the coders have
to go into each visit and attach the modifiers? At our facility, they are
trying to have the coders go into our rendering screen and add these
modifiers. This would involve the coders having to go into each lab visit,
go through each test, and then decide if the test was a duplicate or not.
What are you doing in your facilities?

Kathy Hopkins, RHIA, RN

Health Information Manager

Ridgecrest Regional Hospital

1081 N. China Lake Blvd.

Ridgecrest, Ca. 93555



  • edited May 2016
    We do not do modifiers for lab visits.

    Brenda W. Tuck, BBA, RHIT, CCS
    Director HIM/Privacy Officer
    Granville Medical Center
    919-690-3000 Ext 4423
  • edited May 2016
    At any facility I've worked, charges are the responsibility of the
    department performing the service, or verification by the billing
    department. Not done in HIM.

    Barbara Perrett, RHIA, CCS, CHP, CHC

    Compliance/Privacy Officer

    Tucson Medical Center Healthcare

    Tucson, Arizona 85712

    Phone: 520-324-1962 Fax: 520-324-2338
  • edited May 2016
    Our HIM coding system flags any account with an edit asking for a
    modifier, etc. These accounts get returned to the lab and we determine
    whether the test was repeated, ordered in error, etc., We then determine
    the appropriate modifier and send it back to HIM where it's added and
    sent to billing.

    Julie Bundy
  • edited May 2016

    What system are you using to identify these edits with? We're looking
    at implementing 3M's ARMS product and holding claims in HID for charge
    issues rather than the current process which is having the claim held by
    billing for charge issues (any issue with a hardcode rather than HIM
    soft codes).

    Thank you.

    Nikki Schaefer
  • edited May 2016
    We have a chargemaster coordinator who works with both clinical areas and HIM for CDM edits.

    Terri R. McDaniel, Director HIM and Privacy Officer| Deaconess Hospital | Rockwood Health System| 800 West Fifth Avenue, Spokane, WA 99210 | 509.473.7903 (office)| 509.991.4019 (cell) | 509.473.7522 (fax)|
  • edited May 2016
    Does this person enter the charges in for each patient visit?
  • edited May 2016
    Individual departments perform this function; HIM is not involved.
  • edited May 2016
    Our at facility the departments do it also. Our coders are not involved
    with the chargemaster at all. We do put the revenue code on the coded
    cpt procedures for outpatients and occasionally they need to look at the
    UB to see what the revenue charge code was (either 360 RC or 361 RC) but
    that is about the extent of it. Each department should be the expert in
    their charging and cpt assignments for procedures.

    Catherine S. Kadry, RHIT, CCS, CHA
    Director, Health Information Management
    Pioneers Memorial Healthcare District
    207 W. Legion Road
    Brawley, CA 92227
    Phone (760) 351-3148 Fax (760) 351-3463
  • edited May 2016
    HIM is not involved with the chargemaster. However, we have to work with our CDM coordinator to work through accounts where a rev code is missing. It typically involves communicating back to the department responsible for entering the charge. At first it was felt that HIM was responsible for resolving accounts lacking a rev code and after much discussion with Patient Financial Services, HIM and CDM coordinator, it has to be a collaboration between departments to resolve. So on a regular basis, HIM meets with our CDM coordinator to determine why rev codes are missing. It could be a mapping issue or discrepancy between CPT codes selected by the department and HIM or that the department failed to enter the appropriate charge.

    Rachel Reyes
    Driscoll Children's Hospital
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