Where do we define modifiers (old way line 19 on CMS 1500)

[Kmaeormaenot]

After using Medisoft V12 for 2 years and filing electronic claims, Medicare is now denying claims as modifier -52 is not defined. I tried placing this in Patient Case Information under Miscellaneous - Local use B 60 minutes. Medicare again denied. Any help is greatly appreciated.

[Gavin Walker]

On the CMS-1500 form this is box 24D Modifier field. In Medisoft this is entered in Transaction Entry window M1, M2, or M3 fields.

[Kmaeormaenot]

For Medicare, we have to explain this modifier as it is attached to a CPT code 90808. The -52 reduces the office visit time. We have to give the number of minutes we saw the patient. On the old paper claim, Box 19, I would enter 60 minutes.

I went into the patient profile, Miscellaneous tab, and entered this under local use B, but Medicare denied that as well. Should I try Local use A or Extra 1 or Extra 2 in their profie. Thank you ever so much.

[Gavin Walker]

You might try CPT code 90806 to bill up to 50 minutes. What denial code and message are you getting back from Medicare?

[Kmaeormaenot]

There are 2 Medicare messages.

N29- Missing documentation/orders/notes/summary/report/chart.

226- Information requested from Billing/Rendering provider was not provided or insufficient/incomplete.

I cannot find anywhere in the system other than in the patient's case under the Miscelleaneous tab to enter the amount of time. There was somewhere in the Pro-ACE system for Medicare billing that I used to use, but I have not used that for two years since moving to Medisoft.

Thank you again!

[Gavin Walker]

For paper claims you should attach the documentation stating how the services were reduced on a separate page. If you are using a clearinghouse, then you will need to find out from them where on the claim you should put electronic documentation and how that should be worded.