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MODIFIERS

 

 

A modifier may be attached to the procedure or added or changed at the time of posting.

 

1. Depending on the Modifiers' configuration, two key factors could influence the value of the charge associated with the posted procedure:

 

1.1 The selection made in the <INC/DEC (IDN)>   field of Utility --► Procedure --► Modifier.

 

The selection for this field dictates whether the charge should be modified on the basis of the modifier.
Selections include:

 

 

1.2  The number (whole number as a percent; i.e., 20 = 20%) entered in the <Multiplier> field of Utility --► Procedure --► Modifier.
This field is used only when the modifier should affect the charge of the procedure.

 

Example:

To increase a $1,000 charge by 20%:

 

set Utility --► Procedure --► Modifier <INC/DEC (I/D/N)> = '1' (Increase)

 

set Utility --► Procedure --► Modifier <Multiplier> = 20; i.e., 1000 x 20% = 200 so the charge is increased by $200 which makes a total charge of $1200

 

 

2. AND/OR the Modifier can determine which Utility --► Procedure --► Procedure charge to apply:

 

2.1 The <Charge G/T/P/R> field of Utility --► Procedure --► Modifier is used to determine which charge to post. Selections include:

 

 

Each selection posts the charge as follows:

 

2.1.1 G    Global Charge

Post the global charge:

 

a)  Entered in the Utility --► Procedure <Charge Global> field.

 

b)  Entered in the Utility --► Procedure --► Fee Schedule <Alternate> column when a fee schedule applies.

 

2.1.2 P    Professional Component Charge

Post the professional charge:

 

a)  Entered in the Utility --► Procedure <Professional> field.

 

b)  Entered in the Utility --► Procedure --► Fee Schedule <Prof> field when a fee schedule applies.

 

2.1.3 T    Technical Component Charge

Post the technical charge:

 

a)   Which is the difference between the Utility --► Procedure <Charge Global> field entry and the <Professional> field entry.

 

b)   Which is the difference between the Utility Procedure Fee Schedule <Alternate> column entry and the <Prof.> column entry when a fee schedule applies.

 

2.1.4 R    Retired/Obsolete

 

2.2 The <Modifier Unit> field of Utility --► Procedure --► Modifier is used for Anesthesiology posting. A unit value should be entered which will be used to calculate the Total Units. See the section on Anesthesiology under Charges --►Specialty Charges for more information.

 

 

For additional information on modifier set up, see Utility --► Procedure --► Modifier.        

 

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