Modifiers

NextGen® Therapy Suite Help 30.3.13.0

Payer Specific Adjustments Grid

Some payers do not follow standard coding guidelines regarding the 8-minute rule. For example, a payer may allow a unit to be billed after five minutes of treatment. To accommodate this, use the Payer Specific Adjustments grid to override the 8-minute minimum for a whole financial class or for just a single payer within a financial class. Configure Payer-Specific Adjustments Parent topic: Payer Specific Billing Panel

NextGen® Therapy Suite Help 30.3.13.0

The Financial Category Replacement Code

You can use the Financial Category Replacement Code grid to replace a code if you have a payer that requires a code other than the standard. A few of these are already configured, such as for Electrical Stimulation: when the Financial Category/payer is Medicare, the system replaces the 97014 code with G0283. This can also be filtered down to a specific payer within a Financial Category to accommodate the need for some clients to have different Revenue Codes for PT vs OT on the claim forms, you can set replacement codes based on the modifier attached to codes (GP or GO modifiers). This enables you to have one set of codes for PT and a slightly different set for OT, each tied to the correct Revenue code. When the claim is generated, the actual code can be billed without the modified replacement code showing by setting up the code correctly in your SIM library. Configure a Financial Category Replacement Code Parent topic: Payer Specific Billing Panel

NextGen® Therapy Suite Help 30.3.13.0

Add a Modifier

You can add a modifier to any code in the Codes grid. Select the code that you want to add a modifier to. Select the field below the Mod column of the Modifiers grid, and then enter the modifier to be applied. Select the option for Cpt Code. Select the field below the Cpt Code Ind column. A picklist of codes opens. If a modifier is needed, do the following: Due to billing two therapies together, choose the code for the additional therapy – the one NOT selected from the CPT Code grid, and then select OK. On the code you selected from the CPT Code grid (for example, for a chiropractor who needs to apply an AT modifier to CMT codes and the payer is Medicare), select that same code from the list, and then select OK. Select the field below Financial Category column. A picklist of financial categories opens. Select a financial category from the picklist, and then select OK. Select the field below the Payer Name column and select a financial category from the picklist. Select Add to add the m

NextGen® Therapy Suite Help 30.3.13.0

Payer Specific Billing Panel

Use the grids in the Payer Specific Billing panel to configure any special payer-specific billing rules that you want to apply to a code selected in the Codes panel. Payer Specific Billing panel Payer Specific Adjustments Grid The Financial Category Replacement Code Prevent Billing Grid Modifiers Parent topic: Billing Configuration

NextGen® Adaptive Content Engine Help Enterprise 8

Add PT Modifier 59 Data Set Items

On the Data Sets Setup template, click Data Set and select PT Modifier 59. The existing data set items associated with the PT Modifier 59 data set appear in the grid. PT Modifier 59 data set Click Add. The Template Data Sets Setup – [New Record] template opens. Template Data Sets Setup If applicable, click Diagnosis description to search and select a diagnosis. The associated diagnosis code automatically populates. If applicable, click Provider and select a provider from Dbp Rendering Provider. In Code1, enter the CPT code for the first procedure. In Code2, enter the CPT code for the second procedure. In Modifier, enter the modifier as 59. Note: To bill the secondary service or the procedure that is not a part of the primary service or procedure, the modifier 59 is added. In Code Match 1, enter the primary code with which the modifier 59 is attached and sent for billing. In Code Match 2, enter the secondary code with which the modifier 59 is attached and sent for billing. Click Save, a

NextGen® Adaptive Content Engine Help Enterprise 8

Edit PT Modifier 59 Data Set Items

On the Data Sets Setup template, click Data Set and select PT Modifier 59. The existing data set items associated with the PT Modifier 59 data set appear in the grid. Highlight a grid to modify. Click Update. The Template Data Sets Setup – [New Record] template opens. Make the necessary changes in the applicable fields. Click Save, and then click Close. Parent topic: PT Modifier 59 Data Set

Modifiers

Recommendations

Payer Specific Adjustments Grid

The Financial Category Replacement Code

Add a Modifier

Payer Specific Billing Panel

Add PT Modifier 59 Data Set Items

Edit PT Modifier 59 Data Set Items

Payer Specific Adjustments Grid

The Financial Category Replacement Code

Add a Modifier

Payer Specific Billing Panel

Add PT Modifier 59 Data Set Items

Edit PT Modifier 59 Data Set Items