PATIENT CHARGES – AN OVERVIEW - 2

9. Modifiers: A modifier indicates that a service or procedure was altered by specific circumstances, but not changed in its definition or code. Modifiers are two digit numeric or alpha numeric codes that are appended to the end of CPT/HCPCS codes. Modifiers may be used to indicate that:
• A service or procedure has both a professional and technical component
• A service or procedure was performed by more than one physician
• A service or procedure has been increased or reduced
• Only part of a service was performed
• An additional service was performed
• A bilateral procedure was performed more than once
• Unusual events occurred
This field is printed along with the CPT/HCPCS Code in 24d field of the CMS-1500 Claim Form.

Modifiers that are currently approved for hospital outpatient use with CPT codes as defined by the 2002 AMA CPT manual are:
Modifier Description
-25 Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service
-50 Bilateral procedure
-76 Repeat procedure by same physician
-77 Repeat procedure by another physician
Modifiers that are currently approved for use with HCPCS Level II codes as defined by the 2002 AMA CPT manual are:
Modifier Description
-LT Left side
-RT Right side

10. Diagnosis Code: Diagnosis code is used to indicate the health problem that a patient have. The first of these codes is the ICD-9-CM diagnosis code describing the principal diagnosis (i.e. the condition established after study to be chiefly responsible for causing this hospitalization). The remaining codes are the ICD-9-CM diagnosis codes corresponding to additional conditions that coexisted at the time of admission, or developed subsequently, and which had an effect on the treatment received or the length of stay. Medicare requires physicians to include a complete diagnosis code (or codes) on each claim submitted for payment. The first of these codes is the ICD-9-CM (International Classification of Diseases Ninth Revision Clinical Modification) diagnosis code describing the principal diagnosis (i.e. the condition established after study to be chiefly responsible for causing this hospitalization). A Maximum of 4 diagnosis codes can be printed on the HCFA-1500 claim form.
This field is printed in the 21st field of the CMS-1500 claim form.

11. Number of days/Units: This field contains the length of service performed. We need to enter number of days or units. This field is most commonly used for multiple visits, units of supplies, anesthesia minutes or oxygen volume. If only one service was performed the numerical 1 should be entered.
12. Billed Amount: It is the amount charged by a provider for a specific service. In other words it is the total charge value of the claim. The billed amount for a specific procedure code is based on the provider.