CERNER MILLENNIUM Adding Charge Modifiers This demonstration reviews how to add modifiers to professional service charges. This has been prepared for Millennium code level 2015.01.15 & mPage 6.0. Subsequent updates may display cosmetic & functional changes. Use the keyboard or mouse to advance.

Introduction There are times when a charge order needs to include a Modifier. Discussion of modifiers can get a bit complicated. Most providers just learn the idiosyncrasies of the modifiers needed in their day-to-day work; it is also often helpful to keep a work aid or “cheat sheet” for modifiers most commonly used in your practice.

Introduction Common situations in which you may need a modifier: Two or more professional services are performed at the same visit, e.g., a cryo of a skin lesion during a visit also addressing other medical problems. A Medicaid Well Child Check (EPSDT). A series of Medicaid visits to address the same chronic disease, e.g., asthma. (AKA “Interperiodic Visits.”) A resident who sees a Medicare patient.

Here is a short list of common modifiers (not meant to be all-inclusive): -24 Unrelated E&M during a postop period -25 Unrelated E&M on same day as a procedure -58 Staged procedure (re-excision) during postop period -59 Different procedure on different lesion, same day -79 Unrelated procedure during postop period -EP Medicaid EPSDT -GA Medicare may deny; patient informed -GY Uncovered Medicare service (e.g., cosmetic) -GC Service performed by resident under teaching physician supervision, Medicare patient -GE Service performed by a resident without the presence of a teaching physician under the primary care exception, Medicare patient

Let’s look at an example Let’s look at an example. Say a resident has seen a Medicare patient in the clinic for a medical problem, & also performed & charged for a biopsy on a suspicious skin lesion. We now need to add the E&M charge for the visit. This requires the 25 modifier (unrelated E&M on same day as procedure) & the GC modifier (Medicare service performed by resident under teaching supervision). Click Office Visit Level 3 to add the charge to the checkout cart, then click the checkout cart.

Associate diagnoses (it can be done later if necessary), then click Modify.

Select the office visit charge, displaying the order details below, then click the CPT Modifier dropdown arrow.

Scroll to the desired modifier Scroll to the desired modifier. If you only needed to add one modifier, you’d click on it, then click Sign.

However, in this example we need to add two modifiers However, in this example we need to add two modifiers. It may be a little tricky to do this. It can vary a bit depending on what sort of device you’re using, & it often takes two hands. Scroll to the first modifier. (It doesn’t matter which you select first.) Press the Control Key, then click the modifier, 25 in this example.

Continue to hold the Control Key, then use the mouse to scroll to the second modifier. Click on the second modifier.

Both modifiers now display. Now click Sign, & your charge with the proper modifiers is complete.