Adding Modifiers to Services

Let's review how to add modifiers to professional and institutional services.

Professional Services

Use the following instructions to add a modifier to an existing professional service. 

1. Ensure the correct Organization and Practice are selected in the header.
2. Open Practice Admin and click on the Services tab.
3. Open the service needing the modifier.
4. Click on Billing Profiles and then choose the billing profile that requires the modifier.
   1. Note: If you would like the modifier to show up in every instance the service is billed you will need to update each billing profile for the service.
5. Open the Professional Service Lines tab and click the HCPCS/CPT Code link.
   1. If no Service Line is present, you will need to click Create Service Line and add one.
6. There are two ways to add the modifier depending on your need. If you would like to add the modifier to every claim that has ever gone out with this service (and prompt corrections for every claim as well) you can edit the service at the Baseline by clicking the pencil icon. 
   
   
   • Here, you add the modifier and click Save.
     
7. If this is an existing service and you want to have an effective date for the modifier you will want to click Create Scheduled Change Set.
   
1. Enter the effective date when this modifier should be added on all dates of service and click Create.
   
2. Click on the Edit icon for the selected change set date.
3. Add the Modifier and click Create.
   
8. Note: When adding a modifier to a service, the modifier will appear on every line that the service is on. If you want the modifier to be conditional, a claim rule or a new service may be necessary.

Institutional Services

Use the following instructions to add a modifier to an institutional service

1. Ensure the correct Organization and Practice are selected in the header.
2. Open Practice Admin and click on the Services tab.
3. Open the Service needing the modifier.
4. Click on Billing Profiles and then choose the billing profile that requires the modifier.
   1. Note: If you would like the modifier to show up in every instance the service is billed you will need to update each billing profile for the service.
5. There are two ways to add the modifier depending on your need. If you would like to add the modifier to every claim that has ever gone out with this service (and prompt corrections for every claim as well) you can edit the service at the Baseline by clicking the pencil icon. 
   
   
   • Here, you add the Modifier and click Save.
     
     
6. If this is an existing service and you want to have an effective date for the modifier you will want to click Create Scheduled Change Set.
   
1. Enter the Effective Date when this modifier should be added on all dates of service and click Create.
   
2. Click on the Edit icon for the selected change set date.
3. Add the Modifier and click Create.
   
   
7. Note: When adding a modifier to a service, the modifier will appear on every line that the service is on.  If you want the modifier to be conditional, a claim rule or a new service may be necessary.

Creating an Add-On Service (or Service Billing Profile) with a Modifier

There are some cases where you will have two services rendered on the same day and one of the service lines will require a modifier.  To achieve this in AveaOffice, you will need to create a separate ‘Add On’ service or service billing profile with the modifier.

Use Case Example

If Group Psychotherapy and Individual Psychotherapy were rendered on the same day, you may want to add a modifier 59 to one of those services. 

Standalone Services

If the service is a standalone service, choose which service you would like to have the modifier, and then create a new service that is identical to the existing service with the modifier added to it. You can follow these instructions to create a new service.

U/R Required Services

For U/R required services, create a new service billing profile with the modifier. Click here for instructions on creating a new billing profile. Then, create a separate U/R plan with the new service billing profile for patients that will be using services with the modifier. 

When marking attendance, if those two services are rendered on the same day, you would choose Group Psychotherapy, and then Individual Psychotherapy with the modifier.