anonymous wrote on Thursday, July 08, 2010:
Does anyone know how to bill out using multiple modifiers?
sunsetsystems wrote on Thursday, July 08, 2010:
It will probably need some programming effort. I think the intent was to concatenate them using “:” as the delimiter, but I don’t think that has been carried to completion and might not be the best approach anyway.
anonymous wrote on Thursday, July 08, 2010:
Thanks Rod,
I do know that they are suppose to be separated using “:” as the deliminator, but when entered the programming strips it out.
Do you know how people are getting around not using multiple modifiers for claims that may require them?
ytiddo wrote on Thursday, July 08, 2010:
standard warning: dirty hack:
The field allows us to enter five characters here, so what I’ve been doing for items that require two modifiers has been to use commas when entering them in OpenEMR, then we used the ‘sed’ program to change these commas to the appropriate field delimiter in the x12 file.
its ugly. its wrong. I should not have done it. maybe if i’d solved it right, you wouldn’t be in this spot…
sunsetsystems wrote on Thursday, July 08, 2010:
Again, a proper solution will need some digging into the code.
I don’t remember much about usage scenarios for modifiers, and I’ve not had any complaints from clients about needing more than one. What common situations require that?
tmccormi wrote on Thursday, July 08, 2010:
The way I handled modifiers in the system I designed many many years ago was to treat them as separate code that could be applied to any service code in multiples (up to 4). Almost exactly the way diagnosis codes uses the the ‘Justify’ feature.
Typical other systems just have four separate fields next to every CPT/Service code for entering (or selecting) modifiers. Then the is no need to explore the various scenarios, they just are put on the claim if they exist with the service code. 4 or 5seems to be more than enough and is what will fit on the CMS 1500
So the billing record would need 4, 2 char fields, mod1,mod2,mod2,mod4. And the modifiers would become a new code type in the codes table.
-Tony
-Tony
physmed wrote on Thursday, July 15, 2010:
Hi Rod
I just picked up on this thread and wanted to answer your question about under what circumstances you would need to enter more than one modifier to a code. Medicare is the biggest offender in this regard which is why the newest CMS 1500 form has space for up to 4 modifiers. Depending on the profession the Doctor can have to put 2 or 3 modifiers after a code to let them know that the patient is aware that this is a non covered service etc. Just thought that you would want to know.
Rick
hbueller wrote on Tuesday, August 10, 2010:
In Dermatology, which is very procedure-driven, we use modifiers all the time. -25 modifier is for procedures done at time of E & M office visit, like biopsies or freezing stuff. -59 modifier is for 2nd procedure on same day at different site than 1st procedure, -51 might be added to -59 if there is another site after that. -79 would be used if patient comes in for a different E & M office visit within a global period, and so there may be situations where we use more than one modifier for a given procedure.
Having additional spaces for multiple modifiers is useful, and necessary, in Dermatology.
Howard Bueller, M.D.
visolveemr wrote on Wednesday, August 11, 2010:
Hi
Currently OpenEMR will accept only two modifiers.
We need to customize OpenEMR to accept more than 2 modifiers. The customization will involves both the functionality (Modifier(s) column in Feesheet) & DB (codes & billing table). You also confirm the multiple modifiers format in the X12.
Do let us know for any clarifications.
Thanks,
Vicareplus Team,
services@vicareplus.com
zhhealthcare wrote on Wednesday, August 11, 2010:
We have done some work on the fee sheet to allow modifiers and other stuff: you might want to take a look at http://github.com/zhhealthcare/openemr/commits/jacob-feesheet
Thanks
Sam
drholmes wrote on Thursday, September 09, 2010:
I added a space between the two modifiers and the modifiers appeared correct on a HCFA1500. The colon did not provide the necessary space between the modifiers. Text editing the X12 file appears to work but I am not sure whether to place a colon : or an asterisk * between the modifiers. As a D.C., I, often need two modifiers.
visolveemr wrote on Tuesday, September 14, 2010:
Hi
Based on our understanding, multiple modifiers are segregated by colon. For more informations please refer the following link.
Thanks
VicarePlus Team
services@vicareplus.com
yourika wrote on Sunday, October 09, 2011:
I’ve been working on converting an older Medisoft implementation to OpenEmr 4.1, and I must say for all of OpenEmr’s great, I think I’m most disappointed with the Fee Sheet implementation - especially upon coming from Medisoft that seems to allow pretty fast coding. For example, in OpenEmr, it seems weird that I have to search for a diag code, then click to add it down below to the search list, just to have it finally appear on the “Justify” dropdown, so that I can finally add it onto the “Justify” list. It would actually be faster just to be able to type in all the codes directly than to do it this way. Perhaps, in the future, we’ll see more progress towards making the Fee Sheet much more efficient and effective.
Onto the main point I wanted to add, in Medisoft you can easier add up to 4 modifiers, and after a bit of hair pulling, I believe I’ve figured out a quick (and relatively easy) hack to achieve up to 4 modifiers in OpenEmr 4.1 by using spaces as separators. Here’s what I did:
1. Change the MySql “billing” table’s “modifier” entry from varchar(5) to varchar(12) - I did this using mysqlcc, but any MySql table editor should work.
2. To fix for X12 (converts SPACEs to extra colons), edit file /openemr/library/Claim.class.php and change line 925 in function cptKey to: $tmp = str_replace(’ ‘,’:’,$this->cptModifier($prockey));
3. To fix for HCFA, edit file /openemr/library/gen_hcfa_1500.inc.php and change line 485 (2 lines past the 24d. comment) to: 2. To fix for HCFA (add more space from 6 to 12 in parameter 3), edit file /openemr/library/Claim.class.php and change line 925 in function cptKey to: put_hcfa($lino, 33, 12, $claim->cptModifier($hcfa_proc_index));
4. That’s it! Now, you should be able to code up to FOUR modifiers on the Fee Sheet via the “Mod” column by placing a SPACE between each one (ie. 00 22 LT 33)
I was actually surprised this wasn’t a bigger issue, and hopefully this “should” fix it for others who need it as well.
cverk wrote on Monday, October 10, 2011:
Here was my answer to the fee sheet coding as a CSV file that can be imported to the fee sheet area of myphpadmin. You can then print a fee sheet under the blank forms area to use as a superbill and quickly find our most common codes in drop down lists. I’m not sure if this is what you are looking for, but maybe it will help.
“1New Patient”;“1 99201 Brief _______________ 25 Modifier-Seperate E&M service”;“CPT4|99201|”
“1New Patient”;“2 99202 Limited______________33 Modifier-Preventive service”;“CPT4|99202|”
“1New Patient”;“3 99203 Low Complex”;“CPT4|99203|”
“1New Patient”;“4 99204 Mod Complex”;“CPT4|99204|”
“1New Patient”;“5 99205 Comprehensive”;“CPT4|99205|”
“1New Patient”;“a 99381 New WellCare 0-1”;“CPT4|99381 |”
“1New Patient”;“b 99382 New Wellcare 1-4”;“CPT4|99382 |”
“1New Patient”;“c 99383 New Wellcare 5-11”;“CPT4|99383 |”
“1New Patient”;“d 99384 New Wellcare 12-17”;“CPT4|99384 |”
“1New Patient”;“e 99385 New Wellcare 18-39”;“CPT4|99385 |”
“1New Patient”;“f 99386 New Wellcare 40-65”;“CPT4|99386 |”
“1New Patient”;“g 99387 New Wellcare Over 65”;“CPT4|99387 |”
“2Established Patient”;“1 99211 Nurse”;“CPT4|99211|”
“2Established Patient”;“2 99212 Brief”;“CPT4|99212|”
“2Established Patient”;“3 99213 Low Complex”;“CPT4|99213|”
“2Established Patient”;“4 99214 Mod Complex”;“CPT4|99214|”
“2Established Patient”;“5 99215 Comprehensive”;“CPT4|99215|”
“2Established Patient”;“a 99391 Est Wellcare 0-1”;“CPT4|99391 |”
“2Established Patient”;“b 99392 Est Wellcare 1-4”;“CPT4|99392 |”
“2Established Patient”;“c 99393 Est Wellcare 5-11”;“CPT4|99393 |”
“2Established Patient”;“d 99394 Est Wellcare 12-17”;“CPT4|99394 |”
“2Established Patient”;“e 99395 Est Wellcare 18-39”;“CPT4|99395 |”
“2Established Patient”;“f 99396 Est Wellcare 40-65”;“CPT4|99396 |”
“2Established Patient”;“g 99397 Est Wellcare over 65”;“CPT4|99397 |”
“2Established Patient”;“h000x0 Charges for Records”;“CPT4|000x0|”
“3 Immunizations”;“1 90658 Flu Shot-adult dose”;“CPT4|90658 |”
“3 Immunizations”;“2 93657 Flu Shot-Infant dose”;“CPT4|90657 |”
“3 Immunizations”;“3 90662 Flu Vaccine-High Dose Medicare”;“CPT4|90662|”
“3 Immunizations”;“4 Q2039 Medicare Fluzone”;“HCPCS|Q2038|”
“3 Immunizations”;“c 90716 Chickenpox”;“CPT4|90716 |”
“3 Immunizations”;“d 90700 DPT Infant”;“CPT4|90700 |”
“3 Immunizations”;“h 90632 Hep A Vaccine Adult”;“CPT4|90632 |”
“3 Immunizations”;“h 90633 Hep A Vaccine Child”;“CPT4|90633 |”
“3 Immunizations”;“h 90645 HIB vaccine”;“CPT4|90645 |”
“3 Immunizations”;“h 90744 Hep B Vaccine age 0-19”;“CPT4|90744 |”
“3 Immunizations”;“h 90746 Hep B Vaccine age >19”;“CPT4|90746 |”
“3 Immunizations”;“i 90713 IPV”;“CPT4|90713 |”
“3 Immunizations”;“m 90707 MMR”;“CPT4|90707 |”
“3 Immunizations”;“m 90734 Menactra”;“CPT4|90734 |”
“3 Immunizations”;“p 90670 Prevnar pcv13”;“CPT4|90670|”
“3 Immunizations”;“p 90732 Pneumovax-adult”;“CPT4|90732 |”
“3 Immunizations”;“t 86580 TB skin test”;“CPT4|86580 |”
“3 Immunizations”;“t 90715 TDaP Adult dose”;“CPT4|90715 |”
“4 Vaccine Administration”;“1 90471 Vaccine Admin single”;“CPT4|90471 |”
“4 Vaccine Administration”;“2 90472 Vaccine admin each x_____”;“CPT4|90472 |”
“4 Vaccine Administration”;“3 90460 Vaccination <19 first component”;“CPT4|90460|”
“4 Vaccine Administration”;“4 90461 Vaccination <19 each component______”;“CPT4|90461|”
“4 Vaccine Administration”;“7 G0008 Admin Medicare Flu Shot”;“HCPCS|G0008|”
“5 Office Lab”;“1 81000 UA-complete”;“CPT4|81000 |”
“5 Office Lab”;“2 36415 Venipuncture”;“CPT4|36415 |”
“5 Office Lab”;“3 87880 Rapid Strep Test”;“CPT4|87880 |”
“5 Office Lab”;“4 82272 Hemocult single card”;“CPT4|82272 |”
“5 Office Lab”;“5 81025 UPT”;“CPT4|81025 |”
“5 Office Lab”;“6 87210 Wet Prep”;“CPT4|87210 |”
“6 Office Procedure”;“1 17000 Dest. Actinic #1”;“CPT4|17000 |”
“6 Office Procedure”;“2 17003 Dest Actinic each X_____ 2-14”;“CPT4|17003 |”
“6 Office Procedure”;“3 17110 Dest Benign lesion 1-14”;“CPT4|17110 |”
“6 Office Procedure”;“4 93000 ECG”;“CPT4|93000 |”
“6 Office Procedure”;“5 92552 Audiogram”;“CPT4|92552 |”
“6 Office Procedure”;“6 94010 PFT”;“CPT4|94010 |”
“7Diagnosis List 1”;“1 V70.0 Physical Exam”;“ICD9|V70.0|”
“7Diagnosis List 1”;“2 V04.81 Flu Shot”;“ICD9|V04.81|”
“7Diagnosis List 1”;“3 V06.9 Immunizations”;“ICD9|V06.9|”
“7Diagnosis List 1”;“4 V82.6 Multiphasic screening”;“ICD9|V82.6|”
“7Diagnosis List 1”;“5 V20.2 Well Child Exam”;“ICD9|V20.2|”
“7Diagnosis List 1”;“6 V72.31 Gyn Exam”;“ICD9|V72.31|”
“7Diagnosis List 1”;“aAbdominal Pain 789.00”;“ICD9|789.00|”
“7Diagnosis List 1”;“aActinic keratosis 702.0”;“ICD9|702.0|”
“7Diagnosis List 1”;“aAllergic Rhinitis 477.9”;“ICD9|477.9|”
“7Diagnosis List 1”;“aAllergies 995.3”;“ICD9|995.3|”
“7Diagnosis List 1”;“aAnxiety 300.00”;“ICD9|300.00|”
“7Diagnosis List 1”;“aASCVD 414.00”;“ICD9|414.00|”
“7Diagnosis List 1”;“aAsthma 493.90”;“ICD9|493.90|”
“7Diagnosis List 1”;“bBack Pain 724.4”;“ICD9|724.4|”
“7Diagnosis List 1”;“bBipolar Disorder 296.7”;“ICD9|296.7|”
“7Diagnosis List 1”;“bBPH with Urinary Problem 600.01”;“ICD9|600.01|”
“7Diagnosis List 1”;“bBrochitis,acute 466.0”;“ICD9|466.0|”
“7Diagnosis List 1”;“cCandida Balinitis 112.2”;“ICD9|112.2|”
“7Diagnosis List 1”;“cCellulitis 682.9”;“ICD9|682.9|”
“7Diagnosis List 1”;“cCerumen Impaction 380.4”;“ICD9|380.4|”
“7Diagnosis List 1”;“cConjunctivitis 372.30”;“ICD9|372.30|”
“7Diagnosis List 1”;“dDepression-acute 296.20”;“ICD9|296.20|”
“7Diagnosis List 1”;“dDepression-Recurrent 296.30”;“ICD9|296.30|”
“7Diagnosis List 1”;“eEczema 692.9”;“ICD9|692.9|”
“7Diagnosis List 1”;“eEustation Tube Dysfunction 381.81”;“ICD9|381.81|”
“7Diagnosis List 1”;“fFatigue 780.79”;“ICD9|780.79|”
“7Diagnosis List 1”;“gGastritis 535.50”;“ICD9|535.50|”
“7Diagnosis List 1”;“gGastroenteritis 558.9”;“ICD9|558.9|”
“7Diagnosis List 1”;“gGERD 530.81”;“ICD9|530.81|”
“7Diagnosis List 1”;“gGout 274.00”;“ICD9|274.00|”
“7Diagnosis List 1”;“hHeadache 784.0”;“ICD9|784.0|”
“7Diagnosis List 1”;“hHeadache-Migraine 346.00”;“ICD9|346.00|”
“7Diagnosis List 1”;“hHemorrhoids 455.6”;“ICD9|455.6|”
“7Diagnosis List 1”;“hHives/Urticaria 708.9”;“ICD9|708.9|”
“7Diagnosis List 1”;“hHPV 079.4”;“ICD9|079.4|”
“7Diagnosis List 1”;“hHyperlipidemia 272.4”;“ICD9|272.4|”
“8Diagnosis List 2”;“hHypertension 401.9”;“ICD9|401.9|”
“8Diagnosis List 2”;“hHyperthyroidism 242.90”;“ICD9|242.90|”
“8Diagnosis List 2”;“hHypothyroidism 244.9”;“ICD9|244.9|”
“8Diagnosis List 2”;“iImpetigo 684”;“ICD9|684|”
“8Diagnosis List 2”;“iInfluenza 487.1”;“ICD9|487.1|”
“8Diagnosis List 2”;“lL/S Back Sprain 846.0”;“ICD9|846.0|”
“8Diagnosis List 2”;“lLipoma 214.9”;“ICD9|214.9|”
“8Diagnosis List 2”;“mMenopausal Symptoms 627.2”;“ICD9|627.2|”
“8Diagnosis List 2”;“mMenstrual Disorder 626.9”;“ICD9|626.9|”
“8Diagnosis List 2”;“nNeoplasm Skin-uncertain 238.2”;“ICD9|238.2|”
“8Diagnosis List 2”;“nNIDDM 250.00”;“ICD9|250.00|”
“8Diagnosis List 2”;“oOnchomycosis 110.1”;“ICD9|110.1|”
“8Diagnosis List 2”;“oOtalgia 388.70”;“ICD9|388.70|”
“8Diagnosis List 2”;“oOtitis Externa 380.10”;“ICD9|380.10|”
“8Diagnosis List 2”;“oOtitis Media 382.00”;“ICD9|382.00|”
“8Diagnosis List 2”;“oOtitis Serous 381.4”;“ICD9|381.4|”
“8Diagnosis List 2”;“pPanic Attack 300.01”;“ICD9|300.01|”
“8Diagnosis List 2”;“pPharyngitis 462”;“ICD9|462|”
“8Diagnosis List 2”;“pProstatitis 601.9”;“ICD9|601.9|”
“8Diagnosis List 2”;“rRectal Fissure 565.0”;“ICD9|565.0|”
“8Diagnosis List 2”;“rRhinitis,Chronic 472.0”;“ICD9|472.0|”
“8Diagnosis List 2”;“sSciatica 724.3”;“ICD9|724.3|”
“8Diagnosis List 2”;“sShingles 053.9”;“ICD9|053.9|”
“8Diagnosis List 2”;“sSinusitis,Acute 461.9”;“ICD9|461.9|”
“8Diagnosis List 2”;“sSinusitis,Chronic 473.9”;“ICD9|473.9|”
“8Diagnosis List 2”;“tTinea Corporus 110.5”;“ICD9|110.5|”
“8Diagnosis List 2”;“tTinea Cruris 110.3”;“ICD9|110.3|”
“8Diagnosis List 2”;“tTinea Pedis 110.4”;“ICD9|110.4|”
“8Diagnosis List 2”;“tTinea Versicolor 111.0”;“ICD9|111.0|”
“8Diagnosis List 2”;“uUrethritis 597.80”;“ICD9|597.80|”
“8Diagnosis List 2”;“uURI 465.9”;“ICD9|465.9|”
“8Diagnosis List 2”;“uUTI 599.0”;“ICD9|599.0|”
“8Diagnosis List 2”;“vVaginitis,nonspecific 616.10”;“ICD9|616.10|”
“8Diagnosis List 2”;“vVaginitis,Yeast 112.1”;“ICD9|112.1|”
“8Diagnosis List 2”;“vViral Syndrome 079.99”;“ICD9|079.99|”
“8Diagnosis List 2”;“wWarts 078.10”;“ICD9|078.10|”
bradymiller wrote on Wednesday, October 12, 2011:
Hi,
I’m not very knowledgeable on billing, but would yourika’s above mods for multiple modifiers be useful for the community. If so, would be nice to get it into a git or patch format for testing/review/commit to the official codebase. Best way to do this is to set up a github repo, which is detailed here:
http://www.open-emr.org/wiki/index.php/Git_for_dummies
thanks,
-brady
nursejeff wrote on Thursday, October 13, 2011:
I am new to OpenEMR, today was our first day to use OpenEMR exclusively.
We have been using the Billing for a couple of weeks and have worked out a few problems.
My billing manager came up to me today and mentioned the modifier issue. She needs the ability to add more than one modifier.
We use Availity as our clearinghouse. I mention this because, I had an issue with the NDC codes and Availity. This is a huge issue and I was surprised about the minimal discussion about it on the forums. I have hired someone to help me resolve this issue but my point is that there may not be problems with the modifer or NDC issue with other clearinghouses.
My point is to confirm that this is indeed an issue and probably needs to be addressed for the entire community.
Thank you.
Jeff Guillory Jr.
NP Health Clinic
biller2 wrote on Tuesday, November 29, 2011:
Brady, I would like for yourika fix to be included in the software. It will make it much easier then having to go in and manually make the change every time an upgrade is done. I am going to try the above fixes and see if claims go through I will post back in a week or so with feedback if that is helpful. Thanks for an alternative to include multiple modifiers. John
tmccormi wrote on Wednesday, November 30, 2011:
I need to do this for a customer this week. Though I am inclined to leave the ‘:’ (colon) as the user input separator myself. so modifiers are entered M1:M2:M3:M4. Which means you don’t need the string replace for X12, but you DO for the CMS 1500 form…
I’ll post my patch to github.
Tony
www.mi-squared.com / @tonymi2
oemr.org / @OEMR_org
tmccormi wrote on Friday, December 02, 2011:
Initial code posted on github for review. Some minor things yet to do, but please comment.
https://github.com/tmccormi/openemr/tree/multi-modifier
Tony
tmccormi wrote on Monday, December 05, 2011:
Code has been pushed to the master branch
5b3648a Support Multiple Modifiers for real
M interface/forms/fee_sheet/new.php
M library/Claim.class.php
M library/gen_hcfa_1500.inc.php
M sql/4_1_0-to-4_1_1_upgrade.sql
M sql/database.sql
M version.php
Separator for modifiers was left as “:” colon to avoid changes to existing documentation and data conversions of past multi modifier records
Tony
www.mi-squared.com / @tonymi2
oemr.org / @OEMR_org