CMS Provides Clarification on the Use of Modifiers When Billing “Wrong Surgery on a Patient”

The Centers for Medicare and Medicaid Services (CMS) recently released a Medicare Learning Network podcast which was intended to clarify the correct use of certain HCPCS modifiers, specifically when billing for wrong surgery on a patient.

CMS discussed the HCPCS modifier -PC (Wrong Surgery on Patient), which was established in CR6405 (pdf), along with two other modifiers, for use in Medicare billing, to be added, where appropriate, to all claim lines related to surgical error.

CMS noted that providers may be incorrectly using the HCPCS modifier -PC to indicate the professional component for certain services not related to surgical error when the modifier -26 should have been used. CMS stated that providers need to be aware that the use of the -PC modifier on Medicare claims will result in a claim being denied.

CMS noted that modifier -PC is used to identify wrong surgery on a patient. The modifier -PC is to be added, where appropriate, to all claim lines related to a surgical error. Modifier -26, on the other hand, is used to identify the professional component of a service or a procedure.

To download the podcast, click here (zip). To download the MLN Matters article on "Clarification of the Use of Modifiers When Billing 'Wrong Surgery on a Patient,'" click here (pdf).

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