Auto Modifier Appending gives you the ability to tell Therabill to automatically apply a modifier to any (or all) CPT codes when a claim is going out to a specific insurance company (or payer). For example (this is just an off the cuff example), you can set up a rule to always apply the GO modifier to all CPT codes whenever you send the claim to Blue Cross Blue Shield. Here are instructions on how to do this. NOTE: The automatic appending of a modifier takes place at the time a session is put on a CMS-1500 to the insurance company.
IMPORTANT: The modifiers do not get appended until you create a claim. The modifier is not added when you add a session or edit a session, it is added at the time you create a claim to the insurance company that you have set the auto-modifier for.
Adding an Auto Append Modifier
Auto append modifiers are specific to a payer (or insurance company). To add an auto append modifier, click Billing in the top navigation bar of Therabill. In the sub-navigation bar, click Insurance List.
You will now see a list of all insurance companies that you have entered on insurance cards in Therabill (see example in image to the right). Each insurance company in the list will have various links associated with it. These links allow for various settings to apply to the insurance company. One of those links is labeled Info & Settings (circled in red in image to the right). In this example, we are going to add an auto-append modifier to Blue Cross Blue Shield of Illinois by clicking the Info & Settings link associated with Blue Cross Blue Shield of Illinois.
When you click the Info & Settings link, the insurance company settings form will open up. In the insurance company settings form, click on the Advanced tab at the top right. On the right side of the Advanced tab there is a section labeled Auto CPT Modifier (see image to the right). Here is where you will find a listing of all current auto-append modifiers you have set for this insurance company (in this example, Blue Cross Blue Shield of Illinois).
Initially, you will not have any rules set and the list will be blank. To add a new rule for automatically appending a modifier for this insurance company, click the Add Rule button at the top right. This will open up the Add an Auto Append Modifier form (see image to the left).
The Auto Append Modifier Form
The auto append modifier form has several settings to give you control over how and when the modifier is appended to the CPT code. Here are details of what these various settings mean.
- Add Modifier(s) is where you enter the modifier(s) that you want to append to the CPT code. For example, if you want the KX modifier appended to the CPT code, then you would enter KX. To enter multiple modifiers, separate them by a period. For example, GO.KX would be adding the two modifiers GO and KX.
- When CPT is is an optional field. If you only want the modifier added to a specific CPT code when going out to this insurance company (or payer), then indicate that CPT code here. If you leave the CPT code field blank, then Therabill will append the modifier to all CPT codes.
- How to Append Modifier is where you indicate the position Therabill should insert the modifier(s) if other modifiers are already present on the CPT code. For this example, lets say you are creating an auto-append modifier of GO and it will be appending it to a CPT of 90806 with modifier KX. If you choose Replace, then Therabill will remove any modifiers that are already present with the CPT code and replace them with the auto append modifier that you are creating, resulting in 90806 with modifier GO. If you choose Append at end then Therabill will append the auto append modifier to the end of the modifiers already in place, resulting in 90806.KX.GO. If you choose Append at front then Therabill will append the modifier to the beginning, resulting in 90806.GO.KX.
- Permanent is an important setting. If you choose Yes, then Therabill will actually edit the session to append the modifier to the CPT code. If you wanted to remove the modifier in the future, then you would need to edit the session to remove the modifier. If you choose No, then the auto-append modifier will only show up on the claim form. That is, you will not see the modifier as part of the session afterwards. You will only see the modifier on the claim that is being created.
I created a session and the modifier was not automatically added.
Therabill does not add the modifier at the time the session is created. Therabill will add the modifier at the time that you create an insurance claim to the insurance company that you have set up the auto-modifier rule for. Based on your rule, Therabill may never actually modify the session (add the modifier to the session). Only if you choose the Permanent option for the rule will Therabill actually add the modifier to the session (edit the session). If the auto-modifier is not permanent, then the modifier will only show up on the claim form when you print it.