CMS133: Modifier

XMLWordPrintable

    • Type: EC eCQMs - Eligible Clinicians
    • Resolution: Done
    • Priority: Minor
    • Component/s: Measure
    • None
    • Elissa Chandler
    • 2677255354
    • NextGen Healthcare
    • Hide
      Thank you for your question. Currently, the recommended national standard tools used in electronic clinical quality measure specifications do not have the capability to include code modifiers (i.e., CPT modifiers), and code modifiers are not required for reporting on electronic clinical quality measures in the Meaningful Use program. The eCQM includes guidance noting that this measure is to be reported by the clinician performing the cataract surgery procedure. Clinicians who provide only preoperative or postoperative management of cataract patients are not eligible for this measure. Providers who bill a CPT modifier (54, 55, or 56) do so to indicate they are only providing one portion of the complete services for the management of that patient. CMS 133, as well as CMS 132, are intended to be reported by clinicians and providers who perform the surgery and other management services.
      Show
      Thank you for your question. Currently, the recommended national standard tools used in electronic clinical quality measure specifications do not have the capability to include code modifiers (i.e., CPT modifiers), and code modifiers are not required for reporting on electronic clinical quality measures in the Meaningful Use program. The eCQM includes guidance noting that this measure is to be reported by the clinician performing the cataract surgery procedure. Clinicians who provide only preoperative or postoperative management of cataract patients are not eligible for this measure. Providers who bill a CPT modifier (54, 55, or 56) do so to indicate they are only providing one portion of the complete services for the management of that patient. CMS 133, as well as CMS 132, are intended to be reported by clinicians and providers who perform the surgery and other management services.
    • CMS133v5/NQF0565
    • CMS133v4
    • high impacts clinicians reporting this measure

      CMS 133 looks for instances of cataract surgery. The CMS requirement does not mention looking at modifiers to the CPT code. Surgeons are required to bill the CPT code with a modifier for patients who qualify for global billing (to include their post-surgical visit). Providers bill the qualifying CPT with a 54 modifier for the surgery, then several days later bill the same code with a 55 modifier for the post op visit – the modifiers are required so the provider doesn’t get paid twice. As a result, per the CMS Specification, providers are incrementing the patient twice for the same CPT code since the modifier is not taken into consideration.

      Question: Should a modifier be applied to the Denominator CPT for CMS 133

            Assignee:
            Mathematica EC eCQM Team (Inactive)
            Reporter:
            Elissa Chandler (Inactive)
            Votes:
            0 Vote for this issue
            Watchers:
            1 Start watching this issue

              Created:
              Updated:
              Resolved:
              Solution Posted On: