Q&A: Including modifiers in the chargemaster

Q: Is there a recommended practice for how modifiers should be included in the chargemaster? Is it preferred to add them as a separate field or included in the HCPCS field?

A: Modifiers may be a separate field in the chargemaster or included with the HCPCS field. NUBC states that a UB-04 may have up to four 2-digit modifiers with each 5-digit CPT/HCPCS code. When modifiers are added to a charge line, the description should reflect the modifier used. Charge capture instructions to staff must be explicit so that they are aware of when to choose the charge number that contains the modifier. For example, many ancillary departments may have cases where a test cannot be completed for one clinical reason or another. In this case, the hospital can bill the test with modifier -52. If the department wants the ability to select the test that reflects it was aborted and not completed for a clinical reason, the chargemaster coordinator can set up the tests for which this frequently occurs in the chargemaster with modifier -52. A convention in the description could be “ABRTD,” for example, before the regular description of the test to inform and alert the staff that this is the charge with the modifier -52.

One important consideration that affects the decision to put modifiers in the chargemaster as opposed to relying on coders to add modifiers during their review of documentation is whether the charge capture process and staff are reliable enough to properly use charges with modifiers versus those without.

For more information, see The Chargemaster Essentials Toolkit, Second Edition.