Difference Between 58 and 78 Modifier

Modifier 58, Staged or related procedure or services by the same Physician or other Qualified Health care Professional during the postoperative period.

When to Use modifier 58

Modifier 58 is used to identify those situations when a procedure or services may be staged(planned). While a return to the operating room for a related procedure
may be commonplace, a staged (planned) procedure or services may not be as routine. I will try to clarify the intent when to
exactly use modifier 58 with the procedure code. As per the CPT coding guidelines, Modifier 58 is assigned for any subsequent procedure,
Which is planned or has to be performed with the related original procedure. Following three key points should be remembered before
appending modifier 58 to the procedure codes.

Modifier 78

Unplanned return to the operating / procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period

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What is QMB / MQMB stands for?

In Medical billing or Healthcare industry The term QMB stands for Qualified Medicare Beneficiary & MQMB stands for Medicare Qualified Medicare Beneficiary. The term "QMB" or "MQMB" on the form indicates the client is a Qualified Medicare Beneficiary (QMB) or a Medicaid Qualified Medicare Beneficiary (MQMB). The Medicare Catastrophic Coverage Act of 1988 requires Medicare premiums, deductibles, and coinsurance payments to be paid for individuals who meet the following criteria: Important: Clients limited to QMB are not eligible for THSteps or THSteps-CCP Medicaid benefits. Note: Clients eligible for STAR+PLUS who have Medicare and Medicaid are MQMBs. Medicaid reimburses for the coinsurance and deductibles as well as Medicaid-only services for the MQMB client. QMBs do not receive Medicaid benefits other than Medicare deductible and coinsurance liabilities. MQMBs do qualify for Medicaid benefits not covered by Medicare in addition ...

Rejection Procedure note qualifier is missing

Need to check the Charges tab and double click on the Procedure Code line to open up the Charge Entry window. There is a Notes section on the right hand side. If there is a note typed, we need to select the type. Need to select field and select the appropriate type of note you are sending. Save the changes made Check all the procedure if submitted many procedure. Save the visit again and submit the claim.

Novitas Address for mailing paper claims

According to Novitas “ Effective 04/15/2014, paper claims that were submitted to the old Novitas Solutions mailing addresses are no longer being forwarded by the postal service. The 1500 claim forms are being mailed back to the provider and will need to be resubmitted to the correct mailing address” Herewith we have enclosed the Novitas mailing address Jurisdiction H (JH) includes Arkansas, Colorado, Louisiana, Mississippi, New Mexico, Oklahoma, Texas, Indian Health and Tribal facilities as well as Veterans Affairs. General Mailing Address Novitas Solutions Attn: (dept or function name or specific person) 2020 Technology Parkway, Suite 100 Mechanicsburg, PA 17050 Addresses for Claims and Development Responses This section contains the addresses for submitting initial claims and responding to development requests for additional information. Part B Claims Novitas Solutions Attn: Part B Claims PO Box XXXX (replace the Xs with the PO Box number from ...

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