Medical Billing

Description for 1P: Medical reasons Guidelines for 1P Modifier: In general, PQRI quality measures consist of a numerator and a denominator that permit the calculation of the percentage of a defined patient population that receive a particular process of care or achieve a particular outcome. Where a patient falls in the denominator population but specifications define circumstances in which a patient may be excluded from the measure’s denominator population, CPT Category II code modifiers 1P, 2P, and 3P are available to describe medical, patient, or system reasons, respectively, for such exclusion CPT modifier 1P: the quality measure was not applied due to medical reasons This modifier is only valid with some measures This modifier may only be reported with the CPT Category II codes for quality measures. It does not apply to HCPCS codes for quality measures. Refer to each individual quality measure for specific indications for this modifier

Description for AQ: Physician providing a service in a health professional shortage area. Guidelines/Instructions for AQ: Submit HCPCS modifier AQ in the following instances: When you provide services in ZIP code area that does not fall entirely within a designated full county HPSA bonus area When you provide services in a ZIP code area that falls partially within a full county HPSA but is not considered to be in that county based on the USPS dominance decision When you provide services in a ZIP code area that falls partially within a non-full county HPSA When you provide services in a ZIP code area that was not included in the automated file of HPSA based on the date of the data run used to create the file When services are provided in areas that were eligible for the HPSA bonus on December 31 of the prior year but were not on the automated ZIP code list  Designated HPSAs change periodically, so it is important to verify that services f...

Description: HCPCS Modifier Q6 Services furnished by a locum tenens physician Guidelines/Instructions for Q6: Guidelines Submit HCPCS modifier Q6 to indicate that services were provided under a locum tenens arrangement. Locum tenens background: Physicians may retain substitute physicians to take over their professional practices when they are absent for reasons such as illness, pregnancy, vacation or continuing medical education These substitute physicians, known as 'locum tenens' physicians, generally have no practice of their own and move from area to area as needed The regular physician generally pays the substitute physician a fixed per diem amount. The substitute physician's status is that of independent contractor, rather than employee, and his/her services are not restricted just to the physician's office. Services of non-physician practitioners (e.g., CRNAs, NPs and PAs) may not be billed under the locum tenens or reciprocal billing reassig...