Modifier (5) Dictionary Narrative

Please mark whether this is an addition, edit, or deactative to the modifier dictionary. If you are editing a modifier, only complete the fields that you are editing and the modifier number. If you are adding a new modifier, complete all required fields and any other field that might be needed to do correct billing. If you are deactativing a modifier only complete the modifier number field. If you need to delete the information in the field, enter the word “delete” in the field.

1.MODIFIER DESCRIPTION. This field is required. Enter the description of the modifier.

2. MODIFIER CODE. This field is required. Enter the modifier 2 digit numeric or alpha characters.

3. MEDICARE CODE. When completed, this field will pull on the claim forms if named in the claim form logic as the modifier dictionary field to get modifier from.

  1. BLUE SHIELD CODE. When completed, this field will pull on the claim forms if named in the claim form logic as the modifier dictionary field to get modifier from.
  1. WELFARE CODE. When completed, this field will pull on the claim forms if named in the claim form logic as the modifier dictionary field to get modifier from.
  1. NEED MEDICARE DOCUMENTATION. This field is used for the claim form edits when a claim should kick to the attachment run depending on if a certain modifier is used.
  1. NEED BS DOCUMENTATION.This field is used in combination with the “Attach Information to B/S Claim” field in the procedure code dictionary. An entry of “Y” to this modifier field will assist in determining if the claim form edits should kick an item to the attachment run, based on the modifier used. Recommend review of Procedure code field # 13.
  1. NEED WELFARE DOCUMENTATION. This field is used for the claim form edits when a claim should kick to the attachment run depending on if a certain modifier is used.
  1. NEED COMMERCIAL ATTACHMENT. This field is used in combination with the “Commercial Attachment” field in the procedure code dictionary. An entry of “Y” to this modifier field will assist in determining if the claim form edits should kick an item to the attachment run, based on the modifier used. Recommend review of Procedure code field # 133.
  1. NEED MGD CARE ATTACHMENT. This field is used in combination with the “Managed Care Attachment” field in the procedure code dictionary. An entry of “Y” to this modifier field will assist in determining if the claim form edits should kick an item to the attachment run, based on the modifier used. Recommend review of Procedure code field # 132.
  1. NEED IDPA ATTACHMENT. This field is used for the claim form edits when a claim form

should kick to the attachment run depending on if a certain modifier is used.

12. NEED CHAMPUS ATTACHMENT. This field is used for the claim form edits when a claim form should kick to the attachement run depending on if a certain modifier is used.

13. AN MEDICARE MODIFIER EDIT. This is field is used for the claim form edits to indicate that a modifier is an Anesthesia medicare modifier.

  1. IDPA MODIFIER. When completed, this field will pull on the claim forms when named in claim form logic as the modifier dictionary field to get modifier from.
  1. MANAGED CARE FIELD. When completed, this modifier field will print on the claim forms in Box 24d, if left blank, Box 24d will also have the modifier blank.

Revised June 2, 1999