michigan 31504 640

Chart View: Mich. Procedure Code & Modifiers (Plus Table 10904)

20 Oct, 2023 Frank Ferreri

michigan 31504 640
                               

Birmingham. MI (WorkersCompensation.com) -- In Michigan, a healthcare service must be billed with procedure codes adopted from "Current Procedural Terminology (CPT®) 2023 Professional Edition" or "HCPCS 2023 Level II Professional Edition," as referenced in R 418.10107. Procedure codes from the CPT code set are not included in these rules but are provided on the agency’s website at www.michigan.gov/leo/bureaus-agencies/wdca. "Current Procedural Terminology (CPT®) 2023 Professional Edition" contains standard billing instructions.

A provider billing services described with procedure codes from "HCPCS 2023 Level II Professional Edition" shall refer to the publication as adopted by reference in R 418.10107, for coding information.

Who has to bill codes from "HCPCS 2023 Level II Professional Edition"?

(1) Ambulance providers.
(2) Certified orthotists and prosthetists.
(3) Medical suppliers, including expendable and durable equipment.
(4) Hearing aid venders and suppliers of prosthetic eye equipment.
(5) A home health agency.

If a practitioner performs a procedure that cannot be described by one of the codes listed in the most recent publication entitled “Current Procedural Terminology (CPT®)” or “HCPCS Level II,” the practitioner shall bill the unlisted procedure code. An unlisted procedure code must only be reimbursed when the service cannot be properly described with a listed code and the documentation supporting medical necessity includes all of the following:

(1) Description of the service.
(2) Documentation of the time, effort, and equipment necessary to provide the care.
(3) Complexity of symptoms.
(4) Pertinent physical findings.
(5) Diagnosis.
(6) Treatment plan.

A provider has to add a modifier code following the correct procedure code describing unusual circumstances arising in the treatment of a covered injury or illness. When a modifier code is applied to describe a procedure, a report describing the unusual circumstances must be included with the charges submitted to the carrier.

Applicable modifiers from table 10904 must be added to the procedure code to describe the type of practitioner performing the service. The required modifier codes for describing the practitioner are, as follows:

AAWhen anesthesia services are performed personally by the anesthesiologist.
ADWhen an anesthesiologist provides medical supervision for more than 4 qualified individuals, being either certified registered nurse anesthetists, certified anesthesiologist assistants, or anesthesiology residents.
AHWhen a licensed psychologist bills a diagnostic service or a therapeutic service, or both.
AJWhen a certified social worker bills a therapeutic service.
ALWhen a limited license psychologist bills a diagnostic service or a therapeutic service.
COWhen occupational therapy services are furnished in whole or in part by an occupational therapy assistant.
CQWhen physical therapy services are furnished in whole or in part by a physical therapy assistant.
CSWhen a limited licensed counselor bills for a therapeutic service.
GFWhen a non-physician (nurse practitioner, advanced practice nurse, or physician assistant) provides services.
LCWhen a licensed professional counselor performs a therapeutic service.
MFWhen a licensed marriage and family therapist performs a therapeutic service.
MLWhen a limited licensed marriage and family therapist performs a service.
TCWhen billing for the technical component of a radiology service.
QKWhen an anesthesiologist provides medical direction for not more than 4 qualified individuals, being either certified registered nurse anesthetists, certified anesthesiologist assistants, or anesthesiology residents.
QXWhen a certified registered nurse anesthetist or certified anesthesiologist assistant performs a service under the medical direction of an anesthesiologist.
QZWhen a certified registered nurse anesthetist performs anesthesia services without medical direction.

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    About The Author

    • Frank Ferreri

      Frank Ferreri, M.A., J.D. covers workers' compensation legal issues. He has published books, articles, and other material on multiple areas of employment, insurance, and disability law. Frank received his master's degree from the University of South Florida and juris doctor from the University of Florida Levin College of Law. Frank encourages everyone to consider helping out the Kind Souls Foundation and Kids' Chance of America.

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