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Thursday, July 1, 2010

Denial claim reason - MISSING A MODIFIER OR HAS AN INCOMPLETE OR INVALID MODIFIER :

THE CLAIM IS MISSING A MODIFIER OR HAS AN INCOMPLETE OR INVALID MODIFIER :

Description: 


The modifier necessary to process the claim correctly is either missing, incomplete, or invalid for the specific procedure and diagnosis indicated on the claim form.

Action:

Know the proper use of the CPT modifiers that exist and are appropriate to use for the specific condition or situation. The CPT modifiers are listed in their entirety in Appendix A of the current version of the CPT Manual. You can obtain the CPT manual from the American Optometric Association or from the American Medical Association. You should also know that misuse and abuse of modifiers are under the scrutiny of the Office of Inspector General (OIG) and that can result in significant penalties.

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