Modifiers -GX (notice of liability issued, voluntary under payer policy) and -GY (Item or service statutorily excluded, does not meet the definition of any Medicare benefit or, for non-Medicare insurers, is not a contract benefit) tend to cause confusion for many coding professionals. This resource form may be used to clarify when these modifiers are appropriate to append.
The attached is an excerpt on POA indicators from the book, JustCoding’s Guide to Medical Necessity Denials (Pack of 5) by Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, CDIP, COBGC.
Modifier -25 indicates a "significant, separately identifiable E/M service." Incorporate the tips below and click the "Download file" link above to access a modifier -25 decision tree.
The following chart illustrates the case of a patient admitted for pneumonia with the additional diagnosis of heart failure. In this case, the principal diagnosis is J18.9, pneumonia unspecified, listed under DRG 193, simple pneumonia and pleurisy with MCC. However, the documentation in this instance does not contain enough clinical information to support the heart failure as an MCC. In order to do that, the case requires more clarification of the diagnosis of heart failure and must be queried.