Question:

How do you modify a code submitted to the primary insurance company to let them know it is not covered by them so you can bill to a secondary?

Answer:

In one word — modifiers. Modifiers are the best way to communicate this information to the payer. As an example, if the patient’s primary payer was Medicare and you know that their secondary policy covers a service that Medicare does NOT cover when provided in a chiropractic office (e.g., electrical stimulation, x-ray), then you would include modifier GY to indicate that it is a noncovered service. Keep in mind that there may be other modifiers which would also need to be added to the procedure code on the claim (e.g., GP, GX).

Note: Please see “Medicare Modifiers” beginning on page 115 of the 2020 ChiroCode DeskBook for more comprehensive information on using these modifiers.