One of the most important steps to ensure clean billing of surgical dressings is the appropriate use of the A- modifier. The A- modifier must be used to indicate two things:
- Is the dressing billed for a primary or secondary dressing?
- How many wounds are being treated with the dispensed dressing? An important differentiation is that this is not the number of wounds present, but rather the number of wounds being treated.
A- Modifier Should Be In Box 24d
The A- modifier should be listed in box 24d of the CMS-1500 form (Health Insurance Claim Form). For those that employ electronic billing and do not manually complete the 1500 form, be sure to include the A- modifier in the modifier section of your software and the software should be programmed to allow for proper modifier placement and submission. This must be present every time surgical dressings are billed for. The number that immediately follows the “A” in the modifier is the number of wounds being treated. For example, if two wounds are being treated with the dressings being dispensed, the modifier would be “A2”. This must be done even when only one wound is being treated, indicated with modifier “A1”.
One common error is not including the A- modifier at all. Another is the incorrect thought that the A- modifier is only needed the first time surgical dressings are dispensed to a patient or only when a change in dressings is made. Some make the mistake of using the A- modifier to indicate how many times a week the dressing will be changed.
A- Modifier Not For Compression Garments
The exception to the need for the A- modifier with surgical dressings is found with compression garments. The A- modifier should not be used with compression wraps / garments. When coding for the EXTREMIT-EASE® Compression Garment use the product code of A6545, but do not use an A- modifier in box 24d of the CMS-1500 form.
The A- modifier is only one of the important modifiers to be aware of when coding for surgical dressings. Look for next month’s blog post which will focus on the -AW and laterality modifiers.
DISCLAIMER: The information provided here is intended to educate health care providers regarding compliance for ICD, CPT, and HCPCS coding. The information provided does not guarantee reimbursement and is accurate to the best of our knowledge at the time of this publication. Coding guidelines can change and we encourage you to stay up to date. The existence of a code does not guarantee payment.
About the Author
Dr. Jeffrey D. Lehrman, DPM, FASPS, MAPWCA, CPCDr. Lehrman is in private practice in Fort Collins, CO and operates Lehrman Consulting, LLC. He is a Diplomate of the American Board of Foot and Ankle Surgery, Fellow of the American Society of Podiatric Surgeons, and is recognized as a “Master” by the American Professional Wound Care Association. He is a Fellow of the American Academy of Podiatric Practice Management and an Expert Panelist on Codingline. In his role as a Consultant to the APMA Health Policy and Practice Department, Dr. Lehrman serves as an advisor to the APMA Coding Committee and the APMA MACRA Task Force. Dr. Lehrman sits on the board of directors of both the American Professional Wound Care Association and the American Society of Podiatric Surgeons. He is also on the editorial advisory board of the journal WOUNDS.