The new informational modifier could affect payment, too.
To facilitate claims processing for disaster victims, the Centers for Medicare and Medicaid (CMS) has create a new modifier CR (Catastrophe/disaster related) that you can use if you ever need to code services for patients affected by catastrophe/disaster. This article will familiarize you with modifier coding guidelines and get you key pointers on when, where and why you should use this disaster modifier.
When to Report Modifier CR
Note that you will not be able to report the modifier for all disaster related services – in fact there are some definite factors that must be met prior to using this modifier. For one, you can use this modifier only in visibly catastrophe/disaster situations.
Section 1135 of the Social Security Act empowers the HHS to modify/waive certain Part B Medicare, Medicaid, Children’s Medicaid, and HIPAA requirements. The department allows these waivers in order to better track how payers process claims in uncertain circumstances.
Caution: These two events need to take place for the HHS to raise the 1135 waiver and for you to use the newly-introduced modifier.
• First, the president must declare an emergency/disaster under Stafford/National Emergencies act.
• Secondly, HHS secretary must announce a Public Health Emergency under the Public Health Service Act.
Some recent declarations include floods in North Dakota, Hurricane Sandy in New York and New Jersey, just to mention a few.
Type of Disaster
The scenarios mentioned above involve weather, however you can use modifier CR for any type of disaster, be it for explosions, mass shooting or anything that would meet the criteria for a waiver under section 1135. As soon as the president and secretary make the waiver official, you should report the disaster modifier along with any services for patients impacted by these catastrophes.
Twin Purpose for the New Modifier
The new informational modifier CR could also affect payment. While CMS uses this modifier to identify claims that are conditioned by a formal Section 1135 waiver, the government uses it to streamline process claims in disaster and catastrophe situations.
Tip: Append the modifier for established victims of catastrophe or disaster. This is particularly to safeguard yourself against denials for not using modifier CR in catastrophe/disaster area.