Starting in 2020 medicare cases are required to identify when a PTA and OTA perform more than 10% of a procedure by adding the CQ and CO modifier to PT and OT note charges. SP and SPLA are not recognized as providers by medicare and are not assigned a relevant modifier. CMS states this modifier will not affect payouts in 2020 but is required to be present.
QuickEMR has already implemented a solution to meet this new requirement. Here is a description of the behaviors:
- The modifier will only affect notes dated on or after 1/1/2020.
- The modifier will only affect notes that have a medicare type insurance or have the "Apply CQ/CO Modifier" flag set in the "Insurance" => "Billing" page.
- The new modifier will automatically be applied if the note "Provider" is of "User Type" PTA or OTA.
- The "User Type" is a new required field on the user record. If you have not updated your users in the last 6 months you must visit each user and set their user type. If the note provider does not have a user type set you will receive a warning that the user type is needed when the charge is added. The system will however add the charge despite the warning.
- If the PT performed one of the procedures despite the PTA being the primary provider the modifier may be manually removed after adding the charge, time, and units.
- If the time or units of a charge are edited all modifiers including the CQ and CO will be added back to the charge.
- If the user type, note date, or insurance are changed after the charge is added to the note the modifiers will not be updated and must be manually reviewed.
Disclaimer: While QuickEMR does it's best to assist with fast, easy, accurate documentation it is ultimately the responsibility of the individual providers to insure the charges are defined correctly and with the correct modifiers. Please review your charges carefully to insure the new behaviors match your needs and notify QuickEMR if adjustments are needed.