Invoice Procedure Code Modifier

Introduction

The Invoice Procedure Code Modifier data model is a vital component in healthcare billing and coding systems. It is designed to capture and manage information related to additional codes or modifiers used in healthcare billing to provide more specific details about medical procedures or services. These modifiers help in accurately describing the circumstances or complexities of a medical service or procedure, ensuring proper billing and reimbursement. This data model is especially relevant within the context of the FT1 (Financial Transaction) and PV1 (Patient Visit) segments of HL7 messages.

Use Case

Developers can leverage the capabilities of the Invoice Procedure Code Modifier data model to support various technical use cases, enhancing the accuracy and granularity of healthcare billing and coding:

Modifier Validation: Developers can use this model to validate and ensure that the applied modifiers are compliant with coding regulations and guidelines, reducing billing errors.
Billing Accuracy: The model allows developers to associate specific modifiers with procedures or services, ensuring precise billing and reimbursement for complex or unique cases.
Claims Processing: Developers can integrate this model with claims processing systems to facilitate the automatic inclusion of modifiers in insurance claims, improving claims accuracy and reducing denials.
Procedure Code Mapping: Developers can map procedure codes to appropriate modifiers, streamlining the billing process and ensuring that modifiers are applied consistently.
Reimbursement Analysis: Developers can query the model to analyze the impact of modifiers on reimbursement rates, helping healthcare organisations optimize revenue.
Coding Compliance: Developers can use this model to enforce coding compliance within healthcare organizations, ensuring that modifiers are used appropriately and in accordance with regulations.
Billing Reports: Developers can generate reports that include details about procedure code modifiers, offering insights into how modifiers affect billing and reimbursement.
Modifier History Tracking: Developers can track changes in modifier usage over time, helping organizations identify trends and compliance issues.
Audit Trail: Developers can create an audit trail of modifier changes, allowing organizations to trace who applied or modified a modifier and when.
Billing Code Optimization: By analyzing the impact of modifiers on reimbursement, developers can assist organizations in optimizing their billing codes to maximize revenue.

Data Fields

Attribute Name	Description	HL7 Mapping	Data Type	Label	Use Case
procedure_code_modifier_id	This is diagnosis_code_id attribute	FT1-25	string	Diagnosis Code Id	This field contains modifier codes that provide additional information or specify modifications to procedure codes associated with a financial transaction. These modifiers can affect the billing and reimbursement for medical procedures.
visit_number	Id of the visit	PV1-19-1	string	Visit Number	The visit number serves as a unique identifier for a specific patient visit or encounter within a healthcare facility. It distinguishes one visit from another.
invoice_id	This is invoice_id attribute	FT1+MSH-10	string	Invoice ID	This field can be used to create a unique identifier for an invoice or financial transaction. Healthcare organisations may use such an identifier to manage and track invoices related to patient billing.
lineage	This is lineage attribute	Fixed - HL7	string	Lineage	"lineage" refers to the information about the origin or source of a message. It helps trace the path of the message, indicating where it originated, how it was transmitted, and any intermediate systems or components it passed through before reaching its destination.
xc_visit_id	XC visit id	Based on alternate_visit_id followed by visit_number followed by system generated ID	string	XC visit id	The "xc_visit_id" is a unique identifier used to group together all the interactions, procedures, tests, and check-ups associated with a single patient visit in a healthcare setting. This identifier helps in organising and managing various activities and data related to that specific patient encounter.
alternate_visit_id	Alternative visit id	PV1-50/PID-18	string	Alternate Visit Id	This field provides an alternate identifier for a patient's visit. It is used for tracking and cross-referencing patient visits and records, especially in scenarios requiring multiple identifiers or references. This field is recorded during patient registration and aids in accurate record linkage.
encounter_id	Encounter ID	PV1+MSH-10	string	Encounter ID	This unique identifier is used to associate various HL7 messages with a specific patient encounter or visit. It ensures that data and events are accurately linked to the correct patient's healthcare journey.
batch_id	Batch id	System Generated	string	Batch ID	"batch ID" is a unique identifier assigned to a group of messages that are logically grouped together for processing or transmission. Batching messages is a common practice in healthcare systems to efficiently manage and transmit multiple messages as a single unit
patient_id	This is patient_id attribute	PID-3-1	string	Patient ID	The patient ID is a unique identifier assigned to a patient within the healthcare system. It is used to accurately identify and link a patient's medical records, treatments, and history.
bundle_id	ID of bundle	MSH-10	string	Bundle ID	“bundle ID" typically refers to a unique identifier assigned to a group or bundle of related messages or data elements. This identifier is used to associate multiple messages or pieces of information that are related to a specific patient, event, or transaction.
procedure_code_modifier	Procedure Code Modifier	OBR-45	string	Procedure Code Modifier	This field contains modifier codes that provide additional information or specify modifications to procedure codes associated with an ordered observation or procedure. These modifiers can affect how the procedure is performed or billed.

Invoice Diagnosis Code

Invoice Provider