Under which circumstances are line item trailers for physician services excluded?
In order not to overstate the episode of care counts, line item trailers are excluded if they meet any of the following conditions. 1. General: If the Line Item has been denied (see Medicare FAQ # 78 for this definition) 2. Surgical claims: a. If either the Line HCPCS Initial Modifier Code or Line HCPCS Second Modifier Code is a ’55’ (Postoperative Management) or ’56’ (Preoperative Management). b. If either the Line HCPCS Initial Modifier Code or Line HCPCS Second Modifier Code contained a value of ’62’ (Two Surgeons), only the first line item (record) of the claim is kept, subsequent occurrences of ’62’ for the same claim are dropped. c. If the Line HCFA Type of Service Code contains a value of ‘8’ (Assistant Surgeon). 3. Radiology and Clinical Lab claims: • If either the Line HCPCS Initial Modifier Code or Line HCPCS Second Modifier Code is a ‘TC’ (Technical Component). 4. Miscellaneous claims: • If the Line HCFA Type of Service contains a value of ‘F’ (ASC Facility Charge). This is
