What is a QN Modifier for Medicare Billing

For Medicare purposes, modifiers are two-digit codes appended to procedure codes and HCPCS codes. They are used to provide additional information about the billed procedure. Mostly,  addition of a modifier may directly affect payment. A list of modifiers is always available on internet that includes the modifier description and instructions. In addition, you can also find, whether the modifier affects the Medicare payment or not.

QN modifier is the sub category of HCPCS modifiers, and work in almost exactly the same way like CPT codes. CPT and HCPCS codes are so similar, in fact, that you can regularly use modifiers from one code set to the other. The HCPCS modifier –LT, for example, is regularly used in CPT codes 

when you need to describe a bilateral procedure that was only performed on one side of the body.

In order to differentiate a CPT modifier from HCPCS modifier or the other way round, there is one simple rule i.e. if the modifier has a letter in it, it’s a HCPCS modifier. If that modifier is entirely numeric, it’s a CPT modifier.

QN Modifier for Medicare Billing

QN modifier is used for ambulance service furnished directly by a provider of services. For ambulance services, usually one-digit modifiers are combined to form a two-digit modifier that identifies the ambulance's place of origin with the first digit, and the ambulance's destination with the second digit. The QM and QN modifiers are valid for Medicare.

A simple example may clear the QN purpose and its terms of use. For example, if a patient is suffering from bronchitis and asthma. Patient cant breath  normally and he  calls his doctor to seek help. The doctor advises him to go directly to the emergency room. In hospital, the doctor arranges with the service provider, to pick up the patient in an ambulance with basic life support systems, also known as BLS.

Now in this case, an ambulance has used, and in order to code this procedure on a claim, firstly  it would be looked at the A-codes of HCPCS,  where the ambulance codes reside. A0428 is there and labeled as for  Ambulance service, basic life support, non-emergency transport. Now we have our base HCPCS code.

But as the doctor has arranged ambulance with the help of service provider, means that ambulance was provided by the healthcare provider so now we should add a modifier to explain this. It may sound strange that how only an ambulance can greatly affect the amount of money owed for a procedure but it affects.

Now you have to look for a modifier that pertains to ambulance service. Here QN modifier helps you as QN is for Ambulance service furnished directly by a provider of services. In other words, the hospital, the service provider, sent the ambulance over to pick up our patient. At the end, We’d end up with this code: A0428-QN for a basic life support ambulance service, non-emergency transport, furnished by the provider of services.

Here it would be better to give another example that uses a combination of CPT codes, CPT modifiers, and HCPCS modifiers. For example, if a patient is suffering from a “felon” abscess, which is a complicated infection of the pulp on the distal, or last, phalanx of the hand. now that patient requires the drainage of a large, felon abscess on the tip of the middle finger of his left hand. During the procedure, due to agitation,  doctor decides to discontinue the procedure.

While coding this procedure, you’d first look at the procedure performed. It is basically a surgical procedure. You will find the Hand and Fingers field of codes in the musculoskeletal subsection of surgery section. Here you will pick up two codes, the parent code 26010 for drainage of finger abscess and the indented code 26011 for drainage of finger abscess, due to felon.

In this case,  the additional information is also required as the procedure was discontinued. CPT modifier -53 will be used here for discontinued procedure. F2, for left hand, third digit is also there in order to define that where on the body the procedure was performed. So our code would look like this: 26011-53-F2: a discontinued drainage of a complicated abscess on the third digit of the left hand. This is how, the whole process works for Medicare.