CPT

Question 1

What modifier is added to indicate a repeated procedure or service by the same physician?

Answer 1

Modifier 76

Keywords: repeated, again, previous, etc.

Question 2

What modifier is used when a procedure is repeated by another physician?

Answer 2

Modifier 77

Keywords: repeated by another physician, etc.

Question 3

Which modifier is used for an unplanned return to the operating room by the same physician during the postoperative period?

Answer 3

Modifier 78

Keywords: complications, had to return to OR, etc.

Question 4

What modifier indicates that a procedure performed during the postoperative period is unrelated to the original procedure?

Answer 4

Modifier 79

Keywords: not related to previous care, etc.

Question 5

How is assistant surgeon services identified in procedure coding?

Answer 5

Modifier 80

Keywords: assisted, surgeon called in to help, etc.

Question 6

What modifier is added for minimum assistant surgeon services?

Answer 6

Modifier 81

Keywords: assisted partially, helped with part of procedure, etc.

Question 7

When is modifier 82 used in procedure coding?

Answer 7

When a qualified resident surgeon is not available

Keywords: surgical resident not available, etc.

Question 8

What modifier is used when laboratory procedures are performed by a reference laboratory outside of the treating physician?

Answer 8

Modifier 90

Keywords: independent lab, separate from physician, etc.

Question 9

What indicates a repeat clinical diagnostic laboratory test?

Answer 9

When the same laboratory test is repeated on the same day

Keywords: sequenced lab tests, repeat lab after 4 hours, etc.

Question 10

Which modifier is appropriate for alternative laboratory platform testing?

Answer 10

Modifier 92

Keywords: portable, kit, disposable, etc.

Question 11

What modifier is appended for synchronous telemedicine services rendered via real-time interactive audio and video?

Answer 11

The star symbol modifier

Refer to Appendix P for a list of codes that use this modifier.

Question 12

What modifier is used when two or more modifiers are necessary to delineate a service?

Answer 12

Modifier 99

Other applicable modifiers may be listed as part of the service description.

Question 13

What modifier is added to identify preoperative management only?

Answer 13

Modifier 56

Modifier 56 is used when one physician performs preoperative care and another performs the surgical procedure.

Question 14

What does modifier 57 indicate?

Answer 14

Decision for Surgery

Modifier 57 is added to an E/M code when an evaluation leads to the decision to perform surgery on the same day.

Question 15

In what circumstances is modifier 58 used?

Answer 15

Staged or Related Procedure

Modifier 58 indicates that a procedure during the postoperative period was planned, more extensive, or for therapy following a diagnostic procedure.

Question 16

What does modifier 59 signify?

Answer 16

Distinct Procedural Service

Modifier 59 identifies services that are distinct or independent from other non-E/M services performed on the same day.

Question 17

What are the four subsets of modifier 59?

Answer 17

Modifiers XE, XS, XP, XU

• XE: Separate Encounter
• XS: Separate Structure
• XP: Separate Practitioner
• XU: Unusual Non-Overlapping Service

Question 18

When are two surgeons identified in a procedure?

Answer 18

When they perform distinct parts of a procedure

Each surgeon provides an operative report for their portion of the surgery.

Question 19

What is the significance of a procedure performed on infants less than 4 kg?

Answer 19

Increased complexity and physician workload

Procedures on neonates and infants may involve significantly increased complexity.

Question 20

What modifier is used to report services provided by a surgical team?

Answer 20

Modifier 66

Modifier 66 is added when highly complex procedures are carried out by a surgical team.

Question 21

What is the purpose of modifier 26?

Answer 21

To identify the professional component of a procedure when reported separately

Example: Append modifier 26 to procedure code (77001-77003) for fluoroSCopy performed during surgery by a physician.

Question 22

When should modifier 32 be used?

Answer 22

When an insurance company requests a second opinion before authorizing additional services/procedures

Example: Append modifier 32 to an E/M code for mandated consultation.

Question 23

What does modifier 47 indicate?

Answer 23

Regional or general anesthesia provided by the surgeon

Example: Use modifier 47 when the anesthesiologist is not available.

Question 24

What is a bilateral procedure?

Answer 24

A procedure performed on both sides during the same operative session

Example: Append modifier 50 to the procedure code for bilateral laparoscopic inguinal hernia repair.

Question 25

When is it inappropriate to use modifier 50?

Answer 25

When reporting in addition to Right (RT) and/or Left (LT) modifiers or with add-on codes ## Footnote Modifier 50 indicates bilateral procedures and does not need RT or LT.

Question 26

What does the term 'multiple procedures' refer to?

Answer 26

When multiple procedures are performed at the same session by the same provider, excluding E/M services ## Footnote Keywords include: different procedure, separate from.

Question 27

What is modifier 52 used for?

Answer 27

To indicate a service or procedure that is partially reduced or eliminated ## Footnote Example: Modifier 52 is added to the usual procedure code to signify partial completion.

Question 28

What does a discontinued procedure mean?

Answer 28

A surgical or diagnostic procedure that was started but not completed due to extenuating circumstances ## Footnote Keywords include: procedure stopped before completion.

Question 29

What is indicated by modifier 54?

Answer 29

Surgical services performed by one provider, with preoperative and/or postoperative management by another ## Footnote Example: Modifier 54 is added to the surgical procedure code.

Question 30

What does modifier 55 signify?

Answer 30

Postoperative management performed by a different healthcare professional than the one who performed the surgical procedure ## Footnote Keywords include: postoperative care turned over to, transfer of care.