CPT & HCPCs Modifiers Flashcards
(95 cards)
22
Increased procedural services (surgical –Increased intensity, additional time, technical difficulty
23
Unusual Anesthesia (Provider administers anesthesia for procedure that would not normally require it)
24
Unrelated Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional During a Postoperative Period (EM service rendered by physician in the global period after surgery unrelated to pt. Sx
25
Additional E/M service separate from original E/M visit
26
Professional component to show that the physician provided the supervision and interpretation portion of the service. Typically when provider uses equipment in setting that she doesn’t own append mod. 26. Do not report if provider owns equipment and also performing supervision and interpretation.
27
Multiple Outpatient Hospital E/M Encounters on the Same Date- Append if patient has multiple subsequent encounters on the same day performed by different providers at the SAME hospital or facility.
32
Mandated Service- Append when a 3rd party mandated that the service or procedure be performed. Example : Consultation for worker’s comp.
33
Preventative services- Append to services which are preventative such as screening for specific dz. DO NOT use if the procedure specifically states screening such as encounter for mammogram screening.
47
Anesthesia by surgeon- Append when surgeon performing procedure also administers local or general anesthesia.
50
Bilateral procedure- Modifier 50 applies to procedures performed on paired organs, such as kidneys or lungs, or paired body structures, such as extremities, eyes, and ears. Some codes already include the word bilateral or the words unilateral or bilateral in the code descriptors. Do not append modifier 50 to these codes.Do not use modifier 50 with add–on codes
51
Multiple procedures- Append for subsequent procedures performed by the same provider during same encounter for the same patient.
52
Reduced services- Append to show that the provider did not perform all services listed in the complete procedure. Example provider only performs procedure on one anatomical part when the procedure states bilateral.
54
Surgical care only- Append to a procedure when the provider performs the procedure but does not provide the preoperative or postoperative management. Represents procedure only. Mod. 54-56 likely divided amongst 3 separate providers or locations.
55
Post Operative management only- When provider only renders the post op management and does not take part in the pre-op, evaluation, or the procedure itself. Mod. 54-56 likely divided amongst 3 separate providers or locations.
56
Preoperative management only- Append when provider only performs the preoperative evaluation and nothing else. Mod. 54-56 likely divided amongst 3 separate providers or locations.
57
Decision for surgery-Append if provider decides to perform surgery on the day of an E/M service or the day prior. To append modifier 57 properly, you must remember these points:
–The E/M service occurs the day of or the day before a major surgical procedure, a procedure with a 90 day global period.
–The E/M service must prompt the surgical procedure that follows.
–The E/M service must be related to the procedure that follows.
- The same provider or tax id performs the procedure that performed the E/M service
58
Staged or Related Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period. For scenarios when the patient cannot handle multiple procedure during the same operative session. Examples include, reapplication of cast during global period, procedures for skin grafting and scar removal, procedure more extensive than original procedure. Not to be confused with modifier 78 return to OR
59
Distinct Procedural Service- Append to to identify a procedure that is distinct or independent from other non–E/M services that the provider performs on the same day. Must have supporting documentation from provider to use. Do not append to the E/M service. Do not use when there is a more appropriate modifier to use. Often appended to post operative pain management services to disassociate them from the anesthesia administered during surgery
62
Two surgeons- Append when two primary surgeons are performing on the same operation, but each is performing a distinct part of the procedure. Append 62 to each provider. Example: complex surgery requiring surgeons to work in shifts.
63
Procedure performed on infants less than 4 kg (8.81 lbs). Not appropriate for mod. 63 exempt procedures. Documentation must be provided indicating weight.
66
Surgical Team- Append to a procedure code when the provider who performed the procedure was part of a surgical team performing a highly complex or difficult procedure. Surgical team typically ( 3 or more providers). Do not confuse with modifer 62.
73
Discontinued Out-Patient Hospital/Ambulatory Surgery Center (ASC) Procedure Prior to the Administration of Anesthesia after provider took patient to prep procedure.
74
Discontinued Out-Patient Hospital/Ambulatory Surgery Center (ASC) Procedure Prior after the administration of Anesthesia. Due to complications. Anesthesia including local, general, and regional block.
76
Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional. Provider may repeat procedure was not successful. Also applies to repeat x-rays. Do not append to E/M services
