Chapter 3 Modifiers Flashcards
Increased Procedural Services:When the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier ___ to the usual procedure code. Documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient’s condition, physical and mental effort required).Note:This modifier should not be appended to an E/M service.
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Anesthesia by Surgeon:Regional or general anesthesia provided by the surgeon may be reported by adding modifier ___ to the basic service. (This does not include local anesthesia.)Note:Modifier ___ would not be used as a modifier for the anesthesia procedures.
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Bilateral Procedure:Unless otherwise identified in the listings, bilateral procedures that are performed at the same session, should be identified by adding modifier ___ to the appropriate 5 digit code.
This modifier is used to report a bilateral procedure that are performed at the same operative session as a single line item.
Example: Bilateral mastectomy (both breasts removed)
Inappropriate use of bilateral
Procedure description states bilateral
Example: Vaginal hysterectomy (>250 g) with bilateral salpingo-oophorectomy
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Reduced Services:Under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. Under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier ____, signifying that the service is reduced. This provides a means of reporting reduced services without disturbing the identification of the basic service.
Note:For hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for ASC hospital outpatient use).
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Discontinued Procedure:Under certain circumstances, the physician or Other Qualified Health Care Professional may elect to terminate a surgical or diagnostic procedure. Due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. This circumstance may be reported by adding modifier ___ to the code reported by the physician for the discontinued procedure.
Note:This modifier is not used to report the elective cancellation of a procedure prior to the patient’s anesthesia induction and/or surgical preparation in the operating suite. For outpatient hospital/ambulatory surgery center (ASC) reporting of a previously scheduled procedure or service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for ASC hospital outpatient use).
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Surgical Care Only:When 1 physician or Other Qualified Health Care Professional performs a surgical procedure and another provides preoperative and/or postoperative management, surgical services may be identified by adding modifier ___ to the usual procedure number.
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Postoperative Management Only:When 1 physician or Other Qualified Health Care Professional performed the postoperative management and another performed the surgical procedure, the postoperative component may be identified by adding modifier ___ to the usual procedure number.
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Preoperative Management Only:When 1 physician or Other Qualified Health Care Professional performed the preoperative care and evaluation and another performed the surgical procedure, the preoperative component may be identified by adding modifier ___ to the usual procedure number.
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Staged or Related Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period:It may be necessary to indicate that the performance of a procedure or service during the postoperative period was (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. This circumstance may be reported by adding modifier ____ to the staged or related procedure.Note:For treatment of a problem that requires a return to the operating or procedure room (eg, unanticipated clinical condition), see modifier 78.
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Distinct Procedural Service:Under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-E/M services performed on the same day. Modifier ____ is used to identify procedures or services, other than E/M services, that are not normally reported together but are appropriate under the circumstances. Documentation must support a different session, different procedure or surgery, different site or organ system, separate incision or excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual.
However, when another already established modifier is appropriate it should be used rather than modifier ___. Only if no more descriptive modifier is available and the use of modifier ___ best explains the circumstances should modifier ___ be used.
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