Chapter 3 Modifiers Part 1 Flashcards
Two Surgeons:When two surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier ___ to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons.
Each surgeon should report the cosurgery once using the same procedure code. If additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier ____ added.
Note:If a co-surgeon acts as an assistant in the performance of additional procedure(s) during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate.
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Procedure Performed on Infants less than 4 kg:Procedures performed on neonates and infants up to a present body weight of 4 kg may involve significantly increased complexity and physician or Other Qualified Health Care Professional work commonly associated with these patients. This circumstance may be reported by adding modifier ___ to the procedure number.
Note:Unless otherwise designated, this modifier may only be appended to procedures/services listed in the20005-69990code series. Modifier ___ should not be appended to any CPT codes listed in theEvaluation and Management Services, Anesthesia, Radiology, Pathology/Laboratory, or Medicinesections.
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Surgical Team:Under some circumstances, highly complex procedures (requiring the concomitant services of several physicians or Other Qualified Health Care Professional, often of different specialties, plus other highly skilled, specially trained personnel, various types of complex equipment) are carried out under the “surgical team” concept. Such circumstances may be identified by each participating physician with the addition of modifier ____ to the basic procedure number used for reporting services.
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Discontinued Out-Patient Hospital/Ambulatory Surgery Center (ASC) Procedure Prior to the Administration of Anesthesia:Due to extenuating circumstances or those that threaten the well being of the patient, the physician may cancel a surgical or diagnostic procedure subsequent to the patient’s surgical preparation (including sedation when provided, and being taken to the room where the procedure is to be performed), but prior to the administration of anesthesia (local, regional block(s) or general). Under these circumstances, the intended service that is prepared for but cancelled can be reported by its usual procedure number and the addition of modifier ____.
Note:The elective cancellation of a service prior to the administration of anesthesia and/or surgical preparation of the patient should not be reported. For physician reporting of a discontinued procedure, see modifier 53.
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Discontinued Out-Patient Hospital/Ambulatory Surgery Center (ASC) Procedure After Administration of Anesthesia:Due to extenuating circumstances or those that threaten the well being of the patient, the physician may terminate a surgical or diagnostic procedure after the administration of anesthesia (local, regional block(s), general) or after the procedure was started (incision made, intubation started, scope inserted, etc). Under these circumstances, the procedure started but terminated can be reported by its usual procedure number and the addition of modifier ____.
Note:The elective cancellation of a service prior to the administration of anesthesia and/or surgical preparation of the patient should not be reported. For physician reporting of a discontinued procedure, see modifier 53.
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Repeat Procedure or Service by Same Physician or Other Oualified Health Care Professional:It may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. This circumstance may be reported by adding modifier ___ to the repeated procedure or service.Note:This modifier should not be appended to an E/M service.
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Repeat Procedure or Service by Another Physician or Other Oualified Health Care Professional:It may be necessary to indicate that a basic procedure or service was repeated by another physician or other qualified health care professional subsequent to the original procedure or service. This circumstance may be reported by adding modifier ___ to the repeated procedure or service.Note:This modifier should not be appended to an E/M service.
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Unplanned Return to the Operating/Procedure Room by the Same Physician or Other Oualified Health Care Professional Following Initial Procedure for a Related Procedure During the Postoperative Period:It may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). When this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier ___ to the related procedure. (For repeat procedures, see modifier 76.)
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Unrelated Procedure or Service by the Same Physician During the Postoperative Period:The individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. This circumstance may be reported by using modifier ___. (For repeat procedures on the same day, see modifier 76.)
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Assistant Surgeon:Surgical assistant services may be identified by adding modifier ____ to the usual procedure number(s).
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