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1605 CPT > Chpt 2 > Flashcards

Chpt 2 Flashcards

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NASM ® CPT flashcards
1
Q

Modifiers

A

Give additional information
Append to a CPT code to indicate that a service or procedure has been altered for some reason but it does not change the main definition of the code

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2
Q

CPT modifiers

A

Two-digit numeric codes
Appendix A

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3
Q

HCPCS Modifiers

A

Two-digit alphanumeric modifiers

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4
Q

Physician services

A

Place modifiers in 24d of CMS-1500 form following the CPT code

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5
Q

Reporting modifiers

A

Review modifier instructions for the payer you are billing

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6
Q

Ranking of Modifiers

A

Pricing modifiers before statistical and informational modifiers

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7
Q

Pricing modifiers

A

AA, AD, AH, AJ, AS, GM, QB, QK, QU, QX, QY, QZ, SG, TC, UN, UP, UQ, UR, US
22, 26, 50, 51, 52, 53, 54, 55, 56, 62, 66, 73, 74, 78, 80, 82, 99

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8
Q

Statistical and informational modifiers

A

Use in any order except QT, QW, and SF. These can only be used in the first modifier field

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9
Q

Modifier 99

A

Indicates that multiple modifiers are needed for an individual CPT code
Not recognized by all insurance plans

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10
Q

Modifiers used for Ambulatory Surgery Center Hospital Outpatient Use
Reported on UB-04/CMS-1450 form

A

Level I modifiers
22, 27, 33, 50, 52, 58, 59, 73, 74, 76, 77, 78, 79, 91
Level II modifiers
LT, RT, E1, E2, E3, E4, FA, F1-F9, TA, T1-T9, LV, LD, LM, RC, RI, GG, GH, QM, QN, XE, XS, XP, XU

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11
Q

Modifier 22

A

Increased procedural services
Service is greater than usually required for the procedure
Should not be appended to an E/M code
Only truly unusual cases which must have documentation

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12
Q

Modifier 23

A

Unusual anesthesia
A procédure routinely done with no or local anesthesia requires use of general anesthesia

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13
Q

Modifier 24

A

Unrelated E/M service by the same physician during postoperative period
Appended to the E/M code

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14
Q

Modifier 25

A

Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service

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15
Q

Modifier 26

A

Professional component
Should not be appended to codes that do not have a technical component as part of the code definition

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16
Q

Modifier 27

A

Multiple outpatient hospital E/M encounters on the same date
Not to be used for physician reporting of multiple E/M services performed by the same physician on the same day

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17
Q

Modifier 32

A

Mandated services
Required by an insurance company or governmental, legislative or regulatory agency

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18
Q

Modifier 33

A

Preventive service
For separately reported services specifically identified as preventive, the modifier should not be used

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19
Q

Modifier 47

A

Anesthesia by surgeon
Not used when local anesthesia is used
Never appended to the anesthesia code, but to a procedure or service code.

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20
Q

Modifier 50

A

Bilateral procedure
Same operative session
Used only with codes that describe a unilateral procedure
Some people prefer rt and lt modifiers instead of 50

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21
Q

Modifier 51

A

Multiple procedures
Same provider/same operative/procedural session
Used only by providers and is not used by facilities

22
Q

Modifier 52

A

Reduced services
Partially reduced or eliminated at the physician’s discretion
May require documentation
For outpatient hospital reporting use 73 and 74 not 52

23
Q

Modifier 53

A

Discontinued procedure
Procedure started but discontinued
Not to report elective cancellation
Indicates that additional services might be provided in the future
For outpatient hospital center use 73 and 74, not 53

24
Q

Modifier 54

A

Surgical care only
Don’t provide pre-or postoperative care

25
Q

Modifier 55

A

Postoperative management only

26
Q

Modifier 56

A

Preoperative management only

27
Q

Modifier 57

A

Decision for surgery
Appended to E/M code when , during the service, the initial decision was made to perform surgery

28
Q

Modifier 58

A

Staged or related procedure or service by the same physician during the postoperative period
During original, second is scheduled (staged procedure)
During postoperative period, more extensive care is needed
During the postoperative period, therapy is required following the surgical procedure
Do not use when 78 is appropriate

29
Q

Modifier 59

A

Distinct procedural service
Procedure independent from other non-E/M services performed on the same day.
Procedures that are not typically treated together
Use only if another appropriate modifier is not available

30
Q

Subsets of Modifier 59

A

-X[EPSU] modifiers
XE separate encounter
XS separate structure
XP separate practitioner
XU unusual non-overlapping service
Do not include modifier 59 if you use one of these

31
Q

Modifier 62

A

Two surgeons
Primary surgeons work together to perform a distinct part of a single reportable procedure
Each surgeon reports his own work with modifier 62
Use 80 or 82 if one surgeon assists

32
Q

Modifier 63

A

Procedure performed on infants less than 4 kgs
Only used on codes 20100-69990 unless otherwise designated in the manual

33
Q

Modifier 66

A

Surgical team
Requires several physicians and complex equipment
Each provider appends 66
Need documentation

34
Q

Modifier 73

A

Discontinued outpatient hospital/ambulatory surgery center (ASC) procedure prior to the administration of anesthesia
Well-being of patient is threatened
Not used for elective cancellation

35
Q

Modifier 74

A

Discontinued outpatient hospital/Ambulatory surgery center procedure after administration of anesthesia

36
Q

Modifier 76

A

Repeat procedure or service by same physician
The original procedure or service code is the same for both sessions
Not appended to an E/M code

37
Q

Modifier 77

A

Repeat procedure or service by another physician
Basic service had to be repeated
Same code as original
Not appended to an E/M code

38
Q

Modifier 78

A

Unplanned return to the operating/procedure room by the same physician following initial procedure for a related procedure during the postoperative period
Append 78 to the code of the subsequent procedure
Documentation may be requested

39
Q

Modifier 79

A

Unrelated procedure or service by the same physician during the postoperative period
Unrelated to the original procedure

40
Q

Modifier 80

A

Assistant surgeon
Assistant physician uses the same code but appends 80
Medicare part b does not cover the services of an assistant surgeon for certain procedures
Exemptions on CMS website
Payment cannot be collected from the patient if the provider is a participating Medicare provider

41
Q

Modifier 81

A

Minimum assistant surgeon
Assistant required only for a short time or if a 2nd or 3rd assistant surgeon was needed during the procedure

42
Q

Modifier 82

A

Assistant surgeon when qualified resident surgeon is not available in a teaching facility
Must have certification on file

43
Q

Modifier 90

A

Reference (outside) laboratory

44
Q

Modifier 91

A

Repeat clinical diagnostic laboratory test
Same lab test repeated on the same day to get multiple test results
Not for problems with initial collection, confirmation of initial test results, or the availability of an all inclusive code
1st test with normal code, 2nd test with normal code-91
Also not used when a series of tests are run on the same day

45
Q

Modifier 92

A

Alternative laboratory platform testing
Ie. Kit or transportable instrument

46
Q

Modifier 93

A

Synchronous telemedicine service rendered via telephone other real-time interactive audio-only telecommunications system
Must meet the key components as if the service was performed face-to-face

47
Q

Modifier 95

A

Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system
Must be a service listed in appendix P to be used
Modifier GT listed for HCPCS services for Medicare but not all payers take this
Star icon must appear next to code
All components are completed via telemedicine and documented by provider

48
Q

Modifier 96

A

Habilitative services
PT / OT
Services not yet learned

49
Q

Modifier 97

A

Rehabilitative services
Occur after a patient was sick, hurt, or disabled

50
Q

Modifier 99

A

Multiple modifiers
Use when more than 2 modifiers are necessary
99 first followed by the next three modifiers with the rest in the narrative box number 19 on CMS-1500

51
Q

HCPCS Level II modifiers

A

Also provides codes for ambulances and DME
Codes may or may not be reimbursed
Contact the insurance carrier to see if the code is covered
The service being provided needs to be explained further
See websites of various carriers and CMS for clarification on usage of these modifiers
Comprehensive list in Appendix 2 of HCPCS book

52
Q

HCPCS Modifiers

A

Multiples of supplies
Various body parts when multiple procedures are reported
G1-G5: dialysis for unlisted code
Additional G modifiers for Medicare
J-V: outlines types of modifiers
Ambulance origin and destination modifiers
Left comes before right, A often before numbers

1605 CPT (5 decks)

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