CPT-Modifiers Flashcards
Modifier 22
Increased Procedural Services: When the service(s) provided is greater than that usually required for the listed procedure, it may be identified by adding modifier 22 to the usual procedure code number. Documentation must support the substantial additional work and the reason for the additional work.
KEYWORDS: EXTENDED TIME, TOOK LONGER THAN NORMAL, EXTENUATING CIRCUMSTANCES, ETC.
Modifier 23
Unusual Anesthesia: When a procedure that usually requires either no anesthesia or local anesthesia must be performed under general anesthesia due to unusual circumstances. Modifier 23 is only used by anesthesiologists and CRNA’s with anesthesia codes 00100-01999.
KEYWORDS: UNABLE TO TOLERATE WITHOUT GENERAL ANESTHESIA, ETC.
Modifier 24
Unrelated E/M by the Same Physician or Other Qualified Healthcare Professional During a Postoperative Period: The physician or other qualified healthcare professional may need to indicate an E/M service was performed during a postoperative period for reason(s) unrelated to the original procedure. This circumstance may be reported by adding modifier 24 to the appropriate level of E/M service
KEYWORDS: UNRELATED, OUTSIDE OF, NOT RELATED TO, ETC.
Modifier 25
Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Healthcare Professional on the Same Day of the Procedure or Other Service: It may be necessary to indicate that on the day a procedure or service identified by a CPT code was performed, the patient’s condition required a significant, separately identifiable E/M service above and beyond the other service provided or beyond the usual preoperative and postoperative care associated with the procedure performed.
KEYWORDS: UNRELATED, OUTSIDE OF, NOT RELATED TO, ETC.
Modifier 26
Professional Component: Certain procedures are a combination of a professional component and a technical component. When the professional component is reported separately, identify it as such by adding modifier 26 to the usual procedure code.
KEYWORDS: INDEPENDENT RADIOLOGIST, PERFORMED IN A HOSPITAL, ETC.
Modifier 32
Mandated Services: Services related to mandated consultation and/or related services.
KEYWORDS: SECOND OPINION, REQUIRED BY INSURANCE, ETC.
Modifier 47
Anesthesia by Surgeon: Regional or general anesthesia provided by the surgeon may be reported by adding modifier 47 to the basic service.
KEYWORDS: SURGEON ADMINISTERED ANESTHESIA, ANESTHESIOLOGIST NOT AVAILABLE, ETC.
Modifier 50
Bilateral Procedure: Bilateral procedures performed at the same operative session code.
KEYWORDS: BILATERAL, BOTH SIDES, LEFT AND RIGHT, ETC.
Modifier 51
Multiple Procedures: When multiple procedures, other than E/M services, Physical Medicine and Rehabilitation services or provision of supplies are performed at the same session by the same provider.
KEYWORDS: A DIFFERENT PROCEDURE, SEPARATE FROM, ETC.
Modifier 52
Reduced Services: Under certain circumstances, a service or procedure is partially reduced or eliminated at the physician’s or other qualified healthcare professional’s discretion. Under these circumstances, the service provided can be identified by its usual procedure code and the addition of modifier 52.
KEYWORDS: PARTIALLY, TO BE REDUCED, PART OF PROCEDURE NOT COMPLETED, ETC.
Modifier 53
Discontinued Procedure: Under certain circumstances, the physician or other qualified healthcare 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.
KEYWORDS: PROCEDURE STOPPED BEFORE COMPLETION, ABORTED THE PROCEDURE, ETC.
Modifier 54
Surgical Care Only: When one physician or other qualified healthcare professional performs the surgical procedure, and another provides preoperative and/or postoperative management, surgical services may be identified by adding modifier 55 to the surgical procedure code.
KEYWORDS: ONLY PERFORMED THE SURGICAL PROCEDURE, NO PRE OR POST-OP MANAGEMENT, ETC.
Modifier 55
Postoperative Management Only: When one physician or other qualified healthcare professional performs the surgical procedure and another provider performs postoperative management, the postoperative component is identified by adding modifier 55 to the surgical procedure code.
KEYWORDS: POST-OP FOLLOW UP ONLY, POSTOPERATIVE CARE TURNED OVER TO, TRANSFER OF CARE, ETC.
Modifier 56
Preoperative Management Only: When one physician or other qualified healthcare professional performs the preoperative care and evaluation and another provider performs the surgical procedure, the preoperative component is identified by adding modifier 56 to the surgical procedure code.
KEYWORDS: PRE-OP EVALUATION ONLY, COVERING FOR SURGEON, ETC.
Modifier 57
Decision for Surgery: When an E/M service provided the day before or the day of a surgery results in the decision to perform surgery, append modifier 57 to the appropriate level or E/M service.
KEYWORDS: DECISION TO PERFORM SURGERY, WILL NEED TO GO TO OR, ETC.
Modifier 58
Staged or Related Procedure or Service by the Same Physician or Other Qualified Healthcare Professional During the Postoperative Period: It may be necessary to indicate the performance of a procedure or service during the postoperative period was:
a. Planned prospectively at the time of the original procedure (staged);
b. More extensive than the original procedure; or
c. For therapy following a diagnostic surgical procedure
Report the circumstance by adding modifier 58 to the staged or related procedure.
KEYWORDS: RETURN TO OR, WILL PROCEED WITH ADDITIONAL SERVICES IN NEXT PROCEDURE, ETC.
Modifier 59
Distinct Procedural Service: Under certain circumstances, it may be necessary to indicate a procedure or service was distinct or independent from other non-E/M services performed on the same day. Modifier 59 is used to identify services not normally reported together but are appropriate under the reported circumstances. CMS NCCI documentation has specific examples for the correct use of modifier 59.
CMS provides a subset of modifier 59:
XE: Separate Encounter, a service that is distinct because it occurred during a separate encounter;
XS: Separate Structure, a service ths distinct because it was performed on a separate organ/structure;
XP: Separate Practitioner, a service that is distinct because a different practitioner performed it; and
XU: Unusual Non-Overlapping Service, the use of a service that is distinct because it does not overlap usual components of the main service.
The subset of modifiers are more selective versions of modifier 59 so it would be incorrect to include both modifiers on the same line.
KEYWORDS: SEPARATE PROCEDURE, NEEDED ADDITIONAL SERVICES, ETC.
Modifier 62
Two Surgeons: Append modifier 62 when two surgeons work together as primary surgeons performing distinct part(s) of a procedure. Each surgeon must provide and operative report that describes his or her portion of the surgery. Each surgeon must report the same CPT code with modifier 62.
KEYWORDS: CO-SURGEON, SHARED PROCEDURE WITH, ETC.
Modifier 63
Procedures 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 healthcare professional work commonly associated with these patients.
KEYWORDS: WEIGHT, INCUBATOR, NEONATE, NEWBORN, ETC.
Modifier 66
Surgical Team: Under some circumstances, highly complex procedures are carried out under the “surgical team” concept.
KEYWORDS: SURGICAL TEAM WORKING TOGETHER, PRESENCE OF OTHER SURGEONS, ETC.
Modifier 76
Repeat Procedure or Service by Same Physician or Other Qualified Healthcare Professional: The physician or other qualified healthcare professional may need to indicate a procedure or service was repeated. This may be reported by adding modifier 76 to the repeated service.
KEYWORDS: REPEATED, AGAIN, PREVIOUS, ETC.
Modifier 77
Repeat Procedure by Another Physician or Other Qualified Healthcare Professional: The physician or other qualified healthcare professional may need to indicate a procedure or service performed by another physician or other qualified healthcare professional had to be repeated. Modifier 77 is then added to the repeated procedure/service.
KEYWORDS: REPEATED BY ANOTHER PHYSICIAN, ETC.
Modifier 78
Unplanned Return to the Operating/Procedure Room by the Same Physician or Other Qualified Healthcare Professional Following Initial Procedure for a Related Procedure During the Post-operative Period: It may be necessary to indicate that another procedure was
deperformed during the postoperative period of the initial procedure. Modifier 78 describes a return to the operating room for a complication during the global period of another procedure.
KEYWORDS: COMPLICATIONS, HAD TO RETURN TO OR, ETC.
Modifier 79
Unrelated Procedure or Service by the Same Physician or Other Qualified Healthcare Professional During the Postoperative Period: The physician or other qualified healthcare professional may need to indicate the performance of the procedure or service during the postoperative period was unrelated to the original procedure. This circumstance may be reported by using modifier 79.
KEYWORDS: NOT RELATED TO PREVIOUS CARE, ETC.
Modifier 80
Assistant Surgeon: Surgical surgeon assistant services may be identified by adding modifier 80 to the usual procedure code(s).
KEYWORDS: ASSISTED, SURGEON CALLED IN TO HELP, ETC.
Modifier 81
Minimum Assistant Surgeon: Minimum assistant surgeon services are identified by adding modifier 81 to the procedure code(s). Another surgeon is called in to assist for a limited time.
KEYWORDS: ASSISTED PARTIALLY, HELPED WITH PART OF THE PROCEDURE, ETC.
Modifier 82
Assistant Surgeon (when qualified resident surgeon is not available): The unavailability of a qualified resident surgeon is a prerequisite for the use of modifier 82 appended to the usual procedure code(s).
KEYWORDS: SURGICAL RESIDENT NOT AVAILABLE, ETC.
Modifier 90
Reference (Outside) Laboratory: Identify laboratory procedures performed by a party other than the treating or reporting physician or other qualified healthcare professional by appending modifier 90 to the procedure codes.
KEYWORDS: INDEPENDENT LAB, SEPARATE FROM PHYSICIAN, ETC.
Modifier 91
Repeat Clinical Diagnostic Laboratory Test: Reporting modifier 91 is appropriate when it is necessary to repeat the same laboratory test on the same day to obtain subsequent test result(s). It is not appropriate to use this modifier to repeat a laboratory test due to a lost specimen, equipment failure, or lost results.
KEYWORDS: SEQUENCED LAB TESTS, REPEAT LAB AFTER 4 HOURS, ETC.
Modifier 92
Alternative Laboratory Platform Testing: Reporting modifier 92 is appropriate when laboratory testing is being performed using a kit or transportable instrument that wholly or in part consists of a single use, disposable analytical chamber.
KEYWORDS: PORTABLE, KIT, DISPOSABLE, ETC.
Modifier 95
Synchronous Telemedicine Service Rendered via a Real-Time Interactive Audio and Video Telecommunications System
KEYWORDS: TELEMEDICINE SERVICES
Modifier 99
Multiple Modifiers: Under certain circumstances, two or more modifiers may be necessary to delineate a service completely. Append modifier 99 to the basic procedure. Other applicable modifiers may be listed as part of the service description.
KEYWORDS: N/A
