Modifiers Flashcards
-24
Unrelated E&M service by the same physician during the postoperative period.
When an E&M service is performed during a postoperative period for a reason unrelated to the original procedure.
-25
Significant, Separately Identifiable E&M Service by the same physician on the same day of the procedure or other service.
-50
Bilateral Procedure
-51
When multiple procedures are performed on the same day or session by the same provider, the primary procedure is listed and any additional services are listed with modifier 51, unless the code denotes modifier 51 exempt.
-52
Reduced Services. Procedure is partially reduced or eliminated at the physician’s discretion. Use when you COULD NOT continue with the procedure. (ex. Opening a patient up for lung surgery and seeing they are covered with cancer so they have to close them back up)
-53
Discontinued Procedure. Physician may elect to terminate a surgical or diagnostic procedure due to extenuating circumstances of those that threaten the well-being of the patient. Use when you SHOULD NOT continue with a procedure. (ex. When performing a colonoscopy, the tube may not easily go in and forcing may cause pain for the patient, so the physician discontinues the procedure)
-57
Decision for Surgery. An E&M service that resulted in the initial decision for major surgery and may only be used to indicate the day before or of the surgical procedure. (So it won’t be included in the global fee)
-59
Distinct Procedural Service. Two procedures that normally wouldn’t be billed together, but circumstances say otherwise. (ex. needing two separate procedures in different areas of the same leg)
-62
Two (CO-) Surgeons. When two surgeons work together as primary surgeons performing distinct parts of a single reportable procedure, each surgeon should report his or her distinct operative work using this modifier. Payment is 125% of allowed split between the two surgeons.
-78
Return to the operating room for a RELATED procedure during the postoperative period. Physician may need to indicate that another procedure was performed during the postoperative period of the initial procedure. (Complications due to surgery that require the use of the OR. Not included in global because not everyone requires this)
-79
UNRELATED procedure or service by the same physician during the postoperative period.
-80
Assistant Surgeon. Use to identify the physician who assisted on the surgical procedure. (Use if they are an MD -or- if reporting an assistant to Medicaid)
-AS
Assistant at Surgery. Use when surgical assistant is a PA, NP, CNS, or CSA.
