Introduction to Modifiers The Complete Procedure Coding Book By Shelley C. Safian, MAOM/HSM, CCS-P, CPC-H, CHA Chapter 3 Introduction to Modifiers McGraw Hill/Irwin Copyright © 2009 by The McGraw-Hill Companies, Inc. All rights reserved

Learning Outcomes Determine when a modifier is required. 3 - 2 Determine when a modifier is required. Apply the guidelines to determine the best modifier. Append multiple modifiers in the proper sequence.

Learning Outcomes Correctly use anesthesia physical status modifiers. 3 - 3 Correctly use anesthesia physical status modifiers. Identify circumstances that would require a supplemental report. Distinguish between CPT modifiers and HCPCS modifiers.

Introduction 3 - 4 Modifiers are used to present additional information that is pertinent to a procedure or service, such as the service being provided more than once or not in total.

CPT Modifiers Two-digit codes Identify an unusual circumstance 3 - 5 Two-digit codes Identify an unusual circumstance Listed in Appendix A Placed after the CPT code with a hyphen Example: 12345-12

CPT Modifiers Physical status modifiers 3 - 6 Physical status modifiers Are used ONLY with anesthesia codes (00100 - 01999) Describe the patients condition at the time anesthesia is administered Example: 00100-P1

CPT Modifiers Ambulatory Surgery Center (ASC) 3 - 7 Ambulatory Surgery Center (ASC) Some modifiers can only be used when reporting services provided in an ASC

HCPCS Level II Modifiers 3 - 8 Level II Modifiers Alphabetic or alphanumeric two-digit codes Only used with permission of third-party payer

Notations & Symbols 3 - 9 The CPT book sometimes tells you when to use, or not use, modifiers. Examples: (To report a bilateral procedures, use 68801 with modifier 50)  Modifier 51 exempt

Modifiers Personnel involved in procedure Quantity modifiers 3 - 10 Report Personnel involved in procedure Example: 62 Two surgeons Quantity modifiers Example: 50 Bilateral Limited service Example: 54 Surgical care only

Physical Status Modifiers 3 - 11 Report Patients health level at time anesthesia is administered Explains how hard anesthesiologist must work Example: P3 A patient with severe systemic disease

ASC Modifiers 3 - 12 Report Explain unusual circumstances that may occur in a same day surgery center Example: 73 Discontinued outpatient procedure prior to the administration of anesthesia

HCPCS Level II Modifiers 3 - 13 Report Anatomical site Example: E1 Upper left eyelid Other services Example: QM Ambulance service

Sequencing Multiple Modifiers 3 - 14 The CPT Code Example: 24201 Service related modifier Example: 23 Unusual anesthesia Anatomical site Example: 50 Bilateral Personnel modifier Example: 62 Two surgeons

Reports Sometimes, the modifier reports the whole story. 3 - 15 Sometimes, the modifier reports the whole story. When it does not, include a supplemental report ( a letter of explanation) from the attending physician.

Chapter Summary 3 - 16 Modifiers are used to provide additional explanation to the third-party payer so they will be less likely to deny the claim or hold it for further investigation.