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

Learning Outcomes 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. Identify circumstances that would require a supplemental report. Distinguish between CPT modifiers and HCPCS modifiers

Introduction 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 Listed in Appendix A Placed after the CPT code with a hyphen –Example:

CPT Modifiers Physical status modifiers Are used ONLY with anesthesia codes ( ) Describe the patients condition at the time anesthesia is administered –Example: P

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

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

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

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

Physical Status Modifiers 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 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 Report Anatomical site –Example: E1 Upper left eyelid Other services –Example: QM Ambulance service

Sequencing Multiple Modifiers 1.The CPT Code Example: Service related modifier Example: 23 Unusual anesthesia 3.Anatomical site Example: 50 Bilateral 4.Personnel modifier Example: 62 Two surgeons

Reports 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 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