1. 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

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

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

4. 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. 3 - 4

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

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

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

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

9. Notations & Symbols 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 3 - 9

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

11. 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 3 - 11

12. 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 3 - 12

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

14. Sequencing Multiple Modifiers 1.The CPT Code Example: 24201 2.Service related modifier Example: 23 Unusual anesthesia 3.Anatomical site Example: 50 Bilateral 4.Personnel modifier Example: 62 Two surgeons 3 - 14

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

16. 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. 3 - 16