1. 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

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

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

4. Introduction
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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.

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

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

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

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

9. Notations & Symbols
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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

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

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

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

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

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

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

16. Chapter Summary
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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.