1. © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Modifiers Chapter Seven

2. © 2013 The McGraw-Hill Companies, Inc. All rights reserved. 7 - 2 © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Learning Outcomes (continued) 7.5 Cite appropriate modifiers to identify individuals who assist the primary provider during procedures. 7.6 Discuss circumstances where the amount of work necessary to perform the service differs significantly from the amount typically necessary. 7.7 Define modifiers describing mandatory services, physical status, and genetic tests. 7.8 Define HCPCS modifiers to primary codes.

3. © 2013 The McGraw-Hill Companies, Inc. All rights reserved. 7- 3 © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Key Terms Ambulance trip Anesthesia Assistant surgeon Bilateral procedure Co-surgeons Decision to perform surgery Distinct procedure Global period Multiple procedures Physical status modifiers Professional component Resident physician Staged procedure Surgical team Technical component

4. © 2013 The McGraw-Hill Companies, Inc. All rights reserved. 7 - 4 © 2013 The McGraw-Hill Companies, Inc. All rights reserved. 7.7 Reporting Mandatory Services, Physical Status, and Genetic Tests Physical status modifiers Modifiers attached to CPT codes 00100 - 01999 by anesthesia providers to identify how healthy or sick a particular patient is before undergoing anesthesia.

5. © 2013 The McGraw-Hill Companies, Inc. All rights reserved. 7 - 5 © 2013 The McGraw-Hill Companies, Inc. All rights reserved. 7.7 Reporting Mandatory Services, Physical Status, and Genetic Tests (continued) Mandatory Services Modifier 32 Is added to a code to indicate that the government, a third-party payer, or another entity with the authority to do so mandated the physician to perform a particular service. This modifier is not used when the physician would have performed the service even if not required to do so.

6. © 2013 The McGraw-Hill Companies, Inc. All rights reserved. 7 - 6 © 2013 The McGraw-Hill Companies, Inc. All rights reserved. 7.7 Reporting Mandatory Services, Physical Status, and Genetic Tests (continued) Physical Status Modifiers P1 through P6 Modifiers P1–P6 are physical status modifiers to identify how healthy or sick a particular patient is before undergoing anesthesia. Only anesthesia providers use these modifiers. These modifiers are only added to the anesthesia CPT codes (00100– 01999). Anesthesiologists or other providers use the physical status modifiers to describe the patient’s pre-anesthetic health status. It is inappropriate to add the P1–P6 modifiers to surgical procedure codes or E/M codes to indicate the patient’s state of health.

7. © 2013 The McGraw-Hill Companies, Inc. All rights reserved. 7 - 7 © 2013 The McGraw-Hill Companies, Inc. All rights reserved. 7.7 Reporting Mandatory Services, Physical Status, and Genetic Tests (continued) Genetic Modifiers CPT codes identify general molecular diagnostic procedures and cytogenetic studies rather than identify individual genetic tests. Modifiers are added to these general codes to identify the specific disease for which the tests were performed. These modifiers are not added to codes describing procedures for the treatment of an inherited disease. Genetic modifiers are located in Appendix I of the CPT manual and are organized into 10 major groupings. Each grouping is identified by the first numerical digit of a two-digit alphanumeric code.

8. © 2013 The McGraw-Hill Companies, Inc. All rights reserved. 7 - 8 © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Summary (continued) Learning Outcome 7.7 Modifiers may designate mandatory services, the physical status of a patient undergoing anesthesia, or the specific genetic test performed. Modifiers P1–P6 designate the physical status of a patient undergoing anesthesia. Modifiers listed in Appendix I are a series of over 100 modifiers that identify specific diseases for which genetic tests may be performed.