Modifiers

Objectives Understand what modifiers are. Learn rules for using modifiers. Identify the exceptions to the rules. Objectives This video will give you the opportunity to: Understand what modifiers are. Learn rules for using modifiers. Recognize the exceptions to the rules.

What are modifiers? Modifiers enhance CPT codes. Only 2 digits or characters Define or describe Anatomical position Unusual circumstances Physician involvement What are modifiers? Modifiers enhance CPT codes for a greater degree of specificity. They define anatomical positions, unusual circumstances, and physician involvement as described in the operative and service reports.

Where are they? In the AMA version of the HCPCS manual The CPT book Appendix 2; usually denoted by 1 or 2 alphabetical characters The CPT book Appendix A; denoted by 2 numeric digits with the exception of anesthesia modifiers (P1-P6) Where are they? Modifiers can be found in the HCPCS manual and CPT book. In the AMA version of the HCPCS manual, they are located in Appendix 2, and in the CPT book, they are located in Appendix A.

Body Position Reference For example: A pneumocentesis performed on the left side of the chest: 32420-LT A foreign body removal from the right hand thumb: 26080-F5 Whenever the operative report indicates a body area being serviced (left side, right hand thumb) an anatomical modifier from the HCPCS Appendix 2 is utilized. For example: A pneumocentesis performed on the left side of the chest: 32420-LT A foreign body removal from the right hand thumb: 26080-F5

Bilateral Services If services performed bilaterally (both breasts, both thumbs) CPT Manual, Appendix “A”; Modifier 50. If code is for bilateral procedure, such as a bilateral mammogram CPT code 77056. Modifier 50 would not apply. Read carefully If the report indicates services performed bilaterally (both breasts, both thumbs), refer to the CPT Manual, Appendix “A”; Modifier 50. If the procedure code describes a bilateral procedure, such as a bilateral mammogram, use CPT code 77056. Modifier 50 would not apply. Read all notes and descriptions to avoid making a mistake.

Modifier rules Technical and professional component. CPT code 77010: X-Ray of chest; single view; frontal. If the physician performs the x-ray and interprets the report, no modifier is appended to the code. Modifier rules Radiologic procedures contain a technical component (the process of taking an x-ray) and a professional component (reading and interpreting the report). For example, CPT code 77010 describes an X-Ray of chest; single view; frontal. If the physician performs the x-ray and interprets the report, no modifier is appended to the code.

Modifier rules continued: However, if the x-ray is outsourced, the radiology clinic would report: 71010-TC: Indicating they took the x-ray (technical component.) The physician interpreting the report would submit this: 71010-26: Denoting the professional component. However, if the x-ray is outsourced, the radiology clinic would report: 71010-TC: Indicating they took the x-ray (technical component.) The physician interpreting the report would submit this: 71010-26: Denoting the professional component. This modifier sequence is usually only applied to radiology services.

Multiple Modifiers Up to 4 modifiers First modifier would be “99” Modifiers should be reported in descending order, e.g. 99, 51, 32 HCPCS Modifiers follow CPT Modifiers. e.g. 99, 66, 47, LT Multiple Modifiers Keep in mind that up to 4 modifiers can be appended to a procedure code. If multiple modifiers are used, the first modifier would be “99” to indicate more modifiers to follow. Be aware of this sequencing when reading test questions.

Practical Example Two surgeons perform duodenotomy with biopsy use modifier -62 44010-62 Procedure discontinued, modifier -53 Code would be : 44010-99-62-53 Practical Example If two surgeons conduct a duodenotomy with a biopsy (44010), each performing distinct parts of the procedure, modifier -62 could be appended to each surgeon’s bill. If the procedure had to be discontinued, after the initial incision due to, for instance, a dramatic drop in the patient’s blood pressure you would use modifier -53. Therefore the coding would resemble this: 44010-99-62-53

In conclusion Modifiers meant to enhance, provide detail Read carefully and determine correct codes. The purpose of modifiers is to enhance a service code to a greater degree of specificity. They describe in detail additional time, components, and circumstances provided during a service or procedure. Modifier usage will be found throughout the CPC exam. Don’t panic. Read carefully and look for the things described here to help you determine the correct codes.