1. By Alex Munoz, CPC, NCICS

2.  Used to describe alterations to CPT code  Full list, CPT, Appendix A

3.  Altered (i.e., more or less)  Bilateral  Multiple  Only portions of service (i.e., professional service only)  More than one surgeon  Unusual service

4.  Use of anesthesia where no anesthesia or local would be the norm  Example: Highly agitated senile patient  Only used with anesthesia codes  Written report with submission of modifier

5.  E/M Service not related to surgery is separately billable  Use -24 on E/M code only  If E/M provided during post-op global period, no separate payment for E/M related to surgical procedure  Example: Patient is in global period for hip surgery and is now seen for a fractured collarbone

6.  Documentation must support service  Example: Patient seen for sinus congestion, physician performs H&P, prescribes decongestant, notes lesion on back, and removes  Code: Procedure + E/M-25  Example: A patient seen on consultation by pain management and subsequent to rendering an opinion was given a nerve injection. Modifier -25 is placed on E/M code

7.  Professional component (physician, -26)  Technical component (technician + equipment, -TC)  Example: Radiologist reviews x-rays (-26) taken by supervised technician (-TC)

8.  Mandated by payer, workers’ comp, or official body  Not request of patient, patient’s family, or another physician  Example: Workers’ Comp requests examination of person currently receiving disability benefits

9.  Bilateral  Example: Procedure on hands  Caution: Some codes describe bilateral procedures; in these cases do not apply modifier -50

10.  Same Procedure, Different Sites  Example: Multiple lacerations repaired  Multiple Operation(s), Same Operative Session  Procedure Performed Multiple Times  Example: Trigger point injections (20552)

11. Cont..  List most resource intense first (highest RVU value)  Next other procedure(s) + -51 (unless code is - 51 exempt or an add-on code)  Usual payment: 1 st procedure 100%, 2 nd 50%, 3 rd 25%  Medicare: 1 st procedure paid 100%, 2 nd –5 th paid 50%, more than 5, priced manually

12.  Service reduced from code description  Physician directed reduction  Documentation substantiates reduction  Not for patients unable to pay fee  Example: Lip shave (40500) but advancement flap not performed = 40500-52  Submit full charge, payer will adjust

13.  E/M, 99201-99499  Medicine, 92012-92014 ophthalmologic services  Medicare: Only for pre-op period of major surgery (day before or day of)  90 day global

14.  Both function as co-surgeons (equals)  Usually different specialties  Each surgeon reports same surgery code appending -62  Each surgeon dictates his/her portion of procedure

15.  Kilogram: 2.2 lb (4 kg = 8.8 lb)  Small size increases complexity  Use with all Surgery section codes except Integumentary and those exempt by parenthetical notes

16.  Note: “Same Physician”  Used to indicate necessary service, not typographical error  Example: X-rays before and after fracture repair  Aerosol treatment for an asthma attack repeated in 90 minutes (94640-76)

17.  Note: “Another Physician”  Performed by one physician, repeated by another physician  Submitted with written report to establish medical necessity

18.  For complication of first procedure  Example: Patient has outpatient procedure in morning, was returned to operating room in afternoon with severe hemorrhage  Indicates not typographical error  Does not change global period time

19.  Reimbursed at 15–30%  Payers identify procedures for which they reimburse assistant  -81 Minimum Assistant Surgeon  Services at a level less than that described in - 80 (Assistant Surgeon)  Reimbursed at 10%, if at all

20.  Used when service needs more than one modifier but payer only allows for one modifier with each code

21.  -RT is a Modifier for: the Right side of body  -LT is a Modifier for: the Left side of body  -E1: Upper Left eye lid  -E2: Lower Left eye lid  -E3: Upper Right eye lid  -E4: Lower Right eye lid

22.  -FA: Left hand, thumb  -F1: Left hand, second digit  -F2: Left hand, third digit  -F3: Left hand, fourth digit  -F4: Left hand, fifth digit

23.  -TA: Left foot, great toe  -T1: Left foot, second digit  -T2: Left foot, third digit  -T3: Left foot, fourth digit  -T4: Left foot, fifth digit

24.  CMS-1500 (08/05) has places for multiple modifiers