CUSTOM SOFTWARE SYSTEMS, INC

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1 MODIFIERS 4 21 PROLONGED EVALUATION AND MANAGEMENT SERVICES 5 22 UNUSUAL PROCEDURAL SERVICES 6 23 UNUSUAL ANESTHESIA 7 24 UNRELATED EVALUATION AND MANAGEMENT SERVICE BY THE SAME PHYSICIAN DURING A POSTOPERATIVE PERIOD 8 25 SIGNIFICANT, SEPARATELY IDENTIFIABLE EVALUATION AND MANAGEMENT SERVICE BY THE SAME PHYSICIAN ON THE SAME DAY OF THE PROCEDURE OR OTHER SERVICE 9 26 PROFESSIONAL COMPONENT MULTIPLE OUTPATIENT HOSPITAL E/M ENCOUNTERS ON THE SAME DATE MANDATED SERVICES ANESTHESIA BY SURGEON BILATERAL PROCEDURE MULTIPLE PROCEDURES REDUCED SERVICES DISCONTINUED PROCEDURE SURGICAL CARE ONLY POSTOPERATIVE MANAGEMENT ONLY PREOPERATIVE MANAGEMENT ONLY DECISION FOR SURGERY STAGED OR RELATED PROCEDURE OR SERVICE BY THE SAME PHYSICIAN DURING THE POSTOPERATIVE PERIOD DISTINCT PROCEDURAL SERVICE ALTERED SURGICAL FIELD ALTERED SURGICAL FIELD SURGICAL TEAM DISCONTINUED OUT-PATIENT HOSPITAL/AMBULATORY SURGERY CENTER (ASC) PROCEDURE PRIOR TO THE ADMINISTRATION OF ANESTHESIA DISCONTINUED OUT-PATIENT HOSPITAL/AMBULATORY SURGERY CENTER (ASC) PROCEDURE AFTER ADMINISTRATION OF ANESTHESIA REPEAT PROCEDURE BY SAME PHYSICIAN REPEAT PROCEDURE BY ANOTHER PHYSICIAN RETURN TO THE OPERATING ROOM FOR A REALTED PROCEDURE DURING THE POSTOPERATIVE PERIOD UNRELATED PROCEDURE OR SERVICE BY THE SAME PHYSICIAN DURING THE POSTOPERATIVE PERIOD 31 1

2 80 ASSISTANT SURGEON MINIMUM ASSISTANT SURGEON ASSISTANT SURGEON (WHEN QUALIFIED RESIDENT SURGEON NOT AVAILABLE) REFERENCE (OUTSIDE) LABORATORY REPEAT CLINICAL DIAGNOSTIC LABORATORY TEST MULTIPLE MODIFIERS 37 QQ SERVICE FOR WHICH A STATEMENT OF INTENT WAS SUBMITTED, DEEMED AS VALID, AND AN ACKNOWLEDGMENT LETTER WAS RECEIVED 38 LEVEL II (HCPCS/NATIONAL) MODIFIERS 39 E1 UPPER LEFT, EYELID 39 E2 LOWER LEFT, EYELID 39 E3 UPPER RIGHT, EYELID 39 E4 LOWER RIGHT, EYELID 39 F1 LEFT HAND, SECOND DIGIT 39 F2 LEFT HAND, THIRD DIGIT 39 F3 LEFT HAND, FOURTH DIGIT 39 F4 LEFT HAND, FIFTH DIGIT 39 F5 RIGHT HAND, THUMB 39 F6 RIGHT HAND, SECOND DIGIT 39 F7 RIGHT HAND, THIRD DIGIT 39 F8 RIGHT HAND, FOURTH DIGIT 39 F9 RIGHT HAND, FIFTH DIGIT 39 FA LEFT HAND, THUMB 39 GN USE TO IDENTIFY THE THERAPIST PERFORMING SPEECH THERAPY 40 GO USE TO IDENTIFY THE THERAPIST PERFORMING OCCUPATIONAL THERAPY 40 GP USED TO IDENTIFY THE THERAPIST PERFORMING PHYSICAL THERAPY 40 LC LEFT CIRCUMFLEX CORONARY ARTERY 40 LD LEFT ANTERIOR DESCENDING CORONARY ARTERY 40 LT LEFT SIDE 40 QM AMBULANCE SERVICE PROVIDED UNDER ARRANGEMENT BY A PROVIDER OF SERVICES 40 QN AMBULANCE SERVICE FURNISHED DIRECTLY BY A PROVIDER OF SERVICES 40 QR REPEAT LABORATORY TEST PERFORMED ON THE SAME DAY 40 RC RIGHT CORONARY ARTERY 40 RT RIGHT SIDE 40 T1 LEFT FOOT, SECOND DIGIT 41 2

3 T2 LEFT FOOT, THIRD DIGIT 41 T3 LEFT FOOT, FOURTH DIGIT 41 T4 LEFT FOOT, FIFTH DIGIT 41 T5 RIGHT FOOT, GREAT TOE 41 T6 RIGHT FOOT, SECOND DIGIT 41 T7 RIGHT FOOT, THIRD DIGIT 41 T8 RIGHT FOOT, FOURTH DIGIT 41 T9 RIGHT FOOT, FIFTH DIGIT 41 TA LEFT FOOT, GREAT TOE 41 3

4 MODIFIERS THIS LIST INCLUDES ALL OF THE MODIFIERS APPLICABLE TO CPT 2001 CODES. There are CPT-4 and Level II HCPCS modifiers. They are used to increase accuracy in reimbursement, coding consistency, editing and to capture payment data. Billing accurately with modifiers is an integral part of the OPPS. 4

5 21 PROLONGED EVALUATION AND MANAGEMENT SERVICES When the face-to-face or floor/unit service(s) provided is prolonged or otherwise greater than that usually required for the highest level of evaluation and management service within a given category, it may be identified by adding modifier '-21' to the evaluation and management code number or by use of the separate five digit modifier code A report may also be appropriate. 5

6 22 UNUSUAL PROCEDURAL SERVICES When The Service(S) Provided Is Greater Than That Usually Required For The Listed Procedure, It May Be Identified By Adding Modifier '-22' To The Usual Procedure Number Or By Use Of The Separate Five Digit Modifier Code A Report May Also Be Appropriate. Note: This Modifier Is Not To Be Used To Report Procedure(S) Complicated By Adhesion Formation, Scarring, And/Or Alteration Of Normal Landmarks Due To Late Effects Of Prior Surgery, Irradiation, Infection, Very Low Weight (i.e. Neonates And Infants Less Than 10 Kg) Or Trauma. (See Modifier '-60', As Appropriate.) 6

7 23 UNUSUAL ANESTHESIA Occasionally, a procedure, which usually requires either no anesthesia or local anesthesia, because of unusual circumstances must be done under general anesthesia. This circumstance may be reported by adding the modifier '-23' to the procedure code of the basic service or by use of the separate five digit modifier code

8 24 UNRELATED EVALUATION AND MANAGEMENT SERVICE BY THE SAME PHYSICIAN DURING A POSTOPERATIVE PERIOD The physician may need to indicate that an evaluation and management service was performed during a postoperative period for a reason(s) unrelated to the original procedure. This circumstance may be reported by adding the modifier '- 24' to the appropriate level of e/m service, or the separate five digit modifier may be used. 8

9 25 SIGNIFICANT, SEPARATELY IDENTIFIABLE EVALUATION AND MANAGEMENT SERVICE BY THE SAME PHYSICIAN ON THE SAME DAY OF THE PROCEDURE OR OTHER SERVICE Significant, separately identifiable evaluation and management (E&M) service by the same physician on the same day of the procedure or other service: the physician may need to indicate that on the day a procedure or service identified by a cpt code was performed, the patient's condition required a significant, separately identifiable e/m service above and beyond the other service provided or beyond the usual preoperative and postoperative care associated with the procedure that was performed. The e/m service may be prompted by the symptom or condition for which the procedure and/or service was provided. As such, different diagnoses are not required for reporting of the e/m services on the same date. This circumstance may be reported by adding the modifier '-25' to the appropriate level of e/m service, or the separate five digit modifier may be used. Note: this modifier is not used to report an e/m service that resulted in a decision to perform surgery. See modifier '-57.' If a patient is seen in the Emergency Room and has a procedure done that has a S or T indicator performed used modifier 25 for the ER visit. Modifier 25 should be appended only to evaluation and management (E/M) service codes within the range of , and with HCPCS codes G0101 and G0175. To append modifier 25 appropriately to an E/M code, the service provided must meet the definitions of significant, separately identifiable E/M service as defined by CPT. 9

10 26 PROFESSIONAL COMPONENT Certain procedures are a combination of a physician component and a technical component. When the physician component is reported separately, the service may be identified by adding the modifier '-26' to the usual procedure number or the service may be reported by use of the five digit modifier code

11 27 MULTIPLE OUTPATIENT HOSPITAL E/M ENCOUNTERS ON THE SAME DATE For hospital outpatient reporting purposes, utilization of hospital resources related to separate and distinct e/m encounters performed in multiple outpatient hospital settings on the same date may be reported by adding the modifier '-27' to each appropriate level outpatient and/or emergency department e/m code(s). This modifier provides a means of reporting circumstances involving evaluation and management services provided by physician(s) in more than one (multiple) outpatient hospital setting(s) (e.g., hospital emergency department, clinic). Note: this modifier is not to be used for physician reporting of multiple e/m services performed by the same physician on the same date. For physician reporting of all outpatient evaluation and management services provided by the same physician on the same date and performed in multiple outpatient setting(s) (e.g., hospital emergency department, clinic), see evaluation and management, emergency department, or preventive medicine services codes. Modifier 27 should be appended only to E/M service codes within the range of , and with HCPCS codes G0101 and G0175. Hospitals may append modifier 27 to the second and subsequent E/M code when more than one E/M service is provided to indicate that the E/M services is separate and distinct E/M encounter from the service previously provided that same day in the same or different hospital outpatient setting. When reporting modifier 27, report with condition code G0 when multiple medical visits occur on the same day in the same revenue centers. 11

12 32 MANDATED SERVICES Services related to mandated consultation and/or related services (e.g., pro, third party payer, governmental, legislative or regulatory requirement) may be identified by adding the modifier '-32' to the basic procedure or the service may be reported by use of the five digit modifier

13 47 ANESTHESIA BY SURGEON Regional or general anesthesia provided by the surgeon may be reported by adding the modifier '-47' to the basic service or by use of the separate five digit modifier code (this does not include local anesthesia.) Note: modifier '-47' or would not be used as a modifier for the anesthesia procedures

14 50 BILATERAL PROCEDURE Unless otherwise identified in the listings, bilateral procedures that are performed at the same operative session should be identified by adding the modifier '-50' to the appropriate five digit code or by use of the separate five digit modifier code Do not use modifiers RT and LT when modifier 50 applies. Do not submit two line items to report a bilateral procedure using modifier 50. EXAMPLE: Procedure (Puncture aspiration of cyst of breast) was performed on the right and left breast during the same operative session. This is billed at Use Modifier 50 for: Surgical procedures ( ) Radiology procedure if applicable Any bilateral procedure performed on both sides at the same session Do NOT use Modifier 50 for: Procedures identified by their terminology as bilateral, e.g., (Lengthening of hamstring tendon, multiple, bilateral) Procedures identified as unilateral or bilateral, e.g., (Cystourethroscopy, with meatotomy, unilateral or bilateral) Do Not: Submit two line items to report a bilateral procedure Submit with modifiers RT and LT when modifier 50 applies Do not use a modifier to indicate an anatomical site location on body (modifier 50 or Level II modifiers) if the narrative definition of a code indicates multiple occurrences. EXAMPLE: The code definition indicates two to four lesions Paring or cutting hyperkeratolic lesion, leg (e.g., corn or callous); two or four lesions. The code definition indicates multiple lesions Radiologic examination; both knees, standing, anteroposterior. The code definition indicates the specific site. Do not use a modifier to indicate an anatomic site (modifier 50 or Level II modifiers) if the narrative definition of a code indicates the procedure applies to more than two sites. EXAMPLE: Code (Excision, malignant lesion, trunk, arms, or legs; lesion diameter 9.5 cm or less) 14

15 51 MULTIPLE PROCEDURES When multiple procedures, other than evaluation and management services, are performed at the same session by the same provider, the primary procedure or service may be reported as listed. The additional procedure(s) or service(s) may be identified by appending the modifier '-51' to the additional procedure or service code(s) or by the use of the separate five digit modifier Note: this modifier should not be appended to designated "add-on" codes (see appendix e). 15

16 52 REDUCED SERVICES Under certain circumstances a service or procedure is partially reduced or eliminated at the physician's discretion. Under these circumstances the service provided can be identified by its usual procedure number and the addition of the modifier '-52', signifying that the service is reduced. This provides a means of reporting reduced services without disturbing the identification of the basic service. Modifier code may be used as an alternative to modifier '-52.' note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers '73' and '-74' (see modifiers approved for asc hospital outpatient use). Modifier 52 is for radiology and other diagnostic procedures. Can also be used for surgery when the use of anesthesia was not an inherent part of performing the procedure. Example: If a colonoscopy, HCPCS code 45378, flexible, promimal slenic flexure; diagnostic, with or without collection of specimen(s) by brushing or washing, with or without colon decompression (separate procedure) was started (conscious sedation has been administered), but it was found that the patient was inadequately prepped for the procedure, so the procedure was discontinued, and no exam of even the sigmoid was possible. This should be billed as Modifier 52 is to be used on procedures that require NO anesthesia. Anesthesia under OPPS is considered local, regional block, or general. 16

17 53 DISCONTINUED PROCEDURE Under certain circumstances, the physician may elect to terminate a surgical or diagnostic procedure. Due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. This circumstance may be reported by adding the modifier '-53' to the code reported by the physician for the discontinued procedure or by use of the separate five digit modifier code Note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. For outpatient hospital/ambulatory surgery center (asc) reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well being of the patient prior to or after administration of anesthesia, see modifiers '-73' and '- 74' (see modifiers approved for asc hospital outpatient use). 17

18 54 SURGICAL CARE ONLY When one physician performs a surgical procedure and another provides preoperative and/or postoperative management, surgical services may be identified by adding the modifier '-54' to the usual procedure number or by use of the separate five digit modifier code

19 55 POSTOPERATIVE MANAGEMENT ONLY When one physician performs the postoperative management and another physician has performed the surgical procedure, the postoperative component may be identified by adding the modifier '-55' to the usual procedure number or by use of the separate five digit modifier code

20 56 PREOPERATIVE MANAGEMENT ONLY When one physician performs the preoperative care and evaluation and another physician performs the surgical procedure, the preoperative component may be identified by adding the modifier '-56' to the usual procedure number or by use of the separate five digit modifier code

21 57 DECISION FOR SURGERY An evaluation and management service that resulted in the initial decision to perform the surgery may be identified by adding the modifier '-57' to the appropriate level of e/m service, or the separate five digit modifier may be used. 21

22 58 STAGED OR RELATED PROCEDURE OR SERVICE BY THE SAME PHYSICIAN DURING THE POSTOPERATIVE PERIOD The physician may need to indicate that the performance of a procedure or service during the postoperative period was: a) planned prospectively at the time of the original procedure (staged); b) more extensive than the original procedure; or c) for therapy following a diagnostic surgical procedure. This circumstance may be reported by adding the modifier '-58' to the staged or related procedure, or the separate five digit modifier may be used. An example of modifier 58 is one where a needle biopsy is performed in the morning and the plan, which subsequently carried out, is to perform an excisional biopsy later in the day depending on the results of the surgical pathology report (the post operative period refers to same calendar day). Planned prospectively at the time of the original procedure (staged) More extensive than the original procedure For therapy following a diagnostic surgical procedure Do Not use modifier 58 to report the treatment of a problem that requires a return to the operating room. (see modifier 78). 22

23 59 DISTINCT PROCEDURAL SERVICE Under certain circumstances, the physician may need to indicate that a procedure or service was distinct or independent from other services performed on the same day. Modifier '-59' is used to identify procedures/services that are not normally reported together, but are appropriate under the circumstances. This may represent a different session or patient encounter, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same physician. However, when another already established modifier is appropriate it should be used rather than modifier '-59.' only if no more descriptive modifier is available, and the use of modifier '-59' best explains the circumstances, should modifier '-59' be used. Modifier code may be used as an alternative to modifier '-59.' Modifier 59 is used for procedures/services that are not normally reported together, but may be performed under certain circumstances. Example: Procedures (Incision and drainage, shoulder area; deep abscess or hematoma) and (Exploration of penetrating wound; extremity) are performed on the same patient on the same date of service. The incision and drainage of the shoulder is the definitive procedure and any exploration of the area preceding this is considered an inherent part of the procedure. However, the exploration procedure was conducted on a different part of the same limb, adding the 59 modifier to code will explain the circumstance and prevent denial of the service. If these two codes were billed together without modifier 59, code would be denied. Use modifier 59 for: Indicating that a procedure or service was distinct or independent from other services performed on the same day. Representing Different procedure or surgery Different site or organ system Separate incision, or Separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same physician Different session or patient encounter Do not use modifier 59 if: A level II HCPCS modifier can be used to indicate different body areas 23

24 60 ALTERED SURGICAL FIELD Certain procedures involve significantly increased operative complexity and/or time in a significantly altered surgical field resulting from the effects of prior surgery, marked scarring, adhesions, inflammation, or distorted anatomy, irradiation, infection, very low weight (i.e., neonates and small infants less than 10 kg) and/or trauma (as documented in the patient's medical record). These circumstances should be reported by adding the modifier '-60' to the procedure number or by use of the separate five digit modifier code Note: for unusual procedural services not involving an altered surgical field due to the late effects of previous surgery, irradiation, infection, very low weight (i.e., neonates and infants less than 10 kg) and/or trauma, append the modifier '-22' or use the separate five-digit code ALTERED SURGICAL FIELD Two surgeons: when two surgeons work together as primary surgeons performing distinct part(s) of a single reportable procedure, each surgeon should report his/her distinct operative work by adding the modifier '-62' to the single definitive procedure code. Each surgeon should report the co-surgery once using the same procedure code. If additional procedure(s) (including add-on procedure(s)) are performed during the same surgical session, separate code(s) may be reported without the modifier '-62' added. Modifier code may be used as an alternative to modifier '62'. Note: if a co-surgeon acts as an assistant in the performance of additional procedure(s) during the same surgical session, those services may be reported using separate procedure code(s) with the modifier '-80' or modifier '-81' added, as appropriate. 24

25 66 SURGICAL TEAM Under some circumstances, highly complex procedures (requiring the concomitant services of several physicians, often of different specialties, plus other highly skilled, specially trained personnel, various types of complex equipment) are carried out under the "surgical team" concept such circumstances may be identified by each participating physician with the addition of the modifier '-66' to the basic procedure number used for reporting services. Modifier code may be used as an alternative to modifier '-66.' 25

26 73 DISCONTINUED OUT-PATIENT HOSPITAL/AMBULATORY SURGERY CENTER (ASC) PROCEDURE PRIOR TO THE ADMINISTRATION OF ANESTHESIA Due to extenuating circumstances or those that threaten the well being of the patient, the physician may cancel a surgical or diagnostic procedure subsequent to the patient's surgical preparation (including sedation when provided, and being taken to the room where the procedure is to be performed), but prior to the administration of anesthesia (local, regional block(s) or general). Under these circumstances, the intended service that is prepared for but cancelled can be reported by its usual procedure number and the addition of the modifier '-73' or by use of the separate five digit modifier code Note: the elective cancellation of a service prior to the administration of anesthesia and/or surgical preparation of the patient should not be reported. For physician reporting of a discontinued procedure, see modifier '-53.' Modifier 73 is used for surgical procedures for wish anesthesia (general, regional, or local) is planned. Example: A patient is prepared for procedure repair spigelian hernia. Before anesthesia is administered, the physician decides the procedure should no be performed. This is billed as Use modifier 73 for: Procedures requiring anesthesia An outpatient hospital procedure discontinued After the patient has been prepared for the procedure and/or Before the induction of anesthesia (e.g., local regional block(s) or general anesthesia) Do Not: Use modifiers 52 and 73 together 26

27 74 DISCONTINUED OUT-PATIENT HOSPITAL/AMBULATORY SURGERY CENTER (ASC) PROCEDURE AFTER ADMINISTRATION OF ANESTHESIA Due to extenuating circumstances or those that threaten the well being of the patient, the physician may terminate a surgical or diagnostic procedure after the administration of anesthesia (local, regional block(s), general) or after the procedure was started (incision made, intubation started, scope inserted, etc). Under these circumstances, the procedure started but terminated can be reported by its usual procedure number and the addition of the modifier '-74' or by use of the separate five digit modifier code Note: the elective cancellation of a service prior to the administration of anesthesia and/or surgical preparation of the patient should not be reported. For physician reporting of a discontinued procedure, see modifier '-53.' Modifier 74 is used for surgical procedures for which anesthesia (general, regional or local) has been started. Example: Anesthesia for procedure (Axillary lymphadenectomy complete is given and the procedure has been started, but the physician terminates the procedure before it is complete. This is billed as Use modifier 74 for: Procedures requiring anesthesia An outpatient hospital/ambulatory surgery center (ASC) or diagnostic procedure discontinued after the administration of anesthesia. When multiple procedures were planned and there was a termination: If one or more of the procedures were completed, report the completed procedure(s) as usual. The other(s) planned and not started are not reported. If none of the planned procedures were completed, report the first procedure that was planned with modifier 73 or 74. The others are not reported. 27

28 76 REPEAT PROCEDURE BY SAME PHYSICIAN The physician may need to indicate that a procedure or service was repeated subsequent to the original procedure or service. This circumstance may be reported by adding the modifier '-76' to the repeated procedure/service or the separate five digit modifier code may be used. Modifier 76 is used to indicate that a procedure or service was repeated in a separate session on the same day by the same physician. This modifier may be reported for services ordered by physicians but performed by technicians. The procedure code is listed once and then listed again with modifier 76 added (two line items). The number of times that the procedure was repeated is reported on separate line. Example: EKG (Electrocardiogram, route EKG with atleast 12 leads; with interpretation and report) is performed at 8 a.m. An EKG is ordered and repeated at 1 p.m. The patient s condition requires another EKG, the physician orders and the EKG is done at 10 p.m. This is billed as 93005, one unit (first line) and , two units (next line). For surgical procedures, report the HCPCS code without modifier 76 to indicate the first time the procedure was performed. For each additional time the procedure was performed, the HCPCS code is repeated with modifier 76 added. Do not use the units field to indicate that the procedure was repeated more than once on the same day. Example: Procedure (Open treatment of metacarpal fracture, single, with our without internal or external fixation, each bone). Later, while in the recovery room the internal fixation pin is dislodged, so that the operating surgeon needs to repeat the procedure. This is reported as (first line) and (next line). Both will have units reported as one. 28

29 77 REPEAT PROCEDURE BY ANOTHER PHYSICIAN The physician may need to indicate that a basic procedure or service performed by another physician had to be repeated. This situation may be reported by adding modifier '-77' to the repeated procedure/service or the separate five digit modifier code may be used. Modifier 77 is used for a procedure performed that had to be repeated by a different physician in a separate session on the same day. The procedure code is listed once and then listed again with modifier 77 added. This number of times the procedure was repeated is reported on separate lines. Do not use the units field to indicate that the procedure was performed more than once on the same day. For surgical procedures, report the HCPCS code without modifier 77 to indicate the first time the procedure was performed. For each additional time the procedure was performed, the HCPCS code is repeated with modifier 77 added. Do not use the units field to indicate that the procedure was performed more than once on the same day. Example: Procedure (Open treatment of metacarpal fracture, single, with or without internal or external fixation, each bone). Later, while in the recovery room the internal fixation pin is dislodged and a different surgeon repeats the procedure. This is reported as (first line) and (next line). Both will have units reported as one. The only difference is that a different physician repeats the procedure so that modifier 77 is used in place of

30 78 RETURN TO THE OPERATING ROOM FOR A REALTED PROCEDURE DURING THE POSTOPERATIVE PERIOD The physician may need to indicate that another procedure was performed during the postoperative period of the initial procedure. When this subsequent procedure is related to the first, and requires the use of the operating room, it may be reported by adding the modifier '-78' to the related procedure, or by using the separate five digit modifier (for repeat procedures on the same day, see '-76'.) Modifier 78 is used to indicate that another procedure was performed during the postoperative period of the initial procedure that was performed earlier in the same day. Example: Procedure 23500, (Closed treatment of clavicular fracture with manipulation) and following this is subsequently decided that another procedure is required, such as 23515, (open treatment of clavicular fracture, with or without internal or external fixation) This is reported as on the first line and on the next line. Use modifier 78 if: The subsequent procedure relates to the first procedure; and The subsequent procedure requires the use of an operating room 30

31 78 UNRELATED PROCEDURE OR SERVICE BY THE SAME PHYSICIAN DURING THE POSTOPERATIVE PERIOD The physician may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. This circumstance may be reported by using the modifier '-79' or by using the separate five digit modifier (for repeat procedures on the same day, see '- 76'.) Modifier 79 is used to indicate that the performance of a procedure or service by the same physician during the post-operative period was unrelated to the original procedure that was performed earlier in the day. Example: Procedure (exporation of penetrating wound) separate procedure, extremity followed later in the day by procedure (esophagoscopy, rigid or flexible with control bleeding, any method). 31

32 80 ASSISTANT SURGEON Surgical assistant services may be identified by adding the modifier '-80' to the usual procedure number(s) or by use of the separate five digit modifier code

33 81 MINIMUM ASSISTANT SURGEON Minimum surgical assistant services are identified by adding the modifier '-81' to the usual procedure number or by use of the separate five digit modifier code

34 82 ASSISTANT SURGEON (WHEN QUALIFIED RESIDENT SURGEON NOT AVAILABLE) The unavailability of a qualified resident surgeon is a prerequisite for use of modifier '-82' appended to the usual procedure code number(s) or by use of the separate five digit modifier code

35 90 REFERENCE (OUTSIDE) LABORATORY When laboratory procedures are performed by a party other than the treating or reporting physician, the procedure may be identified by adding the modifier '-90' to the usual procedure number or by use of the separate five digit modifier code

36 91 REPEAT CLINICAL DIAGNOSTIC LABORATORY TEST In the course of treatment of the patient, it may be necessary to repeat the same laboratory test on the same day to obtain subsequent (multiple) test results. Under these circumstances, the laboratory test performed can be identified by its usual procedure number and the addition of the modifier '-91'. Note: this modifier may not be used when tests are rerun to confirm initial results; due to testing problems with specimens or equipment; or for any other reason when a normal, one-time, reportable result is all that is required. This modifier may not be used when other code(s) describe a series of test results (e.g., glucose tolerance tests, evocative/suppression testing). This modifier may only be used for laboratory test(s) performed more than once on the same day on the same patient. Laboratory tests submitted with modifier 91 This modifier indicated that the test was repeated on a different specimen. 36

37 99 MULTIPLE MODIFIERS Under certain circumstances two or more modifiers may be necessary to completely delineate a service. In such situations modifier '-99' should be added to the basic procedure, and other applicable modifiers may be listed as part of the description of the service. Modifier code may be used as an alternative to modifier '-99.' 37

38 QQ SERVICE FOR WHICH A STATEMENT OF INTENT WAS SUBMITTED, DEEMED AS VALID, AND AN ACKNOWLEDGMENT LETTER WAS RECEIVED The processing system will bypass any late filing auto denials for services with this modifier and the claims processors will compare the services on the statement of intent with the services on the claim. If the services do not match, the service will be denied. 38

39 LEVEL II (HCPCS/NATIONAL) MODIFIERS E1 UPPER LEFT, EYELID E2 LOWER LEFT, EYELID E3 UPPER RIGHT, EYELID E4 LOWER RIGHT, EYELID F1 LEFT HAND, SECOND DIGIT F2 LEFT HAND, THIRD DIGIT F3 F4 F5 F6 F7 F8 F9 FA LEFT HAND, FOURTH DIGIT LEFT HAND, FIFTH DIGIT RIGHT HAND, THUMB RIGHT HAND, SECOND DIGIT RIGHT HAND, THIRD DIGIT RIGHT HAND, FOURTH DIGIT RIGHT HAND, FIFTH DIGIT LEFT HAND, THUMB 39

40 LEVEL II (HCPCS/NATIONAL) MODIFIERS GN GO GP LC USE TO IDENTIFY THE THERAPIST PERFORMING SPEECH THERAPY USE TO IDENTIFY THE THERAPIST PERFORMING OCCUPATIONAL THERAPY USED TO IDENTIFY THE THERAPIST PERFORMING PHYSICAL THERAPY LEFT CIRCUMFLEX CORONARY ARTERY (HOSPITALS USE WITH CODES , 92995, 92996) LD LEFT ANTERIOR DESCENDING CORONARY ARTERY (HOSPITALS USE WITH CODES , 92995, 92996) LT LEFT SIDE (USED TO IDENTIFY PROCEDURES PERFORMED ON THE LEFT SIDE OF THE BODY) QM AMBULANCE SERVICE PROVIDED UNDER ARRANGEMENT BY A PROVIDER OF SERVICES QN AMBULANCE SERVICE FURNISHED DIRECTLY BY A PROVIDER OF SERVICES QR REPEAT LABORATORY TEST PERFORMED ON THE SAME DAY RC RT RIGHT CORONARY ARTERY (HOSPITALS USE WITH CODES , 92995, 92996) RIGHT SIDE (USED TO IDENTIFY PROCEDURES PERFORMED ON THE RIGHT SIDE OF THE BODY) 40

41 LEVEL II (HCPCS/NATIONAL) MODIFIERS T1 LEFT FOOT, SECOND DIGIT T2 LEFT FOOT, THIRD DIGIT T3 LEFT FOOT, FOURTH DIGIT T4 LEFT FOOT, FIFTH DIGIT T5 RIGHT FOOT, GREAT TOE T6 RIGHT FOOT, SECOND DIGIT T7 RIGHT FOOT, THIRD DIGIT T8 RIGHT FOOT, FOURTH DIGIT T9 RIGHT FOOT, FIFTH DIGIT TA LEFT FOOT, GREAT TOE 41