MODIFIERS Introduction to Modifiers Correct modifier use is

MODIFIERS

Introduction to Modifiers • Correct modifier use is also an important part of avoiding fraud and abuse or non-compliance issues. One of the top billing errors determined by federal, state and private payers involves the incorrect use of modifiers. • A clear understanding of Medicare's rules and regulations is necessary in order to assign the modifier correctly. This is particularly true for modifiers 22, 25, 50, 59, 76 and 78. Please take careful note of the Medicare usage guidance provided in this manual. • Procedure codes may be modified under certain circumstances to more accurately represent the service or item rendered. For this purpose, modifiers are used to add information or change the description of service in order to improve accuracy or specificity. The documentation of the service provided must support the use of the modifier. There are two levels of modifiers, one for each level of HCPCS codes. This slide show contains a partial list of the most commonly used codes. Please refer to your CPT and HCPCS Coding Manuals for the complete list.

COMMONLY USED MODIFIERS • 22 - UNUSUAL PROCEDURAL SERVICES • 24 - UNRELATED EVALUATION & MANAGEMENT SERVICE • 59 - DISTINCT PROCEDURAL SERVICE • 79 - UNRELATED PROCEDURE OR SERVICE BY THE SAME PROVIDER • LT - LEFT SIDE (USED TO IDENTIFY PROCEDURES PERFORMED ON LEFT SIDE • 26 - PROFESSIONAL COMPONENT OF THE BODY) • RT – RIGHT SIDE (USED TO IDENTIFY • 50 - BILATERAL PROCEDURES PERFORMED ON RIGHT • 57 - DECISION FOR SURGERY SIDE OF THE BODY) • 25 - SIGNIFICANT, SEPARATELY IDENTIFIABLE EVALUATION • 58 - STAGED OR RELATED PROCEDURE OR SERVICE • AS – ASSISTANT SURGEON (PROVIDER NOT AN MD)

NOT SO COMMONLY USED MODIFIERS • 51 – MULTIPLE PROCEDURES DO NOT USE - the processing systems have hardcoded logic to append the modifier to the correct procedure code. • 53 - DISCONTINUED PROCEDURE; Indicates the physician elected to terminate a surgical or diagnostic procedure due to the patient's well-being. • 76 - Repeat Procedure by the Same Physician; use when it is necessary to report repeat procedures performed on the same day. • 78 - Unplanned return to the operating room by the same physician following initial procedure for a related procedure during the postoperative period • 80 - ASSISTANT SURGEON (MUST BE MD) • F 1 -F 9, FA – Finger Modifiers = When a service is performed on the digit described • E 1 -E 4 – Eye. Lid Modifiers = Used on a surgical or diagnostic codes to represent the body part affected by the service

GLOBAL PERIOD MODIFIERS (24) Modifier 24 indicates the physician performed an unrelated E/M service during a post-operative period • Bill modifier 24 with the appropriate level of E/M service • Documentation supports E/M visits submitted with modifier 24 are unrelated to the post operative care of the procedure. ICD codes that clearly indicate the reason for the encounter was unrelated to surgical post operative care must provide sufficient documentation.

GLOBAL PERIOD MODIFIERS (58) Modifier 58 indicates the physician, or member of the same group, planned the performance of a procedure or service during the postoperative period prospectively or at the time of the original procedure. • Bill modifier 58 with the subsequent performed procedure • Use during the post-operative period starting the day after the initial procedure.

GLOBAL PERIOD MODIFIERS (78) Used to indicate the performance of a procedure during the postoperative period or on the same day as the original procedure to treat complications, which required return to the operating room • Bill modifier 78 with the CPT code describing the procedure(s) performed during the return trip. • Only use the procedure code for the original procedure if the identical procedure is repeated. • When the procedure code used to describe a service for treatment of complications is the same as the procedure code used in the original procedure, modifier 78 is still the correct modifier to use.

GLOBAL PERIOD MODIFIERS (79) Modifier 79 indicates the performance of a procedure or service during a post-operative period was unrelated to the post-operative care of the original procedure. • Documentation supports surgical procedure are unrelated to the post operative care of another procedure. ICD codes that clearly indicate the reason for the encounter was unrelated to surgical post operative care, must provide sufficient documentation.

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