2-09 CPT Modifiers
2-09 CPT Modifiers
2-09 CPT Modifiers
● Unusual anesthesia
○ This modifier will alert the payer to the fact that a
procedure that would normally not require
general anesthesia did, in fact, require general
anesthesia.
MODIFIER- 24
● Professional component
○ A professional component is the element of a
procedure performed by a licensed medical
professional. This might mean the interpretation
of a diagnostic test, rather than the
administration of it.
MODIFIER- 32
● Mandated services
○ This modifier describes services, consultations, or
evaluations that are required by a third party,
such as an examination that an insurance
company requires of a patient in order to
determine medical necessity.
MODIFIER- 33
● Preventive Services
○ Medical services performed in order to prevent or
detect future illness or injury, including
immunizations, screenings, etc.
MODIFIER- 47
● Anesthesia by surgeon
○ This modifier includes general or regional
anesthesia administered by the surgeon, but does
not include local anesthetic. This modifier would
not be used with CPT codes for anesthesia, either.
MODIFIER- 50
● Bilateral procedure
○ This modifier describes medical procedures
performed on both sides of the body. This only
applies to parts of the body that are, in fact,
bilateral (eg, the kidneys). This code also typically
requires that the bilateral procedure be
performed in the same operating session.
MODIFIER- 51
● Multiple procedures
○ One of the most common modifiers, this indicates
that the healthcare provider performed more
than one procedure in one session. This modifier
is added to the secondary (or tertiary, etc.)
procedure performed after the initial one.
MODIFIER- 52
● Reduced services
○ In the case of a procedure being reduced in scope
or intensity, or in the case of a physician being
unable to complete the procedure, you may use
this modifier. Note that this is different from a
discontinued procedure (which is modifier -53),
but may be used to describe a discontinued
procedure or one that is aborted.
MODIFIER- 53
● Discontinued procedure
○ If extenuating circumstances demand it, a
healthcare provider or surgeon may elect to stop
a procedure in the middle of performing it. In
cases like this, use -53 at the end of the CPT code
to show that the healthcare provider prepared for
and initiated the service, only to stop mid-way
through.
MODIFIER- 54
● Two surgeons
○ In the case of two surgeons operating on a patient
at the same time, you may use this modifier to
explain to the payer why two separate healthcare
professionals are billing for the same procedure
performed on the same patient.
MODIFIER- 63
● Surgical team
○ This modifier alerts the payer to the fact that a
team of more than two surgeons operated on the
patient during the procedure.
MODIFIER- 76
● Assistant surgeon
○ This is a personnel code, which describes a
situation in which an assistant surgeon helped
with the procedure.
MODIFIER- 81
● Multiple modifiers
○ Most payers only pay attention to the first two
modifiers listed with a procedure code. However,
there may be instances where it’s important for
the healthcare provider’s reimbursement that the
payer acknowledge several modifiers. When this
happens, use the -99 modifier to show that there
are more than two modifiers.
USING CPT MODIFIERS
● Example 1:
○ A surgeon performs a procedure to remove a
bone cyst in the upper arm of a patient. The
procedure also includes obtaining a graft from
elsewhere in the body. Due to minor
complications, the surgeon is unable to fully
excise the bone cyst.
● We’d code
○ 24115, for “excision or curettage of bone cyst or
benign tumor, humerus”
USING CPT MODIFIERS CONT.
● Example 2
● A team of surgeons is performing a closed, or
percutaneous, angioplasty in a patient's renal
system.
● We’d code 35471 for “transluminal balloon
angioplasty, percutaneous; renal or other
visceral artery”
● We’d attach the modifier -66 for “team of
surgeons”
● Finish with 35471-66
USING CPT MODIFIERS, CONT.
● Example 3
● Let’s expand on our previous renal
angioplasty example. The surgical team is
performing the renal angioplasty in the
same procedure as draining a renal abscess.
● We stick with the code for the renal
angioplasty, 35471, and it’s modifier, making
it 35471-66
USING CPT MODIFIERS, CONT.
● Example 4
● The patient from our previous angioplasty
example needed to be anesthetized before
going under the knife.
● Besides his kidney problems, he is in sound
health.
● We’d look up the Anesthesia procedure code
○ 00216: anesthesia for “vascular procedures”
● And add the physical status modifier
○ 00216-P1
MODIFIERS APPROVED FOR
AMBULATORY SURGERY CENTER (ASC)
● ASCs are outpatient facilities that perform
surgical procedures where the patient leaves
that same day
● These CPT modifiers are approved for use in
ASCs
○ -25, -27, -50, -52, -58, -59, -73, -74, -76, -77, -78, -79,
and -91
MODIFIERS APPROVED FOR
AMBULATORY SURGERY CENTER (ASC),
CONT.
● -27
○ multiple outpatient hospital E&M encounters on
the same date
● -73
○ discontinuation of an outpatient surgical
procedure before the administration of
anesthesia
● -74
○ Discontinuation of an outpatient surgical
procedure after the administration of anesthesia
HCPCS MODIFIERS
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