There are two types of Modifiers in Medical coding, Level 1 and Level 2. Level 1 are CPT modifiers, two digit alphanumeric while Level 2 are HCPCS modifiers and are two digit alpha or alphanumeric. We will just talk today about the use of Level 1 modifiers that is CPT modifiers. CPT modifiers consists of long list two digit modifiers. I will try to guide you about how and which modifier is used for different facility. We as a coder should we able to use them correctly because these modifiers play a vital role in changing the CPT code dollar value. Also, Modifier are really important from coding certification exam point of view. If you know how to use a modifier, you can pass any certification exam like CPC to be called as Certified Medical coder.
Modifiers used in Evaluation and Management (E&M)
There are three modifiers used widely for E&M codes. Modifier 24, 25 an 27 are to be used on with E&M CPT codes. Modifier 25 is the most commonly used modifier in E&M coding. Below is the description for all these modifiers
Modifier -24 Unrelated Evaluation and Management Service by the Same Physician during a Postoperative Period
Modifier -25 Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service
Modifier -27 Multiple Outpatient Hospital E/M Encounters on the Same Date.
Now, as per the above description you can easily find out when to use all these modifiers. And do remember try to avoid using Modifier 24 and 25 together, it is hardly possible that these modifiers can be used together. While modifier 27 can be used anytime together with 24 and 25 modifier.
Read also: Utilization of time during CPC exam
Modifiers Used in Radiology Facility
Radiology facility include both the diagnostic and interventional radiology. Now, here we have a very common modifier 26 used as professional component along with radiology CPT codes. The CPT modifier 26 is used to indicate the professional component of the service being billed for ‘interpretation only,’ and it is most commonly submitted with diagnostic tests, including radiological procedures. When using the 26 modifier, you must enter it in the first modifier field on your claim. A CPT code without 26 modifier is a global code, which mean the exam is performed in a facility area like Hospital. Now, we have one more component called Technical component (TC) used with radiology CPT codes. Now, the question when to use 26 modifier and when to use TC component.
For example, if a patient comes to a hospital for an chest X ray exam and the radiologist performs the X ray and interpret the exam. Now, as the radiologist has interpreted the exam he will bill the CPT code with 26 modifier for his professional component, but hospital they will bill the same CPT code with TC component. Now, if the radiologist or physician owns the equipment then it will not bill for technical and professional component, no modifier should be append to CPT code.
Modifier -26 Professional Component
TC – Technical Component
The other commonly used modifiers are listed below
Modifier -50 Bilateral Procedure
Modifier -51 Multiple Procedures
Modifier -52 Reduced Services
Modifier -53 Discontinued Procedure
Modifier -56 Preoperative Management Only
Modifier -57 Decision for Surgery
Modifier -58 Staged or Related Procedure or Service by the Same Physician During the Postoperative Period
Modifier -59 Distinct Procedural Service
Modifier -76 Repeat Procedure by Same Physician
Modifier -77 Repeat Procedure by Another Physician
Now, we have introduced some new modifiers to be used along with 59 modifier. XE, XP, XS and XU are the modifiers to be used for more specificity. Modifier 58 is used for staged or related procedure which only to used for planned or related procedure during postoperative period.
Modifiers used in Surgery Coding
Almost all these modifiers are used in Surgery. Surgery coders are to be perfect in coding modifiers. Surgery CPT codes are highly paid procedures. The modifiers are used to alter the dollar value of CPT codes. Below are the most commonly used modifier used in Surgery.
Modifier -62 Two Surgeons
Modifier -63 Procedure Performed on Infants less than 4kg
Modifier -66 Surgical Team
Modifier -73 Discontinued Outpatient Hospital/Ambulatory Surgery Center (ASC) Procedure prior to the Administration of Anesthesia
Modifier -74 Discontinued Outpatient Hospital/Ambulatory Surgery Center (ASC) Procedure after Administration of Anesthesia
Modifier -78 Return to the Operating Room for a Related Procedure During the Postoperative Period
Modifier -79 Unrelated Procedure or Service by the Same Physician During the Postoperative Period
Modifier -80 Assistant Surgeon
Modifier -81 Minimum Assistant Surgeon
Modifier -82 Assistant Surgeon (when qualified resident surgeon not available)
Modifier -99 Multiple Modifiers
Modifier used with Pathology CPT codes
There are few modifiers to be used with Laboratory procedures. The commonly used modifier for pathology CPT codes is 91. Modifier 91 is used for repeat laboratory test when the same exam is performed again on same day.
Modifier -90 Reference (Outside) Laboratory
Modifier -91 Repeat Clinical Diagnostic Laboratory Test
Modifier -92 Alternative Laboratory Platform Testing