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Kickass tips for Modifiers used in Medical Coding

There are two types of Modifiers in Medical coding, Level 1 and Level 2. Level 1 are CPTKickass tips for Modifiers used in Medical Coding 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.

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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.

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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