“Procedure” code is a catch-all term for codes used to identify what was done to or given to a patient (surgeries, durable medical equipment, medications, etc.). Understanding and identifying the codes relevant to one’s study question is a key part of analyzing claims data.

The correct process for assigning accurate procedure codes has six steps: (1) review complete medical documentation; (2) abstract the medical procedures from the visit documentation; (3) identify the main term for each procedure; (4) locate the main terms in the CPT Index; (5) Verify the code in the CPT main text; and …

The purpose of the NCCI MUE program is to prevent improper payments when services are reported with incorrect units of service.

Modifier 59 is used to identify procedures/services, other than E/M services, that are not normally reported together, but are appropriate under the circumstances.

Modifier 51 is defined as multiple surgeries/procedures. Multiple surgeries performed on the same day, during the same surgical session. Diagnostic Imaging Services subject to the Multiple Procedure Payment Reduction that are provided on the same day, during the same session by the same provider.

Current Procedural Terminology (CPT®) modifier 26 represents the professional (provider) component of a global service or procedure and includes the provider work, associated overhead and professional liability insurance costs. This modifier corresponds to the human involvement in a given service or procedure.

Modifier GX The GX modifier is used to report that a voluntary Advance Beneficiary Notice of Noncoverage (ABN) has been issued to the beneficiary before/upon receipt of their item because the item was statutorily noncovered or does not meet the definition of a Medicare benefit.

Modifier 58 is defined as a staged or related procedure performed during the postoperative period of the first procedure by the same physician. A new postoperative period begins when the staged procedure is billed.

When to Use Modifier 58. Modifier 58 is used for a “staged or related procedure or service by the same physician during the post-operative period.” Further, according to CMS.gov, modifier 58 indicates that the procedure was: Planned, either at the time of the first procedure or prospectively.

Modifier 57 Decision for Surgery: add Modifier 57 to the appropriate level of E/M service provided on the day before or day of surgery, in which the initial decision is made to perform major surgery. Major surgery includes all surgical procedures assigned a 90-day global surgery period.

Modifier 78 is used to report the unplanned return to the operating/procedure room by the same physician following an initial procedure for a related procedure during the postoperative period.

CPT modifier 77 is used to report a repeat procedure by another physician. Guidelines and Instructions. Submit this modifier to indicate that a basic procedure or service performed by another physician had to be repeated.

Modifier -74 is used by the facility to indicate that a surgical or diagnostic procedure requiring anesthesia was terminated after the induction of anesthesia or after the procedure was started (e.g., incision made, intubation started, scope inserted) due to extenuating circumstances or circumstances that threatened …

Modifier 76 Used to indicate a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service.

Do not code 76 whenever you see same CPT code because sometimes the procedures will be performed on different parts of the body but the code will be same. As I have told you, Modifier 76 can be used only when the same procedure is performed same day.

Modifier 79 is appended to a procedure code to indicate that the service is an unrelated procedure that was performed by the same physician during a post-operative period.

Modifier -73 is used by the facility to indicate that a procedure requiring anesthesia was terminated due. to extenuating circumstances or to circumstances that threatened the well being of the patient after the. patient had been prepared for the procedure (including procedural pre-medication when provided), and.

modifier -53

Modifier 53 has the caveat that the procedure was discontinued due to the well-being of the patient after the induction of general anesthesia. Whereas modifiers 73 and 74 have no requirement that the patient’s well being be tied to the procedure’s discontinuance.

Modifier 91 is used to report repeat laboratory tests or studies performed on the same day on the same patient.

95 modifier: Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system.

Code Description Modifier 90 Reference (Outside) Laboratory: When laboratory procedures are performed by a party other than the treating or reporting physician or other qualified health care professional, the procedure may be identified by adding modifier 90 to the usual procedure number.

Appendix A — Modifiers tells us: Under certain circumstances 2 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 32 indicates mandated services. This modifier is not appropriate when billing Medicare for federally mandated visits for patients in a Skilled Nursing Facility (SNF) or Nursing Facility (NF).

Physicians should append modifier -95 to the claim lines delivered via telehealth. Claims with POS 02 – Telehealth will be paid at the normal facility rate, which is typically less than the non-facility rate under the Medicare physician fee schedule.

HCPCS Modifiers List. A modifier provides the means by which the reporting physician or provider can indicate that a service or procedure that has been performed has been altered by some specific circumstance but not changed in its definition or code.

Modifier 25 (significant, separately identifiable evaluation and management [E/M] service by the same physician on the same day of the procedure or other service) is the most important modifier for pediatricians in Current Procedural Terminology (CPT®).

Physical Status Modifiers are Anesthesia Modifiers. The 1 to 6 levels are consistent with the American Society of Anesthesia (ASA) ranking of patient physical status. Physical status is used to distinguish among various levels of complexity of the anesthesia service provided.

A modifier is a word, phrase, or clause that modifies—that is, gives information about—another word in the same sentence.