Modifiers

Front 1

22

Back 1

* Increase Procedural Services
* Due to: Increase intensity,time, technicality, severity, physical and mental effort.
* Do not use with E/M

Front 2

23

Back 2

• Unusual anesthesia

• Procedure normally doesn't use anethesia

Front 3

24

Back 3

* Unrelated Eval/Management by same physician or others during postoperative
* Eval/Management initiated during postoperative unrelated to the original procedure

Front 4

25

Back 4

* Significant, Separately Identifiable Eval/Management, Same Physician or Other, Same Day of the Procedure or Other Service:
* Do not use:

-Result decision to perform surgery, Use 57

-For significant, separately identifiable non-E/M services, Use 59

Front 5

26

Back 5

Professional Component

Front 6

32

Back 6

• Mandated Services

• 3rd party payer, government, legislative, or regulatory

Front 7

33

Back 7

• Preventive Services

• Delivery of an evidence based service with a US Preventive Services Task Force A or B rating in effect and other preventive services identified in preventive services mandates (legislative or regulatory)

• Do not use: Separately reported services identified as preventive

Front 8

47

Back 8

• Anesthesia by Surgeon (Regional and General)

• Local not included

Front 9

50

Back 9

* Bilateral Procedures

Front 10

51

Back 10

* Multiple Procedures
* Except E/M, Medicine, Rehab, supplies(vaccine)

Front 11

52

Back 11

• Reduced Services
• Hospital outpatient using anesthesia, see 73 and 74

Front 12

*53

Back 12

• Discontinued Procedure
• Surgical/diagnostic was discontinued
• do not use in cancellation of procedure prior to anesthesia induction or surgical prep on OR

Front 13

54

Back 13

Surgical Care Only

Front 14

55

Back 14

Postoperative Management Only

Front 15

56

Back 15

Preoperative Management Only

Front 16

57

Back 16

• Decision for Surgery
• An evaluation and management service that resulted in the initial decision to perform the surgery
  

Front 17

58

Back 17

Staged or Related procedure or Service by the same Physician or Other qualified healthcare professionals during post operative period

-The subsequent procedure was planned, either at the time of the first procedure or prospectively;-The subsequent procedure was more extensive than the first procedure, either as part of the process or because the first did not have the desired outcome;-Or you need to indicate therapy after a diagnostic surgical procedure.

Hint 17

https://www.carecloud.com/continuum/procedure-coding-58-modifier/

Front 18

59

Back 18

* Distinct Procedural Service
* Do not use E/M use 25
* different session or patient encounter, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same physician.
* two procedures are performed in distinctly separate 15 minute intervals.

Front 19

62

Back 19

* Two primary surgeons performing distinct parts of a procedure
* Co-surgeon acts as an assistant, use 80, 82

Front 20

63

Back 20

Procedure Performed on Infants less than 4 kg

Front 21

66

Back 21

Surgical Team

Front 22

73

Back 22

Discontinued Out-Patient Hospital/Ambulatory Surgery Center (ASC) Procedure Prior to the Administration of Anesthesia, due to extenuating circumstances or those that threaten the well being of the patient

Front 23

74

Back 23

Discontinued Out-Patient Hospital/Ambulatory Surgery Center (ASC) Procedure After Administration of Anesthesia

Front 24

76

Back 24

* Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional
* Do not code E/M

Front 25

77

Back 25

* Repeat Procedure by Another Physician or Other Qualified Health Care Professional
* Do not code E/M

Front 26

79

Back 26

Unrelated Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period

Front 27

78

Back 27

Unplanned Return to the Operating/Procedure Room by the Same Physician or Other Qualified Health Care Professional Following Initial Procedure for a Related Procedure During the Postoperative Period

Front 28

80

Back 28

Assistant Surgeon

Front 29

81

Back 29

Minimum Assistant Surgeon

Front 30

82

Back 30

Assistant Surgeon (when qualified resident surgeon not available)

Front 31

90

Back 31

* Reference (Outside) Laboratory
* When laboratory procedures are performed by a party other than the treating or reporting physician or other qualified health care professional

Front 32

91

Back 32

* Repeat Clinical Diagnostic Laboratory Test
* In the course of treatment of the patient, it may be necessary to repeat the same laboratory test on the same day to obtain subsequent (multiple) test results.
* example, glucose.

Front 33

92

Back 33

• Alternative Laboratory Platform Testing
• Laboratory testing using a kit or transportable instrument that wholly or in part consists of a single-use, disposable analytical chamber

Front 34

95

Back 34

Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and VideoTelecommunications System

Front 35

96

Back 35

• Procedure that may be either habilitative or rehabilitative in nature is provided for habilitative purposes
• Help patients develop skills or functions that they were incapable of developing on their own.

Front 36

97

Back 36

Rehabilitative services help an individual keep, get back, or improve skills and functioning for daily living that have been lost or impaired because the individual was sick, hurt, or disabled.

Front 37

99

Back 37

Multiple Modifiers