Cpt Modifiers (2)

Front 1

Modifier blank is used when the procedure is terminated at the physician’s discretion.

Back 1

52

Front 2

Lisa was admitted to the outpatient surgery service for a colonoscopy. The physician attempted to perform a complete colonoscopy but, due to poor colon preparation, the physician was unable to view the entire colon and the procedure was terminated before the entire colon was viewed.

Back 2

Endoscopy
colon
exploration 45378
"Numeric Section":
45378
Colonoscopy, flexible, proximal to splenic flexure; diagnostic, with or without collection of specimen(s) by brushing or washing, with or without colon decompression (separate procedure)
Appendix A: 52 Reduced Services
Colonoscopy, abbreviated due to poor prep. 45378-52

Front 3

Tony was scheduled for a duodenal intubation and aspiration. He was taken to the laboratory where intubation was performed. The physician gave the patient a local anesthetic and a tube was inserted nasally and positioned in the duodenum. Before the specimen was obtained, the patient experienced severe nausea and vomiting. The physician elected to discontinue the procedure before obtaining the specimen.
PROCEDURES PERFORMED: Duodenal intubation and aspiration.

Back 3

Aspiration
duodenal 43756-43757
"Numeric Section":
43756
Duodenal intubation and aspiration, diagnostic, includes image guidance; single specimen (eg, bile study for crystals or afferent loop culture)
Appendix A: 53 Discontinued Procedure
Duodenal aspiration, discontinued at provider discretion. 43756-53

Front 4

Modifier blank is to be used when the surgeon provides the surgical care only and does not provide the preoperative and postoperative care. Modifier blank is appended to the surgical code.

Back 4

54

Front 5

Suzette underwent an open reduction internal fixation of a proximal tibia fracture. The emergency room on-call surgeon performed the procedure with the preoperative and postoperative care performed by the patient’s primary care physician.

Back 5

The procedure code for the surgeon will be modified with modifier 54 to indicate the surgeon provided only the operative care.
PROCEDURE: Open reduction internal fixation of proximal tibia fracture.
"CPT® Index":
Fracture
tibia
open treatment 27535–27536, 27540, 27758, 27766, 27814, 27826–27828
"Numeric Section":
27535
Open treatment of tibial fracture, proximal (plateau); unicondylar, includes internal fixation, when performed
Appendix A: 54 Surgical Care Only
Open reduction, internal fixation proximal tibial fracture, surgery only. 27535–54

Front 6

If one physician, the surgeon, provides only surgical care and uses modifier blank, the other providers will need to bill for pre/postoperative care associated with the operative procedure.
Modifier blank is used when the provider provides only postoperative care.
Modifier blank is used when the provider provides only preoperative care.

Back 6

54, 55, and 56

Front 7

Rayshad underwent an incision and drainage of an ischiorectal abscess. The surgeon did not perform the postoperative care; the patient’s primary care doctor performed it.
When coding for the primary care physician, modifier 55 would be added to the procedure code.

Back 7

Incision and drainage
abscess
rectum 45005–45020, 46040, 46050–46060
"Numeric Section":
46040
Incision and draining of ischiorectal and/or perirectal abscess (separate procedure)
Appendix A: 55 Postoperative Management Only
Postoperative care for I and D of ischiorectal abscess. 46040–55

Front 8

Austin’s primary care physician provided Austin with preoperative care prior to Austin’s surgery for laryngoscopic removal of a foreign body. Austin was admitted to the surgery center at the hospital, where he underwent a laryngoscopic removal of a foreign body by direct visualization through the scope by the ENT surgeon. Austin followed up with the ENT surgeon for postoperative care.

Back 8

When coding for the primary care physician, modifier 56 would be added to the procedure code to indicate the primary care physician did not participate in surgical or postsurgical care.
"CPT® Index":
Removal
foreign body
larynx 31511, 31530–31531, 31577
"Numeric Section":
31530
Laryngoscopy, direct, operative, with foreign body removal
Appendix A: 56 Preoperative Management Only
Preoperative care only for laryngoscopic removal of a foreign body. 31530–56

Front 9

Example
Nathan presented to the hospital after several hours of abdominal pain. The on-call surgeon saw him and performed a comprehensive history and examination with medical decision making of high complexity. The patient was found to have acute cholecystitis. The surgeon discussed cholecystectomy surgery with the patient, including risks, benefits, potential complications and desired outcome. The patient agreed to surgery and was admitted to the hospital for an emergency laparoscopic cholecystectomy.

Back 9

Let’s code Nathan’s encounter from the standpoint of the surgeon. Evaluation and management code for this encounter is 99223 (read the detailed description in the “Numeric Section”). You will want to determine if this visit is the encounter “that resulted in the initial decision to perform the surgery.” Re-read the example.
The documentation clearly states the surgeon gave detailed information and the patient made the decision to proceed with surgery, which was accomplished on the same day that the E/M service was provided. Modifier 57 provides the additional information that this is a complex and detailed surgical decision encounter.
Evaluation and management with initial decision to undergo surgery. 99223–57


Coding Challenge
Do the ICD-9 diagnosis coding for this patient. What is the correct diagnosis code?
DIAGNOSIS: Acute cholecystitis

Front 10

Tiny Alicia is an infant with a body weight of 3 kg. She underwent an endoscopic percutaneous gastrostomy tube placement because of feeding problems.

Back 10

Gastrostomy tube
placement
percutaneous
endoscopic 43246
"Numeric Section":
43235
Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure)
43246
with directed placement of percutaneous gastrostomy tube
Code 43246 provides information about the procedure. Since the patient is under 4 kg, the addition of Modifier 63 alerts the third-party payer that the patient requires special care.
Appendix A: 63 Procedure Performed on Infants less than 4kg
Gastrostomy tube placement, endoscopic in infant under 4 kg. 43246-63

Front 11

A 65-year-old man was brought to the operating room for repair of a recurrent inguinal hernia. The patient was prepped and positioning was carried out. Before the administration of anesthesia, the patient complained of chest pain with cardiac monitor revealing ST segment changes. The procedure was cancelled.

Back 11

Hernia repair
inguinal
recurrent 49520
"Numeric Section":
49520
Repair recurrent inguinal hernia, any age; reducible
Appendix A: 73 Discontinued Out-Patient Hospital/Ambulatory Surgery Center (ASC) Procedure Prior to the Administration of Anesthesia
Scheduled recurrent inguinal hernia repair, canceled after prep and prior to anesthesia. 49520–73

Front 12

Modifiers blank are used only for Ambulatory Surgery Center Hospital Outpatient Use.

Back 12

73/74

Front 13

Administration of Anesthesia. Modifier blank is for use in the hospital outpatient setting when the service/procedure is discontinued after the administration of anesthesia

Back 13

74

Front 14

A 45-year-old man was taken to the operating room for a laparoscopic cholecystectomy. After making the portal entry incision, the anesthesiologist noticed the patient having ventricular fibrillation on the cardiac monitor. Defibrillation effort was tried two times, finally the arrhythmia abated. The procedure was cancelled pending further cardiac consultation

Back 14

Laparoscopy
cholecystectomy 47562–47564
"Numeric Section":
47560
Laparoscopy, surgical; with guided transhepatic cholangiography, without biopsy
47562
cholecystectomy
Appendix A: 74 Discontinued Out-Patient Hospital/Ambulatory Surgery Center (ASC) Procedure After Administration of Anesthesia
Attempted laparoscopic cholecystectomy canceled after post administration of anesthesia. 47562–74

Front 15

A blank begins with general anesthesia to put a patient to sleep before the first incision in the navel is made. That is where the blank is inserted. Next, two very tiny incisions are made to accommodate two needle thin tools that are used to move the gall bladder and other abdominal structures about. Another small incision allows for the surgical tools used to perform the actual cutting and clipping of the gall bladder to be inserted.

Back 15

laparoscopic cholecystectomy
laparoscope

Front 16

An abnormal heartbeat (blank) is any variation in the normal heartbeat. Abnormal heartbeats occur when the heart has an irregular heart rhythm, beats too fast (blank), or beats too slow (blank).

Back 16

arrhythmia
tachycardia)
bradycardia

Front 17

Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter 0.5 cm or less

Back 17

PROCEDURE: Repair of a trigger finger of his left thumb.
"CPT® Index":
Trigger finger repair 26055
"Numeric Section":
26055
Tendon sheath incision (eg, for trigger finger)
Appendix A: FA Left hand, thumb
PROCEDURE: Repair trigger finger, left thumb. 26055–FA.

Front 18

Surgery for carpal tunnel syndrome is called a “blank” because it cuts the volar carpal ligament, thus releasing the median nerve from pressure... www.pdrhealth.com

Back 18

release

Front 19

The physician performed a right carpal tunnel release procedure on the patient

Back 19

Carpal tunnel syndrome
decompression 64721
"Numeric Section":
64716
Neuroplasty and/or transposition; cranial nerve (specify)
64721
median nerve at carpal tunnel
Appendix A: RT Right side
Right carpal tunnel release. 64721-RT.

Front 20

PROCEDURE: Complete excision of nail and nail matrix of an ingrown toenail on the right great toe.

Back 20

Excision
nails 11750–11752
"Numeric Section":
11750
Excision of nail and nail matrix, partial or complete (eg, ingrown or deformed nail), for permanent removal
Appendix A: T5 Right foot, great toe
PROCEDURE: Complete excision of nail and nail matrix, ingrown toenail, right great toe. 11750–T5.

Front 21

The patient was sent to us for comprehensive audiogram testing without interpretation, as the primary care provider wanted to review these himself.

Back 21

Audiologic function tests
audiometry
comprehensive 0212T, 92557
"Numeric Section":
92557
Comprehensive audiometry threshold evaluation and speech recognition (92553 and 92556 combined)
Comprehensive audiogram testing. 92557-TC.

Front 22

When the study, test, or x-ray is performed this is considered the blank

Back 22

technical component.

Front 23

When the physician interprets the results of the study, test, or x-ray, this is considered the blank.

Back 23

professional component