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Modifiers

Increased Procedural Services

22

Unusual Anesthesia Modifier

23

Unrelated E/M Services by the Same Physician During a Postoperative Period

24

Significant Separately Identifiable E/M Service by the Same Physician on the Same Day of the Procedure or Other Service

25

Professional Component

26

Mandated Services

32

Anesthesia by Surgeon

47

Bilateral Procedure

50

Multiple Procedures

51

Reduced Services

52

Discontinued Procedure

53

Surgical Care Only

54

Postoperative Management Only

55

Preoperative Management Only

56

Decision for Surgery

57

Staged or Related Procedure or Service by the Same Physician During the Postoperative Period

58

Distinct Procedural Service

59

Two Surgeons

62

Procedure Performed on Infants Less than 4 kg

63

Surgical Team

66

Repeat Procedure or Service by Same Physician

76

Assistant Surgeon

80

Repeat Procedure by Another Physician

77

Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the postoperative Period

78

Unrelated Procedure or Service by the Same Physician During the Postoperative Period

79

Minimum Assistant Surgeon

81

Assistant Surgeon (When Qualified Resident Surgeon Not Available)

82

Reference (Outside) Laboratory

90

Repeat Clinical Diagnostic Laboratory Test

91

Alternative Laboratory Platform Testing

92

Multiple Modifiers

99

Payment for the intraoperative or surgery portion of the surgical procedure is being requested.

54

(Postoperative Management Only) should be assigned when a provider other than the surgeon is responsible for postoperative management.

55

A service that has been partially reduced at the physician's discretion is reflected by the modifier

52

When two primary surgeons are required during an operative, each performing distinct parts of a reportable procedure, modifier ___________ should be assigned.

62

When a procedure was repeated because of special circumstances involving the original service and the same physician performed the repeat procedure, modifier ____ should be recorded.

76

Workers' Compensation referred a patient to a physician for a mandatory examination to determine the legitimacy of a claim (insurance certification). What modifier would be added to the code for the examination service?

32

Dr. Ramus administers regional anesthesia by intravenous injection (also known as Bier's local anesthesia) for a surgical procedure on the patient's lower arm. Dr. Ramus then performs the surgical procedure. What modifier would be added to the surgical code.

47

A patient came to the office twice in one day to see the same physician for unrelated problems. What modifier would be added to the code for the second office visit?

25

1. Same Operation, Different Site
2. Multiple Operation(s), same Operative Session
3. Procedure Performed Multiple Times

51

What appendix in the CPT manual contains a complete list of all modifiers?

Appendix A

Dr. Wells began surgery on an 86-year-old female with severe hypertension. The patient was satisfactorily anesthetized and the site opened to view. Shortly thereafter, the patient's blood pressure dropped significantly, and the physician was unable to stabilize the patient. The procedure was discontinued.

53

The patient is a 10-month-old boy who fell while trying to walk. He cut the bottom of his lip open. Sutures are necessary, but due to the patient's age and excessive movement, general anesthesia is needed.

23

A patient has a hernia repair and 2 days later must be returned to the operating room for a dehiscence of the incision. When coding the secondary hernia repair, which modifier would you add onto the surgical codes?

78

A surgeon performed a repair of an enterocele using an abdominal approach and reported the service with 57270. Then patient was morbidly obese with a BMI of 42, and due to this circumstance, the procedure took a significant amount of additional time to perform.

22

Technical Component

-TC

Adding modifier ______________, Unusual Services modifier, indicates "additional effort or time":

22

A patient is admitted and has bilateral arthroscopy of the knees due to Baker's cysts.

50

Anesthesia provided by the ENT physician during a tympanoplasty for repair of a tympanic membrane perforation

47

A patient is seen at the direction of Workers' Compensation for a complete physical examination for insurance certification.

32

The patient returns to the operating room for removal of deep pins during the postoperative period, due to complication (dislodged) after an open repair of a humerus fracture

78

A patient has a surgical procedure on Turesday, and later that day the physician must take the patient back to the operating room to repeat (redo) a coronary bypass, due to complications of initial procedure.

76

The patient underwent a bilateral tympanoplasty.

50

If you must use two or more modifiers to describe a service, you would use which modifier to indicate this
?

99

A surgeon performs a procedure on a neonate weighing 9kg; the procedure was extremely complicated.
modifier would you use to indicate this service, which has an increased level of complexity?

22

Dr. Storely performed cataract surgery on 10/31/2008 and Dr. Jones provided postoperative care following discharge.
What modifier would you use to indicate the postoperative care following discharge?

55

Dr. Merideth serves as an assistant surgeon to Dr. Taylor. What modifiers; would you add to the procedure code to indicate Dr. Merideth's status during the procedure?

80

What Level II modifier indicates the upper left eyelid?

E1

Which modifier is requests payment for the full fee of the subsequent service because it was unassociated with the
procedure. A new global period should start when modifier _____ is submitted

79

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