Modifiers Chapter 14 Test

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May affect the way payment is made by 3rd party payers

Modifiers

Modifiers are used to indicate

Bilateral procedure, Multiple Procedures, Service greater than required

Modifier -57

Decision for surgery can be used with an E/M code

Modifier -79

Unrelated procedure or service by the same physician during the past.

Op period

Can only be used with a surgery code

Modifier -51

Multiple procedure, can only be used with a surgery code

Modifier -80

Assistant Surgeon, is used when a 2nd surgeon provides assistance to primary surgeon

Modifier -32

Indicates a service is mandated. Ex- an insurance company requires a 2nd opinion prior to surgery

Modifier -59

Distinct procedure service indicates services that are usually bundled into one payment were provided as separate
services

Modifier -25

Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service is used to report an E/M service provided on the same day as a minor procedure performed by the same physician

Modifier -58

Staged or related procedure or service by the same physician during the post op period indicates a subsequent surgery was planned at the time of the 1st surgery

Modifier -52

Reduced services- a service was reduced without changing the definition of the code

Modifier -AA

Is a HCPCS modifier- is used to report anesthesia services performed personally by anesthesiologist or when an anesthetist assists a physician ...

Modifier- 99

Multiple Modifiers

Modifier- 26

Professional component

Modifier- 51

Indicates multiple procedures

Apendix A

Lists some HCPCS modifiers

TC

Tecchnical component of a diagnostic procedure

Modifier- 90

Used to indicate services of an outside laboratory

When two or more physicians, with technicians and specialized equipment, work together to complete a complicated procedure and each physician has a specific portion to complete.

Surgical Team

This modifier indicates an increased service and is overused and results in an increase in payment of 20%-30%. As such, assignment of this modifier comes under scrutiny by 3rd party payers.

Modifier -22

When modifier -54 is assigned payment for the ___________ portion of the surgical procedure is being requested.

Inoperative

Joan assigned modifier -32 to an E/M consultation code 99244. Medical records shows request was made by patient's spouse. Is Joan correct?

No, this modifier is NOT to be used to report 2nd opinion requested by a patient, spouse or another physician

It is only appended to other than E/M codes

Modifier -59

What is the weight in pounds of a 4-kilogram infant?

8.8

Which two statements are not true about modifier -53?

Describes circumstances based on the patients preoperative condition
describes circumstances in which the patient cancelled the procedure

Modifier -57 can be added to Surgery section codes?

False

When adding multiple CPT modifiers to a code, you would list the modifiers from

Highest to lowest

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

Appendix A

What is the word that means assigning multiple codes when one code would do?

Unbundling

What is the term that describes the services provided to a patient by the physician before surgery

Pre-operative

What is another term for the time after the surgery that the physician provides services to the patient?

Post-operative

Do all third party payers recognize all modifiers as listed in the CPT manual?

No

What is the term that decribes two physicians working together in the completion of a procedure when each has the same level of responsibility

Co-surgeons

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